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Journal of Virology, June 2009, p. 5947-5950, Vol. 83, No. 11
0022-538X/09/$08.00+0 doi:10.1128/JVI.00450-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.
Influenza A Virus Lacking M2 Protein as a Live Attenuated Vaccine
Shinji Watanabe,1
Tokiko Watanabe,1 and
Yoshihiro Kawaoka1,2,3*
Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin—Madison, Madison, Wisconsin 53706,1
International Research Center for Infectious Diseases,2
Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, Shirokanedai, Minato-ku, Tokyo 108-8639, Japan3
Received 4 March 2009/
Accepted 16 March 2009

ABSTRACT
Mutant influenza virus that lacks the transmembrane and cytoplasmic
tail domains of M2 (M2 knockout [M2KO]) is attenuated in both
cell culture and mice. Here, we examined the potency of M2KO
influenza virus as a live attenuated influenza vaccine. M2KO
virus grew as efficiently as the wild-type virus in cells stably
expressing the wild-type M2, indicating the feasibility of efficient
vaccine production. Mice intranasally vaccinated with M2KO virus
developed protective immune responses and survived a lethal
challenge with the wild-type virus, suggesting that the M2KO
virus has potential as a live attenuated vaccine.

TEXT
Influenza A viruses cause a highly contagious, acute respiratory
disease responsible for human suffering and economic burden
every winter. Vaccination is a primary means for prophylaxis
against influenza infection, and inactivated and live attenuated
influenza virus vaccines are currently available. Inactivated
vaccines, administered parenterally, are generally 70% to 90%
effective for reducing the incidence of clinical illness in
healthy persons as long as the antigenicities of the circulating
virus strains match those of the vaccine (
5). However, because
mucosal immunity and cytotoxic T-cell responses are limited,
protective efficacy of inactivated vaccines lasts for only a
short period, requiring annual vaccination. In contrast, live
attenuated influenza virus vaccines are intranasally administered
and elicit robust mucosal immunity and cellular responses; their
protective efficacy, therefore, lasts for longer periods (
6).
Only two live attenuated vaccines are currently on the market,
and use of these vaccines in the United States is limited to
persons aged 2 to 49 years (
4).
Several lines of evidence suggest that the M2 protein of influenza A virus is responsible for key steps in the viral life cycle (7, 8, 13, 14, 17, 23, 24). Indeed, we have previously shown that the influenza A virus that lacks the transmembrane and cytoplasmic tail domains (M2 knockout [M2KO]) of M2 is highly attenuated in cell culture and in mice compared to the wild-type virus (8, 26). Here, we examined the potential of M2KO influenza A virus as a live attenuated vaccine by immunizing mice and testing immune responses and protective efficacy in a mouse model experimentally infected with A/Puerto Rico/8/34 (PR8), a highly lethal virus in mice.
To generate the M2KO virus, we first constructed the mutated M segment into which we inserted two stop codons downstream of the open reading frame of the M1 protein to remove the transmembrane and cytoplasmic tail domains of the M2 protein (Fig. 1A). We then generated the wild-type PR8 and M2KO viruses by plasmid-based reverse genetics (15). To confirm attenuation of the M2KO virus we made in this study, we inoculated the PR8 and M2KO viruses into both MDCK and M2CK cells (8) at a multiplicity of infection of 0.001, and virus titers were determined at various times postinfection by using M2CK cells (Fig. 1B). M2KO virus was highly attenuated in MDCK cells (Fig. 1B, left) but replicated as well as the wild-type virus in M2CK cells (Fig. 1B, right). These data suggest that the M2KO virus is highly attenuated in normal cells but that high titer virus stocks can be produced in cells expressing the M2 protein.
Attenuation of viruses in animals is essential for live vaccines.
We therefore examined the pathogenicity of the M2KO virus in
mice. We intranasally infected 4-week-old female BALB/c mice
with different doses of M2KO virus and determined the virus
titers in lungs and nasal turbinates. Body weights were also
monitored. When mice were infected with even 3
x 10
6 or 3
x 10
5 PFU of virus, virus was recovered from the lungs, but titers
were significantly lower than those in the lungs of mice infected
with PR8 (
P < 0.05) (Table
1). By day 8 postinfection, we
no longer detected M2KO virus in the lungs (data not shown).
Although virus was recovered from the lungs of one of the animals
infected with 3
x 10
4 PFU of virus, we did not detect virus
from any mice infected with lower titers (i.e., 3
x 10
2 or 3
x 10
3 PFU) of M2KO virus (Table
1 and data not shown). In nasal
turbinates, no virus was recovered from any mice inoculated
with the M2KO virus on days 3 and 6 postinfection (Table
1).
The body weights of mice infected with 5
x 10
6 PFU of PR8 rapidly
decreased, and these mice were euthanized by 4 days postinfection
(Fig.
1C). On the other hand, mice infected with 3
x 10
6 PFU
of M2KO virus showed no body weight loss (Fig.
1C). Taken together,
these data indicate that the M2KO virus is highly attenuated
in mice, satisfying its requirement for a live attenuated influenza
vaccine.
We next examined the level of antibody responses elicited by
the M2KO virus. We intranasally inoculated 4-week-old female
BALB/c mice with different doses of M2KO virus. As negative
and positive controls, we also intranasally inoculated mice
with phosphate-buffered saline (PBS) or a dose equivalent to
3
x 10
6 PFU of formalin-inactivated PR8 (32 hemagglutination
units), and a 50% mouse lethal dose of PR8 of 0.3 (500 PFU),
respectively. Four weeks after inoculation, titers of immunoglobulin
G (IgG) and IgA antibodies against PR8 in sera, trachea/lungs,
and nasal washes were determined by an enzyme-linked immunosorbent
assay (Fig.
2). Neither the IgG nor the IgA response was appreciable
in negative control mice (PBS and inactivated PR8). Although
IgG and IgA titers in mice infected with a 50% mouse lethal
dose of PR8 of 0.3 were higher, those in mice inoculated with
3
x 10
6 PFU of M2KO virus were also similarly increased. Moreover,
antibody responses correlated with the doses of M2KO virus,
although responses in mice inoculated with 3
x 10
2 PFU of M2KO
virus were limited.
To assess the protective efficacy of M2KO virus, mice intranasally
inoculated with M2KO virus, formalin-inactivated PR8, or PBS
were challenged with a lethal dose of PR8 at 4 and 12 weeks
postimmunization. Virus titers in lungs and nasal turbinates
of challenged mice were determined by using MDCK cells 3 days
postchallenge. We could not detect virus in organs of mice inoculated
either with 3
x 10
6 or 3
x 10
5 PFU of M2KO viruses, indicating
that vaccination with these amounts of M2KO virus gave mice
sterile immunity (Table
2). All mice immunized with lower doses
(3
x 10
4 and 3
x 10
3 PFU), with the exception of one mouse inoculated
with 3
x 10
3 PFU of virus, survived a lethal challenge, although
we detected virus in both organs tested and the amounts of virus
were not significantly lower than those in the control mice
(Table
2). This is probably because virus clearance later than
day 3 postchallenge (the time point at which organ virus titers
were examined) was more efficient in these immunized mice than
that in the control mice. Indeed, although these mice lost body
weight until 7 days postchallenge, they ultimately regained
their body weight (data not shown). Taken together, our data
indicate that M2KO virus confers effective protection against
challenge with a lethal dose of PR8.
Here, we demonstrated that M2KO influenza virus that lacks the
transmembrane and cytoplasmic tail domains of the M2 protein
can be used as a live attenuated influenza vaccine. It appears
to be considerably safe and strongly immunogenic. Moreover,
the growth profile of this virus is indistinguishable from that
of the parent virus (PR8) in cells stably expressing the wild-type
M2 protein, suggesting the feasibility of efficient vaccine
production, although the cell line expressing the M2 protein
will need to be validated for the lack of unwanted properties,
such as the presence of adventitious agents and tumorigenicity,
prior to its use in vaccine production for humans.
Embryonated hen eggs are currently used for the manufacture of the vaccine; however, they have potentially serious problems. One of the major problems is that cultivation of viruses in eggs can lead to the selection of variants that are antigenically distinct from viruses grown in mammalian cells (9, 19, 21). In addition, there is a risk of allergic sensitization and reactions to egg proteins present in vaccines made from embryonated eggs. However, isolation of human influenza viruses from mammalian cells allows one to obtain viruses that are closely related to those present in clinical specimens of influenza patients (10, 18, 20). In addition, it has been demonstrated that inactivated vaccines prepared from cell-grown viruses induce greater cross-reactive serum antibody and cellular responses or protect better than those made from egg-grown viruses compared in animal models (1, 3, 11, 28). The fact that M2KO virus amplification relies on cells stably expressing the wild-type M2 protein demonstrates its suitability for vaccine production and solves many of the problems associated with vaccines made from embryonated eggs.
There has always been a question regarding the safety of live influenza vaccines due to possible reassortment between field strains and attenuated vaccine strains during epidemics and pandemics. However, such concerns are unfounded because even if reassortment occurs, as long as the backbone virus for the live vaccines is less pathogenic than the field strains, the pathogenicity of the resultant reassortant would be the same or less than that of the field strain.
Recent outbreaks of highly pathogenic H5N1 avian influenza virus pose a serious threat to human health. Although several clinical trials using inactivated H5 vaccine have been conducted (2, 12, 16, 22, 25), the efficacy of inactivated vaccines against such highly pathogenic viruses in immunologically naïve populations remains unknown. It is important to explore live vaccines, which could provide better protective immunity than inactivated vaccines due to their ability to provide mucosal and cellular immune responses. Our M2KO vaccine presented here, together with the M2 cytoplasmic tail mutant vaccine that we recently reported (27), may set the stage for further development of live attenuated H5 influenza vaccines.

ACKNOWLEDGMENTS
We thank Susan Watson for editing the manuscript and Krisna
Wells and Martha McGregor for excellent technical assistance.
This work was supported by Public Health Service research grants from the National Institute of Allergy and Infectious Diseases, by grants-in-aid for Scientific Research on Priority Areas Specially Promoted Research, by the Program of Founding Research Centers for Emerging and Reemerging Infectious Diseases from the Ministry of Education, Culture, Sports, Science, and Technology, and by a contract research fund from the Ministry of Education, Culture, Sports, Science, and Technology, Japan.

FOOTNOTES
* Corresponding author. Mailing address: Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin—Madison, 2015 Linden Drive, Madison, WI 53706. Phone: (608) 265-4925. Fax: (608) 265-5622. E-mail:
kawaokay{at}svm.vetmed.wisc.edu 
Published ahead of print on 25 March 2009. 

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Journal of Virology, June 2009, p. 5947-5950, Vol. 83, No. 11
0022-538X/09/$08.00+0 doi:10.1128/JVI.00450-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.