Scientific article
OA Policy
English

Influenza A(H1N1)pdm09 virus resistance to baloxavir, oseltamivir and sialic acid mimetics in single and dual therapies : Insights from human airway epithelia and murine models

Published inAntiviral research, vol. 239, 106174
Publication date2025-07
First online date2025-05-03
Abstract

Influenza viruses pose a significant threat due to annual epidemics and pandemic potential. Resistance to current antivirals underscores the need for new drugs and strategies to prevent its emergence. We previously developed two novel HA-targeting compounds (CD-6'SLN and CD-SA) with demonstrated efficacy against influenza A and B strains. Here, we compared their resistance barrier to that of FDA-approved oseltamivir (OS) and baloxavir marboxil (BXM). We established a resistance testing assay in human airway epithelia (HAE) and in mice. We also evaluated the impact of combination therapies on resistance emergence. In HAE, highly reduced inhibition (HRI) by CD-6'SLN and CD-SA occurred within 2 and 4 weeks respectively without fitness loss, while reduced inhibition (RI) by baloxavir acid (BXA) emerged within 4 weeks. No reduction of susceptibility to OS was observed in the same time frame. Of note, emergence of RI by CD-SA was not delayed in BXA/CD-SA co-treatment, and slightly reduced upon OS/CD-SA co-treatment. In mice, RI by CD-SA was observed after 8 passages in one of three mice treated with OS/CD-SA, but not in mice with single therapies. This study demonstrates that (1) HAE represents a relevant model to detect emergence of resistance and (2) HA-targeting compounds are prone to induce resistance followed by BXA and OS. Importantly, combination of clinically available antivirals and HA-targeting compounds did not prevent the emergence of variants with HA substitutions. Additional research is needed to develop anti-influenza antivirals with high resistance barrier and compounds should be tested in HAE before moving to animal experimentation.

Keywords
  • Antiviral resistance
  • Baloxavir
  • Combination therapy
  • Human airway epithelia
  • Influenza virus
  • Mice
  • Oseltamivir
  • Sialic acid mimetics
  • Animals
  • Drug Resistance, Viral
  • Oseltamivir / pharmacology
  • Antiviral Agents / pharmacology
  • Humans
  • Triazines / pharmacology
  • Dibenzothiepins / pharmacology
  • Influenza A Virus, H1N1 Subtype / drug effects
  • Morpholines / pharmacology
  • Pyridones / pharmacology
  • Orthomyxoviridae Infections / drug therapy
  • Orthomyxoviridae Infections / virology
  • Disease Models, Animal
  • Thiepins / pharmacology
  • Influenza, Human / drug therapy
  • Influenza, Human / virology
  • Pyridines / pharmacology
  • Drug Therapy, Combination
  • N-Acetylneuraminic Acid / pharmacology
  • Female
  • Respiratory Mucosa / virology
Citation (ISO format)
FAGE, Clément et al. Influenza A(H1N1)pdm09 virus resistance to baloxavir, oseltamivir and sialic acid mimetics in single and dual therapies : Insights from human airway epithelia and murine models. In: Antiviral research, 2025, vol. 239, p. 106174. doi: 10.1016/j.antiviral.2025.106174
Main files (1)
Article (Published version)
Secondary files (1)
Supplemental data
accessLevelPublic
Identifiers
Journal ISSN0166-3542
8views
47downloads

Technical informations

Creation04/06/2026 15:14:35
First validation06/07/2026 09:29:28
Update06/07/2026 09:29:28
Status update06/07/2026 09:29:28
Last indexation06/07/2026 09:29:29
All rights reserved by Archive ouverte UNIGE and the University of GenevaunigeBlack