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The influenza envelope glycoprotein hemagglutinin (HA) on the surface of the influenza virus consists of a highly variable globular head domain (HA1) and a more conserved stem domain (HA2/HA1). Influenza viruses comprise two phylogenetic groups (Groups 1 and 2) consisting of 18 HA subtypes and numerous genetic variants or strains within each subtype. Although vaccination can prevent influenza infection, current vaccines are strain specific, and provide minimal protection against drifted or shifted strains or subtypes.
Broadly neutralizing monoclonal antibodies (bnAbs) that bind the conserved HA stem can neutralize diverse influenza strains in vitro, suggesting that antivirals targeting the HA stem could provide similar widespread protection. BnAbs can bind to the fusogenic region of the HA stem and inhibit the conformational rearrangements in HA required for membrane fusion. The protection by HA-stem binding bnAbs is greatly enhanced through FcγR engagement in vivo. And Fc-FcγR interaction and activation of antibody-dependent cellular cytotoxicity (ADCC) are critical for in vivo efficacy of stem-binding bnAbs.