{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T02:46:57Z","timestamp":1772160417085,"version":"3.50.1"},"reference-count":28,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,10,24]],"date-time":"2020-10-24T00:00:00Z","timestamp":1603497600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005612","name":"Shionogi","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005612","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004337","name":"Roche","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004337","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Influenza Resp Viruses"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Baloxavir marboxil (BXM) is an approved drug that selectively targets cap\u2010dependent endonuclease on PA subunit in the RNA polymerase complex of influenza A and B viruses. Amino acid substitutions at position 38 in the PA subunit were identified as a major pathway for reduced susceptibility to baloxavir acid (BXA), the active form of BXM. Additionally, substitutions found at positions E23, A37, and E199 in the PA subunit impact BXA susceptibility by less than 10\u2010fold.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We comprehensively evaluated the impact of novel amino acid substitutions identified in PA, PB1, and PB2 subunits in BXM clinical trials and influenza sequence databases by means of drug susceptibility and replicative capacity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>PA\/I38N in A(H1N1)pdm09 and PA\/I38R in A(H3N2) were newly identified as treatment\u2010emergent substitutions in the CAPSTONE\u20102 study. The I38N substitution conferred reduced susceptibility by 24\u2010fold, whereas replicative capacity of the I38N\u2010substituted virus was impaired compared with the wild\u2010type. The I38R\u2010substituted virus was not viable in cell culture. All other mutations assessed in this extensive study did not significantly affect BXA susceptibility (&lt; 2.4\u2010fold change).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These results provide additional information on the impact of amino acid substitutions in the trimeric viral polymerase complex to BXA susceptibility and will further support influenza surveillance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/irv.12821","type":"journal-article","created":{"date-parts":[[2020,10,24]],"date-time":"2020-10-24T23:02:02Z","timestamp":1603580522000},"page":"389-395","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Comprehensive assessment of amino acid substitutions in the trimeric RNA polymerase complex of influenza A virus detected in clinical trials of baloxavir marboxil"],"prefix":"10.1111","volume":"15","author":[{"given":"Takashi","family":"Hashimoto","sequence":"first","affiliation":[{"name":"Shionogi &amp; Co., Ltd.  Osaka Japan"},{"name":"Shionogi Techno Advance Research, Co., Ltd.  Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keiko","family":"Baba","sequence":"additional","affiliation":[{"name":"Shionogi &amp; Co., Ltd.  Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kae","family":"Inoue","sequence":"additional","affiliation":[{"name":"Shionogi Techno Advance Research, Co., Ltd.  Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miyako","family":"Okane","sequence":"additional","affiliation":[{"name":"Shionogi Techno Advance Research, Co., Ltd.  Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoshi","family":"Hata","sequence":"additional","affiliation":[{"name":"Shionogi Techno Advance Research, Co., Ltd.  Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2549-0945","authenticated-orcid":false,"given":"Takao","family":"Shishido","sequence":"additional","affiliation":[{"name":"Shionogi &amp; Co., Ltd.  Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akira","family":"Naito","sequence":"additional","affiliation":[{"name":"Shionogi &amp; Co., Ltd.  Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9779-5740","authenticated-orcid":false,"given":"Steffen","family":"Wildum","sequence":"additional","affiliation":[{"name":"F. Hoffmann\u2010La Roche Ltd.  Basel Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2730-3912","authenticated-orcid":false,"given":"Shinya","family":"Omoto","sequence":"additional","affiliation":[{"name":"Shionogi &amp; Co., Ltd.  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