Specifically, they recognize cell-surfaceglycoconjugates containing sialic acid on the surface of host red blood cells with a low affinity and use them to enter the endosome of host cells.[6] Hemagglutinins tend to recognize α-2,6-linked sialic acids of the host cells in humans and α-2,3-linked sialic acids in avian species, although there is evidence that hemagglutinin specificity can vary. This correlates to the fact that Influenza A typically establishes infections in the upper respiratory tract in humans, where many of these α-2,6-linked sialic acids are present.[7] There are various subtypes of hemagglutinins, in which H1, H2, and H3 are known to have human susceptibility.[8] It is the variation in hemagglutinin (and neuraminidase) subtypes that require health organizations (ex. WHO) to constantly update and surveil the known circulating flu viruses in human and animal populations (ex. H5N1).
In the endosome, hemagglutinins undergo conformational changes due to a pH drop to of 5–6.5 enabling viral attachment through a fusion peptide.[9]
The name "hemagglutinin" comes from the protein's ability to cause red blood cells (erythrocytes) to clump together ("agglutinate") in vitro.[12]
^Couch, Robert B. (1996), Baron, Samuel (ed.), "Orthomyxoviruses", Medical Microbiology (4th ed.), Galveston (TX): University of Texas Medical Branch at Galveston, ISBN978-0-9631172-1-2, PMID21413353, retrieved 30 January 2024