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Nat Med . Drivers of adaptive evolution during chronic SARS-CoV-2 infections

tetano

Editor, Senior Moderator
Nat Med


. 2022 Jun 20.
doi: 10.1038/s41591-022-01882-4. Online ahead of print.
Drivers of adaptive evolution during chronic SARS-CoV-2 infections


Sheri Harari[SUP] 1 2 [/SUP], Maayan Tahor[SUP] 1 [/SUP], Natalie Rutsinsky[SUP] 1 [/SUP], Suzy Meijer[SUP] 3 4 [/SUP], Danielle Miller[SUP] 1 2 [/SUP], Oryan Henig[SUP] 3 4 [/SUP], Ora Halutz[SUP] 5 [/SUP], Katia Levytskyi[SUP] 3 4 [/SUP], Ronen Ben-Ami[SUP] 3 4 [/SUP], Amos Adler[SUP] 3 4 [/SUP], Yael Paran[SUP] 3 4 [/SUP], Adi Stern[SUP] 6 7 [/SUP]



Affiliations

Abstract

In some immunocompromised patients with chronic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, considerable adaptive evolution occurs. Some substitutions found in chronic infections are lineage-defining mutations in variants of concern (VOCs), which has led to the hypothesis that VOCs emerged from chronic infections. In this study, we searched for drivers of VOC-like emergence by consolidating sequencing results from a set of 27 chronic infections. Most substitutions in this set reflected lineage-defining VOC mutations; however, a subset of mutations associated with successful global transmission was absent from chronic infections. We further tested the ability to associate antibody evasion mutations with patient-specific and virus-specific features and found that viral rebound is strongly correlated with the emergence of antibody evasion. We found evidence for dynamic polymorphic viral populations in most patients, suggesting that a compromised immune system selects for antibody evasion in particular niches in a patient's body. We suggest that a tradeoff exists between antibody evasion and transmissibility and that extensive monitoring of chronic infections is necessary to further understanding of VOC emergence.
 
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