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Review 1: "Evolution of Omicron Lineage Towards Increased Fitness in the Upper Respiratory Tract in the Absence of Severe Lung Pathology"

Reviewers found that the preprint was well-written and well-designed, but suggested several improvements in discussion section along with a number of minor comments.

Published onAug 05, 2024
Review 1: "Evolution of Omicron Lineage Towards Increased Fitness in the Upper Respiratory Tract in the Absence of Severe Lung Pathology"
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Evolution of Omicron lineage towards increased fitness in the upper respiratory tract in the absence of severe lung pathology
Evolution of Omicron lineage towards increased fitness in the upper respiratory tract in the absence of severe lung pathology
Description

Abstract The emergence of the Omicron lineage represented a major genetic drift in SARS-CoV-2 evolution. This was associated with phenotypic changes including evasion of pre-existing immunity and decreased disease severity. Continuous evolution within the Omicron lineage raised concerns of potential increased transmissibility and/or disease severity. To address this, we evaluated the fitness and pathogenesis of contemporary Omicron variants XBB.1.5, XBB.1.16, EG.5.1, and JN.1 in the upper (URT) and lower respiratory tract (LRT). We compared in vivo infection in Syrian hamsters with infection in primary human nasal and lung epithelium cells and assessed differences in transmissibility, antigenicity, and innate immune activation. Omicron variants replicated efficiently in the URT but displayed limited pathology in the lungs compared to previous variants and failed to replicate in human lung organoids. JN.1 was attenuated in both URT and LRT compared to other Omicron variants and failed to transmit in the hamster model. Our data demonstrate that Omicron lineage evolution has favored increased fitness in the URT.

RR:C19 Evidence Scale rating by reviewer:

  • Reliable. The main study claims are generally justified by its methods and data. The results and conclusions are likely to be similar to the hypothetical ideal study. There are some minor caveats or limitations, but they would/do not change the major claims of the study. The study provides sufficient strength of evidence on its own that its main claims should be considered actionable, with some room for future revision.

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Review: Wickenhagen et al's manuscript "Evolution of Omicron lineage towards increased fitness in the upper respiratory tract in the absence of severe lung pathology" compares the replication and transmission of Omicron variants in both in vivo (hamster) and in vitro (hamster and human epithelial cells) models and demonstrates the fitness evolution of Omicron variants. The project was decently designed and the manuscript was well organized and written. The information of this manuscript is important and provides important implications on predicting the evolution of SARS-CoV-2 variants and developing efficient strategies of preventing SARS-CoV-2 transmission.

The major weakness of this manuscript lies in the Discussion section. Instead of simple summary of findings made in this project, these interesting and important data deserve further analysis and deeper interpretation. For example, the discussion of "selection pressure" mentioned in Lines 274-276, as well as "transmission efficiency" of JN.1 mentioned in Lines 285-286 and lines 309-310, could be expanded by including advances on structure biology and epidemiology, respectively.

One minor issues is that Hamster ACE2 alone data needs to be added as a key control in Figure 1.

Comments
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Prateek Karnadhar:

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I found your review of "Evolution of Omicron Lineage Towards Increased Fitness in the Upper Respiratory Tract in the Absence of Severe Lung Pathology" by Jian Zheng to be highly insightful and well-articulated.

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Thank you for your valuable contribution!