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	<title>Collection : COVID-19 SARS-CoV-2 preprints from medRxiv and bioRxiv</title>
	<link>https://biorxiv.org</link>
	<description>
	This feed contains articles for Collection "COVID-19 SARS-CoV-2 preprints from medRxiv and bioRxiv"
	</description>

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	<prism:publicationName>bioRxiv</prism:publicationName>
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	<title>bioRxiv/medRxiv</title>
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	<link>https://biorxiv.org</link>
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	<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.09.12.751050v1?rss=1">
<title>
<![CDATA[
Host soluble inositol phosphate signaling promotes coronavirus replication 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.09.12.751050v1?rss=1"
</link>
<dc:creator>Shats, I.</dc:creator>
<dc:creator>Wang, H.</dc:creator>
<dc:creator>Zhou, Y.</dc:creator>
<dc:creator>Gu, C.</dc:creator>
<dc:creator>Carr, A.</dc:creator>
<dc:creator>Guardia, C. M.</dc:creator>
<dc:creator>Shears, S.</dc:creator>
<dc:creator>Stanley, R. E.</dc:creator>
<dc:creator>Zhang, Q.</dc:creator>
<dc:creator>Blind, R.</dc:creator>
<dc:creator>Wang, X.</dc:creator>
<dc:creator>Li, X.</dc:creator>
<dc:date>2026-09-15</dc:date>
<dc:identifier>doi:10.64898/2026.09.12.751050</dc:identifier>
<dc:title><![CDATA[Host soluble inositol phosphate signaling promotes coronavirus replication]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-15</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Coronaviruses rely extensively on host pathways for replication, making host-directed therapies an attractive strategy for broad-spectrum antivirals with reduced risk of viral resistance. Here we identify the host soluble inositol phosphate pathway as a previously unrecognized dependency for coronavirus infection. Genetic or pharmacologic inhibition of several kinases in this pathway markedly suppresses replication of both alpha- and betacoronaviruses, while increasing pathway activity promotes viral replication. We developed UNC7844, a potent multi-target inhibitor of these kinases, which reduces coronavirus replication by more than four orders of magnitude in cultured cells and suppresses coronavirus infection in mice. Mechanistically, UNC7844 suppresses inositol (pyro)phosphates production, disrupts phosphoinositide homeostasis, and impairs late endosomal dynamics, blocking early post-entry steps required for viral genome release and replication. Together, our findings establish the soluble inositol (pyro)phosphate pathway as an important regulator of coronavirus infection and highlight its inhibition as a promising host-directed antiviral strategy.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.09.12.750390v1?rss=1">
<title>
<![CDATA[
A rational design strategy and validation for protease-resistant fusion-inhibitor antiviral peptides 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.09.12.750390v1?rss=1"
</link>
<dc:creator>Yang, K.</dc:creator>
<dc:creator>Wang, C.</dc:creator>
<dc:creator>Topi, F.</dc:creator>
<dc:creator>Muratcioglu, S.</dc:creator>
<dc:creator>Kant, R.</dc:creator>
<dc:creator>Strandin, T.</dc:creator>
<dc:creator>Bong, Y. T.</dc:creator>
<dc:creator>Kareinen, L.</dc:creator>
<dc:creator>Mäki, S.</dc:creator>
<dc:creator>Saber, S. H.</dc:creator>
<dc:creator>Binder, T.</dc:creator>
<dc:creator>Sironen, T.</dc:creator>
<dc:creator>Subramanian, S.</dc:creator>
<dc:creator>White, K. I.</dc:creator>
<dc:creator>Pfuetzner, R.</dc:creator>
<dc:creator>Esquivies, L.</dc:creator>
<dc:creator>Vapalahti, O.</dc:creator>
<dc:creator>Joensuu, M.</dc:creator>
<dc:creator>Kuriyan, J.</dc:creator>
<dc:creator>Hepojoki, J.</dc:creator>
<dc:creator>Balistreri, G.</dc:creator>
<dc:creator>Brunger, A. T.</dc:creator>
<dc:date>2026-09-15</dc:date>
<dc:identifier>doi:10.64898/2026.09.12.750390</dc:identifier>
<dc:title><![CDATA[A rational design strategy and validation for protease-resistant fusion-inhibitor antiviral peptides]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-15</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Peptide-based fusion inhibitors are promising pharmaceuticals in the fight against enveloped viruses relying on membrane fusion for host infection. However, peptide therapeutic applications have long been hindered by their poor stability in vivo. Here, we discovered that peptide inhibitors with the wildtype sequence of the heptad repeat 2 (HR2) domain of the SARS-CoV-2 spike protein are efficiently cleaved by Transmembrane Protease, Serine 2 (TMPRSS2), a key protease involved in the SARS-CoV-2 virus-cell fusion pathway. We then identified the corresponding cleavage sites and designed three protease-resistant peptides using ranking based on deep mutational scanning and natural occurrence. The three candidates all exhibit inhibitory activity in a cell-cell fusion assay. A high-resolution cryo-EM structure of the top candidate, HR2-NHN, bound to its HR1 target reveals the molecular basis for its potent activity. The top candidate of the cell-based screening assay significantly improved efficacy relative to the wildtype peptide when administered 12 h before infection in both an authentic virus-cell infection assay and a mouse assay. More broadly, our results suggest that the design strategies for protease-resistant peptides could be applied to a broad spectrum of other enveloped viruses and pave the way for the development of safe, prophylactic antivirals that can be administered before exposure.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.09.11.750491v1?rss=1">
<title>
<![CDATA[
Multi-omics reveals a monocyte-macrophage-fibroblast axis in post-COVID-19 fibroinflammatory lung remodelling 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.09.11.750491v1?rss=1"
</link>
<dc:creator>Mehta, P.</dc:creator>
<dc:creator>Mawer, C. M. A.</dc:creator>
<dc:creator>Beattie, G.</dc:creator>
<dc:creator>Smith, D. J. F.</dc:creator>
<dc:creator>Nikola, F.</dc:creator>
<dc:creator>Selway-Clarke, H.</dc:creator>
<dc:creator>Zhao, A. Y.</dc:creator>
<dc:creator>Adams, T. S.</dc:creator>
<dc:creator>Kunzemann-Martinez, A.</dc:creator>
<dc:creator>Stanel, S. C.</dc:creator>
<dc:creator>Worlock, K. B.</dc:creator>
<dc:creator>Yoshida, M.</dc:creator>
<dc:creator>Walters, R.</dc:creator>
<dc:creator>Goldsworthy, S.</dc:creator>
<dc:creator>Uddin, I.</dc:creator>
<dc:creator>Barnes, J. L.</dc:creator>
<dc:creator>Rockett, G. J.</dc:creator>
<dc:creator>Nikolic, M. Z.</dc:creator>
<dc:creator>Piazza, P.</dc:creator>
<dc:creator>Plate, M.</dc:creator>
<dc:creator>Stewart, I.</dc:creator>
<dc:creator>Porter, J. C.</dc:creator>
<dc:creator>Nair, A.</dc:creator>
<dc:creator>Jacob, J.</dc:creator>
<dc:creator>Yan, X.</dc:creator>
<dc:creator>Kaminski, N.</dc:creator>
<dc:creator>Alhendi, A. S. N.</dc:creator>
<dc:creator>Chambers, R. C.</dc:creator>
<dc:date>2026-09-14</dc:date>
<dc:identifier>doi:10.64898/2026.09.11.750491</dc:identifier>
<dc:title><![CDATA[Multi-omics reveals a monocyte-macrophage-fibroblast axis in post-COVID-19 fibroinflammatory lung remodelling]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-14</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Post-COVID-19 residual lung abnormalities (RLA) are associated with persistent respiratory symptoms and radiological changes, yet the underlying mechanisms remain unclear. We performed integrated multi-omic profiling of paired bronchoalveolar lavage and blood samples from patients with post-COVID-19 RLA and healthy controls, combining single-cell RNA sequencing, CITE-seq, single-cell T cell receptor sequencing, bronchoalveolar lavage fluid proteomics and functional fibroblast assays. In post-COVID-19 RLA lungs, we identified an increased abundance of profibrotic SPP1hi monocyte-derived alveolar macrophages, arising from an expanded circulating HLA-DRlowCD163+PDE4Dhi classical monocyte progenitor population, supporting a blood-lung myeloid axis. Cell-cell communication modelling positioned macrophages as central hubs of immune-stromal crosstalk, promoting monocyte recruitment with profibrotic priming, and fibroblast activation. Proteomic analysis of bronchoalveolar lavage fluid from post-COVID-19 RLA and idiopathic pulmonary fibrosis, compared with healthy controls, revealed shared and distinct signatures. These alveolar proteins in post-COVID-19 RLA were predominantly attributed to myeloid cells and predicted to engage fibroblast receptors. Bronchoalveolar lavage fluid induced fibroblast proliferation, differentiation and collagen deposition in vitro, with proliferation attenuated by the antifibrotic drug nintedanib. We also identified compartment-specific lymphoid dysregulation, including depletion of mucosal-associated invariant T (MAIT) cells in both the lung and blood, decreased natural killer (NK) cells with oligoclonal T cell expansion in the lung, and expansion of regulatory and cytotoxic T cells in the blood. These findings support a persistent monocyte-macrophage-fibroblast axis linking immune dysregulation to fibroproliferative remodelling after COVID-19 and highlights candidate therapeutic targets for post-viral lung fibrosis. We provide a publicly available atlas (on publication).
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.09.10.750645v1?rss=1">
<title>
<![CDATA[
Antibody evasion and receptor binding of SARS-CoV-2 RW.1.1 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.09.10.750645v1?rss=1"
</link>
<dc:creator>Daniel, K.</dc:creator>
<dc:creator>Hong, H.</dc:creator>
<dc:creator>Huang, C.-Y.</dc:creator>
<dc:creator>Gordon, A.</dc:creator>
<dc:creator>Guo, Y.</dc:creator>
<dc:creator>Ho, D. D.</dc:creator>
<dc:creator>Mellis, I. A.</dc:creator>
<dc:date>2026-09-14</dc:date>
<dc:identifier>doi:10.64898/2026.09.10.750645</dc:identifier>
<dc:title><![CDATA[Antibody evasion and receptor binding of SARS-CoV-2 RW.1.1]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-14</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The continued evolution of SARS-CoV-2 is shaped by changes in antibody evasion and receptor engagement that influence viral fitness. RW.1.1, an emerging descendant of XFJ carrying five additional spike substitutions, has recently increased in frequency in North America. Here, we characterized the serum antibody evasion, monoclonal antibody sensitivity, and ACE2 receptor engagement of RW.1.1. Pseudovirus neutralization assays using sera from adults showed that RW.1.1 was not more resistant to serum neutralization than currently circulating variants, with neutralizing titers comparable to XFG, BA.3.2.2, and NB.1.8.1 in the tested cohort. Neutralization of RW.1.1 also did not differ significantly among adults, children, and infants and toddlers. Despite the absence of increased overall serum antibody resistance, monoclonal antibody neutralization assays revealed substantial resistance to several RBD class 1 antibodies and increased resistance to a subset of class 1/4 antibodies. Moreover, RW.1.1 exhibited reduced ACE2 receptor engagement compared with XFG, which itself has reduced receptor engagement relative to earlier JN.1 subvariants. Thus, RW.1.1 has continued to expand despite a further reduction in receptor engagement and without a substantial increase in overall serum antibody evasion. These findings suggest that the fitness of emerging SARS-CoV-2 variants may depend not only on the magnitude of antibody evasion but also on the specific components of the polyclonal antibody response that are evaded, highlighting the increasingly complex interplay between population immunity and receptor engagement in shaping SARS-CoV-2 evolution.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.09.11.750997v1?rss=1">
<title>
<![CDATA[
Breathlessness catastrophising after COVID-19 involves both interoceptive and visceromotor connectivity 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.09.11.750997v1?rss=1"
</link>
<dc:creator>Qiu, L.</dc:creator>
<dc:creator>Raman, B.</dc:creator>
<dc:creator>Cassar, M.</dc:creator>
<dc:creator>Fraser, E.</dc:creator>
<dc:creator>Atkinson, L. Z.</dc:creator>
<dc:creator>Clare, S.</dc:creator>
<dc:creator>Clarke, W. T.</dc:creator>
<dc:creator>Neubauer, S.</dc:creator>
<dc:creator>Davies, H. E.</dc:creator>
<dc:creator>Harrison, N. A.</dc:creator>
<dc:creator>Evans, C. J.</dc:creator>
<dc:creator>Ezra, M.</dc:creator>
<dc:creator>Pattinson, K. T. S.</dc:creator>
<dc:date>2026-09-14</dc:date>
<dc:identifier>doi:10.64898/2026.09.11.750997</dc:identifier>
<dc:title><![CDATA[Breathlessness catastrophising after COVID-19 involves both interoceptive and visceromotor connectivity]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-14</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Persistent breathlessness is common after COVID-19, yet its severity typically correlates weakly with objective clinical measures. This discordance is often attributed to perceptual inference amplified by anxiety. Because breathing involves a closed perception-action loop, breathlessness may also reflect alterations in interoceptive and visceromotor pathways. We acquired 7-tesla resting-state functional MRI in 53 post-COVID patients with varying breathlessness and estimated functional connectivity across 18 pre-defined interoceptive and visceromotor regions. Linear regression identified two connections associated with breathlessness catastrophising: reduced dorsal periaqueductal grey-posterior insula (dPAG-PoI1) and increased basolateral amygdala-dorsal anterior cingulate (BLA-dACC) connectivity. The dPAG-PoI1 association was stronger in patients who had required mechanical ventilation, whereas the BLA-dACC association was attenuated at higher generalised anxiety. These findings are consistent with two potentially separable contributions to symptom burden: weakened interoceptive signalling between brainstem and sensory cortex, and heightened visceromotor influence of threat processing on autonomic control, rather than anxiety-driven misperception alone.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.09.09.26362623v1?rss=1">
<title>
<![CDATA[
Functional plasticity of the olfactory network following functional septorhinoplasty in persistent COVID-19-related olfactory dysfunction: an fMRI study 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.09.09.26362623v1?rss=1"
</link>
<dc:creator>Sharma Khatiwada, A.</dc:creator>
<dc:creator>Mancini, L.</dc:creator>
<dc:creator>Pendolino, A. L.</dc:creator>
<dc:creator>Gandini Wheeler-Kingshott, C. A. M.</dc:creator>
<dc:creator>Andrews, P. J.</dc:creator>
<dc:date>2026-09-13</dc:date>
<dc:identifier>doi:10.64898/2026.09.09.26362623</dc:identifier>
<dc:title><![CDATA[Functional plasticity of the olfactory network following functional septorhinoplasty in persistent COVID-19-related olfactory dysfunction: an fMRI study]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-13</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Background: Persistent COVID-19-related olfactory dysfunction (C19OD) has a significant disease burden. The underlying pathology is unclear, both at the level of the olfactory epithelium, and the higher neural networks. Functional septorhinoplasty (fSRP) is a novel intervention aimed at restoring odorant airflow to the olfactory epithelium, demonstrating clinically meaningful olfactory improvements in persistent C19OD patients. In the same cohort, we investigated the functional plasticity within the primary and higher-order olfactory brain networks using task-based functional magnetic resonance imaging (fMRI) before and after fSRP. Methods: In a prospective cohort study, patients with persistent C19OD underwent psychophysical olfactory testing, nasal airflow measurements, and olfactory task-based fMRI at baseline and 6 months post-fSRP. Whole-brain fMRI data was analysed to evaluate changes in neural activation and their correlations with clinical parameters. Results were mapped to standardized anatomical and olfactory atlases. Findings: Eight participants completed pre- and post-operative fMRI assessments. At baseline, increased deactivation was seen in the left hippocampus, and increased activation in bilateral cerebellum. Task-based activation was positively correlated with nasal volume in the right thalamus, and left cerebellum lobule VI. Post-operatively, task-based deactivation was seen in the left cerebellum crus II. Reduced task-dependent activation post- compared to pre-operatively was seen in the bilateral insula. Increased activation post- compared to pre-operatively positively correlated with change in nasal airflow in the right orbitofrontal cortex (OFC), superior and middle frontal gyrus, and frontal pole (FP). Increased post- compared to pre-operative activation correlated negatively with change in olfactory scores in bilateral insula, and left FP. Interpretation: Persistent C19OD is characterized by widespread functional alterations across higher-order cortical regions, reflecting altered central olfactory processing. fSRP elicits significant neural plasticity within these higher-order olfactory areas. The findings support the mechanism that augmenting airflow to the olfactory cleft drives olfactory recovery through
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.09.11.26362835v1?rss=1">
<title>
<![CDATA[
Hit hardest, healed least: disruption and incomplete recovery of public mental-health outpatient services across two COVID-19 waves in India, 2017-2022 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.09.11.26362835v1?rss=1"
</link>
<dc:creator>Mishra, V.</dc:creator>
<dc:creator>Parihar, K. S.</dc:creator>
<dc:date>2026-09-13</dc:date>
<dc:identifier>doi:10.64898/2026.09.11.26362835</dc:identifier>
<dc:title><![CDATA[Hit hardest, healed least: disruption and incomplete recovery of public mental-health outpatient services across two COVID-19 waves in India, 2017-2022]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-13</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Background: The COVID-19 pandemic disrupted healthcare worldwide, but whether mental health was affected differently from physical healthcare, and whether it recovered following successive waves, has not been described from routine administrative data in a low- or middle-income country. Methods: Interrupted time-series analysis of India's routine Health Management Information System (HMIS), April 2017 to March 2022. We extracted monthly counts of mental-illness outpatient visits and adolescent counseling sessions across ~700 districts, projected expected monthly counts from a log-linear model fitted to pre-pandemic trends, and compared disruption and recovery against an index of routine physical-health services. Results: Mental-illness outpatient visits fell to 31.2% of expected in April 2020 during the national lockdown, a collapse deeper than that observed for routine immunisation (48.3%) or institutional delivery (72.1%). During the Delta wave (April-June 2021), mental-health outpatient visits dropped again to 57.8% of expected. In the post-Delta recovery period (July 2021-March 2022), while immunisation and delivery volumes returned to >95% of expected, mental-illness outpatient visits reached only 58.4% of expected, representing a cumulative two-year deficit of 41.6% (~5.8 million missed outpatient visits). Deficits were widespread across states. Conclusion: Public mental-health outpatient services in India were hit harder than physical-health services by the pandemic and showed essentially no post-Delta volume recovery. As India implements its national digital mental health initiative (Tele-MANAS), these data define the large, quantified outpatient deficit that digital and facility-based services must urgently address.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.09.11.26362837v1?rss=1">
<title>
<![CDATA[
ACE2 Polymorphisms rs2285666 and rs147311723 Are Clinically Relevant Variants in SARS-CoV-2 and Mycobacterium tuberculosis Co-infection. 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.09.11.26362837v1?rss=1"
</link>
<dc:creator>Kameni, M. N.</dc:creator>
<dc:creator>Jean Paul, A. A.</dc:creator>
<dc:creator>Berenger Tchoupe, E.</dc:creator>
<dc:creator>Toyim Albert, N.</dc:creator>
<dc:creator>Maxime Tchoutang, A.</dc:creator>
<dc:creator>Franklin, M.</dc:creator>
<dc:creator>Svetlana Carel, T. V.</dc:creator>
<dc:creator>Georgette Njila, K.</dc:creator>
<dc:creator>Neba, F. R.</dc:creator>
<dc:creator>Donald Kamdem, S.</dc:creator>
<dc:creator>Masumbe Netongo, P.</dc:creator>
<dc:date>2026-09-13</dc:date>
<dc:identifier>doi:10.64898/2026.09.11.26362837</dc:identifier>
<dc:title><![CDATA[ACE2 Polymorphisms rs2285666 and rs147311723 Are Clinically Relevant Variants in SARS-CoV-2 and Mycobacterium tuberculosis Co-infection.]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-13</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters host cells primarily through the angiotensin-converting enzyme 2 (ACE2) receptor. Genetic variation in the ACE2 gene may influence host inflammatory responses and clinical outcomes during COVID-19. Tuberculosis (TB) on the other hand increases the level of ACE2 expression through interferon stimulation. The objective of this study was to investigate the association between specific single-nucleotide polymorphism (SNP) in the ACE2 gene and their impact on susceptibility to and severity of SARS-CoV-2 and Mycobacterium tuberculosis Co-infection. Methods: This retrospective cross-sectional study included 120 symptomatic individuals recruited between September 2020 and December 2023 from four hospitals in Yaounde, Cameroon. Participants were classified into four groups: COVID-19, TB, TB/COVID-19 co-infection, and infection-negative controls. Diagnoses were confirmed using RT-PCR and standard microbiological methods. Serum biochemical markers and cytokines were quantified, and genotyping of ACE2 polymorphisms was performed using TaqMan assays. Results: Statistical analysis showed a significant association between ACE2 expression and inflammatory or biochemical markers, particularly for rs147311723. Several ACE2 polymorphisms (rs6632677, rs147311723, rs4646140, rs2285666, and rs4646142) were significantly associated with increased pro-inflammatory cytokine levels. Selected biochemical parameters demonstrated suggestive associations with ACE2 variants, including creatinine (rs147311723, p = 0.0522), AST (rs2285666, p = 0.0536), and ALT (rs4646142, p = 0.0582), indicating potential renal and hepatic involvement. Principal component analysis identified distinct immunometabolic profiles across patient groups, with co-infected individuals exhibiting heightened inflammatory and metabolic perturbations. Conclusions: These findings suggest that ACE2 genetic variability is associated with modulation of inflammatory responses and may contribute to organ-specific dysfunction in COVID-19 and TB across different populations. This highlights the potential role of host genetics in shaping disease severity and underscore the need for larger studies to validate these associations in diverse populations. Keywords: ACE2 polymorphisms; COVID-19; tuberculosis; co-infection; cytokines; biomarkers; genetic susceptibility;
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.09.04.26362245v1?rss=1">
<title>
<![CDATA[
Healthy vaccinee effect in SARS-CoV-2 vaccinees without documented infection 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.09.04.26362245v1?rss=1"
</link>
<dc:creator>Riedmann, U.</dc:creator>
<dc:creator>Brenner, H.</dc:creator>
<dc:creator>Ioannidis, J.</dc:creator>
<dc:creator>Pilz, S.</dc:creator>
<dc:date>2026-09-11</dc:date>
<dc:identifier>doi:10.64898/2026.09.04.26362245</dc:identifier>
<dc:title><![CDATA[Healthy vaccinee effect in SARS-CoV-2 vaccinees without documented infection]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-11</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
ImportanceEstimates of SARS-CoV-2 vaccine effectiveness (VE) from observational studies may be biased if healthier (healthy vaccinee effect; HVE) or less healthy individuals are preferentially vaccinated. Quantifying HVE is essential for interpreting VE estimates for informed vaccination policy.

ObjectiveTo assess the HVE by comparing all-cause mortality, cancer mortality, and deaths from external causes between vaccinated and unvaccinated individuals.

Design, Setting, and ParticipantsThis nationwide retrospective cohort study used Austrian national registry data from 2021 to August 31, 2022, and included the entire adult population of Austria with no previously documented SARS-CoV-2 infection on January 1, 2021. Cox regression was used to estimate hazard ratios (HRs) for mortality comparing vaccinated with unvaccinated individuals while adjusting for age, sex and Austrian long-term care allowance (ALTCA) recipiency, stratified by vaccinations (1 to 4). Analyses were performed for the whole observation period, 3-month blocks (quarters) and the 2 months with highest and lowest COVID-19 disease burden per year. Additionally, newly vaccinated individuals were matched on day of vaccination based on the aforementioned covariates plus highest education and HRs were assed for the two weeks following vaccination.

ExposureReceipt of at least 1 dose of SARS-CoV-2 vaccine.

Main Outcomes and MeasuresAll-cause mortality, cancer mortality, and deaths from external causes (e.g., falls and transport accidents).

ResultsAmong 7,416,077 eligible adults, all-cause mortality was lower among vaccinated than unvaccinated individuals regardless of vaccination number. Differences in risk were greatest shortly after vaccination and attenuated over time. E.g., adjusted all-cause HRs in the quarter after vaccination introduction were 0.46, 0.52, 0.38 and 0.43 for vaccinated vs unvaccinated individuals for 1, 2, 3 and 4 vaccinations, respectively. Respective HRs for the first 2 weeks after vaccination in the matched analysis were 0.24-0.32 across all vaccinations. Findings for cancer mortality and deaths from external causes paralleled those for all-cause mortality.

Conclusions and RelevanceA pronounced HVE was observed for SARS-CoV-2 vaccination during the pandemic, evidenced by markedly lower mortality from causes not plausibly related to vaccination (cancer, external causes) among vaccinated individuals. This bias needs to be accounted for when interpreting observational estimates of SARS-CoV-2 VE.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.09.10.26362752v1?rss=1">
<title>
<![CDATA[
Longitudinal antibody correlates of SARS-CoV-2 infection in a US household cohort during Omicron waves 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.09.10.26362752v1?rss=1"
</link>
<dc:creator>Yang, Y.</dc:creator>
<dc:creator>Callear, A.</dc:creator>
<dc:creator>Smith, M.</dc:creator>
<dc:creator>Juntila-Raymond, C.</dc:creator>
<dc:creator>Godonou, E.-T.</dc:creator>
<dc:creator>Johnson, E.</dc:creator>
<dc:creator>Lauring, A. S.</dc:creator>
<dc:creator>Fitzsimmons, W. J.</dc:creator>
<dc:creator>Jones, J. M.</dc:creator>
<dc:creator>Midgley, C. M.</dc:creator>
<dc:creator>Monto, A. S.</dc:creator>
<dc:creator>Martin, E. T.</dc:creator>
<dc:date>2026-09-11</dc:date>
<dc:identifier>doi:10.64898/2026.09.10.26362752</dc:identifier>
<dc:title><![CDATA[Longitudinal antibody correlates of SARS-CoV-2 infection in a US household cohort during Omicron waves]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-11</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Background: SARS-CoV-2 vaccines have been updated based on circulating variants and the antibody protection from prior vaccination and infection against emerging variants. We evaluated longitudinal antibody correlates of SARS-CoV-2 infection risk during Omicron waves. Methods: We used data from a longitudinal cohort study from 2021 through 2025 with prospective surveillance for acute respiratory illness and repeated blood collection. A subset of participants also provided weekly respiratory specimens to identify asymptomatic infections. Serum samples were tested using multiplex assays measuring anti-Spike (S) binding IgG and angiotensin-converting enzyme 2 (ACE2) inhibition, a measure of inhibition of the ACE2 receptor interaction, across multiple SARS-CoV-2 variants. Cox models were used to evaluate associations between antibody levels, prior vaccination and infection, and SARS-CoV-2 infections. Findings: Among 119 participants who contributed 438.8 person-years of follow-up, 81 symptomatic SARS-CoV-2 infections and 4 asymptomatic infections (from 33 participants with weekly swabs) were detected. Each two-fold increase in anti-S IgG concentration was associated with a 15% lower hazard of symptomatic infection (hazard ratio [HR] = 0.85, 95% CI: 0.82-0.88). Similarly, each 10% increase in ACE2 inhibition was associated with a 7% lower infection hazard (HR = 0.93, 95% CI: 0.90-0.95). After adjusting for antibody levels, prior SARS-CoV-2 infection remained protective, while recent vaccination was not associated with infection hazard. The peak predicted antibody level after repeated COVID-19 vaccinations was estimated to confer 62-65% protection against symptomatic infection. Interpretation: Higher levels of binding and functional antibodies were associated with reduced risk of SARS-CoV-2 infections across multiple waves between 2021-2025. These findings support the use of longitudinal serologic surveillance to inform vaccine evaluation and future booster strategies against evolving SARS-CoV-2 variants.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.09.10.750728v1?rss=1">
<title>
<![CDATA[
Real-time accessible phylogenetics for every highly sampled virus 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.09.10.750728v1?rss=1"
</link>
<dc:creator>Hinrichs, A. S.</dc:creator>
<dc:creator>Karim, L. M.</dc:creator>
<dc:creator>Turakhia, Y.</dc:creator>
<dc:creator>Sanderson, T.</dc:creator>
<dc:creator>Corbett-Detig, R.</dc:creator>
<dc:date>2026-09-11</dc:date>
<dc:identifier>doi:10.64898/2026.09.10.750728</dc:identifier>
<dc:title><![CDATA[Real-time accessible phylogenetics for every highly sampled virus]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-11</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The scale of viral genome sequencing has outpaced the phylogenetic tools traditionally used to analyze it, as highlighted by the COVID-19 pandemic. We present viral_usher, a unified framework for scalable viral phylogenetics built on UShER. viral_usher is a containerized command-line tool that constructs mutation-annotated trees directly from public sequence repositories with minimal user input, building phylogenies of tens of thousands of genomes in minutes. Applying it across the International Nucleotide Sequence Database Collaboration, we assembled viral_usher_trees, a repository of 446 phylogenies spanning 163 well-sequenced viral species, rebuilt automatically monthly as new genomes are deposited. We extended Taxonium from a tree viewer into a web platform supporting in-browser phylogenetic placement and de novo tree construction, so that users can upload sequences and contextualize them within global phylogenies without local computational infrastructure. Because every tree is built by the same procedure, the repository enables comparative analyses across the breadth of viral diversity. We demonstrate the utility of this resource by asking what factors shape viral mutation spectra. We found that replication machinery, captured as Baltimore class, explains 46% of the variance across 162 viral genomes, while host taxon and envelope status together explain under 5%. These resources provide an extensible platform for real-time genomic epidemiology and for comparative evolutionary analysis across viral pathogens. Resources and code are freely available at https://taxonium.org/, https://github.com/lilymaryam/spectrum_analysis, https://github.com/AngieHinrichs/viral_usher_trees, and https://github.com/AngieHinrichs/viral_usher.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.09.10.750593v1?rss=1">
<title>
<![CDATA[
Hantavirus mutagenesis is impacted by mutagens and host antiviral proteins 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.09.10.750593v1?rss=1"
</link>
<dc:creator>Ruis, C.</dc:creator>
<dc:creator>Parkhill, J.</dc:creator>
<dc:creator>Floto, R. A.</dc:creator>
<dc:date>2026-09-11</dc:date>
<dc:identifier>doi:10.64898/2026.09.10.750593</dc:identifier>
<dc:title><![CDATA[Hantavirus mutagenesis is impacted by mutagens and host antiviral proteins]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-11</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Hantaviruses are emerging zoonotic viruses that infect humans with high fatality rates. We currently have a poor understanding of the processes that contribute to hantavirus mutagenesis and therefore the potential for viral adaptation. To understand the drivers of mutations in hantaviruses, we calculated and compared mutational spectra across 14 divergent hantavirus species. We found that mutagens that are conserved across host species have a major impact on hantaviruses mutagenesis, contributing to at least six of the 12 possible mutation types. We found differences in mutational signatures across hantaviruses, some of which may be due to variation in host mutagen levels that are known to influence somatic mutations. However, we could find no evidence for differential mutational signatures between viruses associated with distinct diseases in humans and no evidence of tissue tropism differences between reservoir hosts. Using a novel method to quantify the impact of ZAP-mediated selection, we found that ZAP greatly influences mutational patterns in transition mutation types across hantaviruses. We also find evidence that APOBEC family proteins drive mutagenesis in all hantaviruses, with the likely exception of Nova virus. Our results therefore provide strong support that mutagens and host antiviral proteins are major contributors to hantavirus mutagenesis, thereby generating the genetic diversity necessary for viral adaptation.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.09.08.26362558v1?rss=1">
<title>
<![CDATA[
A comparison of two forecasting models for COVID-19 hospitalizations using wastewater concentration data 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.09.08.26362558v1?rss=1"
</link>
<dc:creator>Keyel, A.</dc:creator>
<dc:creator>Hill, D. T.</dc:creator>
<dc:creator>Johnson, K. E.</dc:creator>
<dc:creator>Lang, D.</dc:creator>
<dc:creator>Rosenberg, E. S.</dc:creator>
<dc:creator>Bush, K.</dc:creator>
<dc:creator>Larsen, D. A.</dc:creator>
<dc:date>2026-09-10</dc:date>
<dc:identifier>doi:10.64898/2026.09.08.26362558</dc:identifier>
<dc:title><![CDATA[A comparison of two forecasting models for COVID-19 hospitalizations using wastewater concentration data]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-10</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Wastewater surveillance has become a prominent part of public health efforts to track circulating pathogens and has been incorporated into disease forecasting models. We compared two recent wastewater forecasting models for forecasting COVID-19 hospitalizations using SARS-CoV-2 concentrations in wastewater: a generalized linear mixed model (GLMM) and a Bayesian mechanistic model known as wwinference. We retrospectively produced 1-week ahead forecasts using these two conceptually different models across 10 regions in New York state, from September 2022 - mid-April 2024. We compared the performance of forecasts produced from the two models fit with wastewater and clinical data to a version of each model fit to only clinical data. Models were scored against observations using Continuous Ranked Probability Scores for each forecast (n = 363 forecasts). Of the two models, the GLMM showed improved forecast performance across space and time when evaluated on a natural scale compared to the wwinference model, but no significant difference in forecast performance was found on a log-scale, which evaluates the relative rather than absolute error. Consequently, either model could be used to forecast COVID-19 hospitalizations. Including wastewater concentrations in these models at these spatial and temporal scales did not provide additional forecasting benefit beyond just clinical data. The performance of a wastewater-only model relative to simple null models; however, demonstrates that there is a clear forecasting signal present in wastewater, thus we think the lack of change is likely due to the strong signal from the clinical measures included in the model at this spatial and temporal scale.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.09.06.26362161v1?rss=1">
<title>
<![CDATA[
Mental health before, during, and after COVID-19 (through 2025) in boys, girls, and gender-diverse youth 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.09.06.26362161v1?rss=1"
</link>
<dc:creator>Kiviruusu, O.</dc:creator>
<dc:creator>Therman, S.</dc:creator>
<dc:creator>Lehtonen, J.</dc:creator>
<dc:creator>Ystrom, E.</dc:creator>
<dc:creator>Butwicka, A.</dc:creator>
<dc:creator>Halldorsdottir, T.</dc:creator>
<dc:creator>Ask, H.</dc:creator>
<dc:creator>Suvisaari, J.</dc:creator>
<dc:date>2026-09-10</dc:date>
<dc:identifier>doi:10.64898/2026.09.06.26362161</dc:identifier>
<dc:title><![CDATA[Mental health before, during, and after COVID-19 (through 2025) in boys, girls, and gender-diverse youth]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-10</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundAdolescent mental health after the COVID-19 pandemic has been a major public health concern. Studies covering the post-pandemic period remain scarce and rarely include gender-diverse youth. We examined trends in mental health among cisgender, transgender, and nonbinary youth during the pandemic and through 2025.

MethodsParticipants (N=636,201) were adolescents in grades 8-11 from the Finnish School Health Promotion study between 2019 and 2025, a repeated cross-sectional classroom survey.

Validated questionnaires were used to assess clinical levels of depressive, generalized anxiety and social anxiety symptoms, as well as mental well-being.

ResultsIn 2025 there were 81,145 (48.6%) cisgender girls, 1137 (0.7%) transgender boys, 78,898 (47.2%) cisgender boys, 449 (0.3%) transgender girls, and 4658 (2.8%) nonbinary youth. Clinically significant depressive and generalized anxiety symptoms remained more prevalent in 2025 (reference) compared with pre-pandemic levels across all groups (ORs for 2019, 0.48-0.86; p<0.01). Compared with other groups, symptoms were most prevalent among transgender boys and nonbinary youth. Among cisgender youth, generalized anxiety symptoms increased across the post-pandemic period (ORs for 2021 and 2023, 0.81-0.95; p<0.0001). Nonbinary youth were the only group to show a recovery pattern in depressive, generalized anxiety, and social anxiety symptoms (ORs for 2021, 1.36-1.52; p<0.0001) and demonstrated improved mental well-being after the pandemic (beta for 2021, -0.68; p<0.0001).

ConclusionsThe results indicate that the elevated levels of mental health problems among adolescents associated with the COVID-19 pandemic have not subsided. They also reveal persistent disparities by gender identity and call for targeted policy action.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.09.09.26362611v1?rss=1">
<title>
<![CDATA[
Pre-Infection Mental Health, but Not Brain Volumetry, Predicts Risk of Post-COVID Condition: A Population-Based Cohort Study in the German National Cohort (NAKO) 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.09.09.26362611v1?rss=1"
</link>
<dc:creator>Flint, C.</dc:creator>
<dc:creator>Spreckelsen, C.</dc:creator>
<dc:creator>Otto, C.</dc:creator>
<dc:creator>Mikolajczyk, R.</dc:creator>
<dc:creator>Frost, J.</dc:creator>
<dc:creator>Claass, L. V.</dc:creator>
<dc:creator>Fasshauer, J. M.</dc:creator>
<dc:creator>Scholz, M.</dc:creator>
<dc:creator>Buschmann, L.</dc:creator>
<dc:creator>Rübsamen, N.</dc:creator>
<dc:creator>Wright, M. N.</dc:creator>
<dc:creator>Burk, L.</dc:creator>
<dc:creator>Bamberg, F.</dc:creator>
<dc:creator>Schlett, C. L.</dc:creator>
<dc:creator>Niendorf, T.</dc:creator>
<dc:creator>Forsting, M.</dc:creator>
<dc:creator>Li, Y.</dc:creator>
<dc:creator>Steindorf, K.</dc:creator>
<dc:creator>Karrasch, S.</dc:creator>
<dc:creator>Leitzmann, M.</dc:creator>
<dc:creator>Haug, S.</dc:creator>
<dc:creator>Bärnighausen, T. W.</dc:creator>
<dc:creator>Schmidt, B.</dc:creator>
<dc:creator>Harries, M.</dc:creator>
<dc:creator>Melhorn, V.</dc:creator>
<dc:creator>Krist, L.</dc:creator>
<dc:creator>Keil, T.</dc:creator>
<dc:creator>Peters, A.</dc:creator>
<dc:creator>Opel, N.</dc:creator>
<dc:date>2026-09-10</dc:date>
<dc:identifier>doi:10.64898/2026.09.09.26362611</dc:identifier>
<dc:title><![CDATA[Pre-Infection Mental Health, but Not Brain Volumetry, Predicts Risk of Post-COVID Condition: A Population-Based Cohort Study in the German National Cohort (NAKO)]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-10</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundPost-COVID Condition (PCC) affected 10-30% of individuals after SARS-CoV-2 infection, and pre-infection predictors of who goes on to develop it are not well established. We compared pre-infection structural brain variation and baseline psychiatric phenotype as candidate predictors of PCC within a common multi-modal framework in the German National Cohort (NAKO). Both are candidate "first hits" under the second-hit hypothesis, which motivates the comparison; the vulnerability-by-infection interaction that hypothesis turns on is not identifiable among infected participants, so this is a prediction study rather than a test of the hypothesis.

MethodsIn 8,464 SARS-CoV-2-infected NAKO neuroimaging participants, of whom 2,304 (27.2%) met PCC criteria (weighted post-COVID syndrome (PCS) score > 10.75) and the rest were symptom-free controls, ten pre-infection modalities (T1-weighted volumetric brain MRI across six parcellations, baseline mental health (PHQ-9, GAD-7), demographics, and seven further biomedical and socioeconomic domains) entered a stacked ensemble with 10x5 nested cross-validation (primary metric: the area under the precision-recall curve, PR-AUC). Pre-specified analyses assessed transportability to a non-imaging cohort and robustness to symptom trajectory and unmeasured confounding. SARS-CoV-2 infection status and the PCC outcome were ascertained by self-report; no clinically confirmed diagnoses were available.

ResultsBaseline mental health, assessed 3-8 years before infection, was the strongest predictor (38.2% of feature importance; standalone ROC-AUC = 0.640), whereas all six brain-MRI parcellations performed at or near chance (ROC-AUC 0.496-0.516). The multi-modal model achieved moderate, well-calibrated discrimination (ROC-AUC = 0.664, 95% CI 0.652-0.677; PR-AUC = 0.413, 0.392-0.434; ECE = 0.015). Applied without retraining to the non-imaging cohort it retained discrimination (ROC-AUC = 0.660, 0.654-0.665), meeting two of three pre-specified equivalence criteria. Adjusting for the full symptom trajectory shrank the base-line mental-health odds ratio from 2.06 (1.83-2.32) to a conservative lower bound of 1.38 (1.20-1.58; E-value 2.66) while leaving it independently significant, and was essentially unchanged under an alternative control definition (2.07). Baseline mental health did not predict objectively measured hyposmia in participants screened before their infection (0.89) while predicting self-reported smell loss in the same participants (1.92).

ConclusionsBaseline mental health years before infection is the strongest pre-infection predictor of PCC among the infected, and the association held across the pre-specified sensitivity analyses. Whether it acts specifically on COVID-19 sequelae is a separate question this design cannot answer, and the indirect evidence points away from specificity: the association is undiminished after mild infection but absent among the hospitalised, and baseline mental health predicts current symptom load no more strongly in infected than in non-infected participants. The volumetric structural candidate is not supported: pre-pandemic T1-weighted volumetry carried no predictive signal in this single neuroimaging cohort, consistent with COVID-19-associated brain changes being acute-onset rather than pre-existing. Risk stratification may benefit from incorporating baseline psychiatric phenotype; whether treating it reduces PCC incidence requires interventional study.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.09.08.26362589v1?rss=1">
<title>
<![CDATA[
Clinico-Epidemiological Characteristics, Hospital Care Interventions, and Clinical Outcomes of Patients with SARS-CoV-2 in Nepal: The Mediating Role of Age 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.09.08.26362589v1?rss=1"
</link>
<dc:creator>Neupane, M. S.</dc:creator>
<dc:creator>Hassan, H. C.</dc:creator>
<dc:creator>Uranw, S.</dc:creator>
<dc:creator>Mehta, R. K.</dc:creator>
<dc:date>2026-09-10</dc:date>
<dc:identifier>doi:10.64898/2026.09.08.26362589</dc:identifier>
<dc:title><![CDATA[Clinico-Epidemiological Characteristics, Hospital Care Interventions, and Clinical Outcomes of Patients with SARS-CoV-2 in Nepal: The Mediating Role of Age]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-10</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Coronavirus disease 2019 (COVID-19) outcomes among hospitalized patients are influenced by demographic characteristics, clinical presentation, and requirements for hospital-based care. Age is an important determinant of COVID-19 outcomes; however, its statistical role in the relationships between hospital-care interventions and survival has received limited attention in resource-constrained settings. This prospective observational analytical study assessed clinico- epidemiological characteristics, hospital-care interventions, clinical outcomes, and the mediating role of patient age group among adults hospitalized with SARS-CoV-2 infection in Nepal. A total of 348 adults with laboratory-confirmed SARS-CoV-2 infection were consecutively recruited at a tertiary care teaching hospital from March 30, 2022 to June 30, 2023 and followed until discharge or in-hospital death. Associations with survival were examined using Chi-square/Fishers exact tests and multivariable binary logistic regression. Mediation analyses were performed using Hayes PROCESS Macro version 4.2, Model 4, with 5,000 bias-corrected bootstrap samples. Of 348 participants, 277 (79.6%) survived and 71 (20.4%) died. Older adults constituted 41.1% of participants. Hypertension (29.3%) and diabetes mellitus (23.0%) were the most common comorbidities, while fever (81.0%), cough (75.9%), and dyspnea (48.0%) were the predominant symptoms. Age group and dyspnea remained independently associated with hospital survival in multivariable analysis. Steroid therapy, oxygen therapy, and respiratory support were significantly associated with survival in unadjusted analyses. Age group partially statistically mediated the steroid therapy-survival relationship (indirect effect = -0.1371; 95% bootstrap CI: -0.3053 to -0.0154), while the direct effect remained significant (c' = -2.8670; p = 0.0049). No significant age-mediated indirect effects were observed for oxygen therapy or respiratory support. These findings highlight the importance of age and respiratory presentation in hospital outcomes and suggest age-related heterogeneity in the steroid therapy-survival relationship. The mediation finding should be interpreted as statistical rather than causal because age precedes treatment exposure.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.09.07.26362439v1?rss=1">
<title>
<![CDATA[
Risk of acute gastroenteritis following COVID-19 exposure: a retrospective population-based analysis conducted in England 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.09.07.26362439v1?rss=1"
</link>
<dc:creator>Hawkings, M. J.</dc:creator>
<dc:creator>Hughes, D. M.</dc:creator>
<dc:creator>Elliot, A. J.</dc:creator>
<dc:creator>Buchan, I. E.</dc:creator>
<dc:creator>Hungerford, D.</dc:creator>
<dc:date>2026-09-09</dc:date>
<dc:identifier>doi:10.64898/2026.09.07.26362439</dc:identifier>
<dc:title><![CDATA[Risk of acute gastroenteritis following COVID-19 exposure: a retrospective population-based analysis conducted in England]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-09</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundSevere COVID-19 is associated with immune dysregulation, microbiome disruption, and increased vulnerability to secondary infections. However, the longer-term risk of acute gastroenteritis (AGE) following COVID-19 remains poorly studied. We compared AGE incidence among community-managed and hospitalised COVID-19 patients with test-negative controls and hospitalised sepsis patients.

MethodsWe conducted a retrospective cohort study using electronic healthcare data. Patients with a recorded SARS-CoV-2 PCR test between 01 March 2020 and 01 March 2022 were allocated to test-negative, community COVID-19, or hospitalised COVID-19 cohorts. A hospitalised sepsis cohort was assembled for an age-, sex- and time-matched analysis. AGE incidence rates were calculated for the two years before enrolment and during follow-up. Negative binomial regression and conditional Poisson models estimated incidence rate ratios (IRRs) adjusting for demographic and clinical covariates.

ResultsAmong 788 103 patients, AGE incidence in the pre-pandemic period was higher among individuals later hospitalised with COVID-19 or sepsis compared with community cases. During follow-up, AGE incidence was slightly lower in community COVID-19 cases than test-negative controls (adjusted IRR 0{middle dot}88 [95% CI 0{middle dot}85-0{middle dot}92]), but substantially higher among hospitalised COVID-19 patients (IRR 5{middle dot}80 [95% CI: 5{middle dot}38-6{middle dot}25]). Matched analyses confirmed increased AGE rates compared with community controls (IRR 4{middle dot}63 [95% CI: 4{middle dot}15-5{middle dot}17]) and hospitalised sepsis controls (IRR 1{middle dot}41 [95% CI 1{middle dot}21-1{middle dot}64]).

ConclusionsCOVID-19 hospitalisation is associated with a marked increase in AGE risk after discharge, exceeding that associated with sepsis hospitalisation. By contrast, lower AGE rates in community COVID-19 cases likely reflect baseline differences rather than protective effects of infection. Overall, these findings demonstrate heightened post-discharge vulnerability to gastrointestinal illness after COVID-19 hospitalisation and support the need for improved follow-up and surveillance strategies.

FundingNational Institute for Health Research
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.09.08.749933v1?rss=1">
<title>
<![CDATA[
PhenoMapR: scalable mapping of sample phenotypes to single-cell, spatial, and bulk transcriptomics data 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.09.08.749933v1?rss=1"
</link>
<dc:creator>Benard, B. A.</dc:creator>
<dc:creator>Lalgudi, C. K.</dc:creator>
<dc:creator>Azizi, A.</dc:creator>
<dc:creator>Gentles, A. J.</dc:creator>
<dc:date>2026-09-09</dc:date>
<dc:identifier>doi:10.64898/2026.09.08.749933</dc:identifier>
<dc:title><![CDATA[PhenoMapR: scalable mapping of sample phenotypes to single-cell, spatial, and bulk transcriptomics data]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-09</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Single-cell and spatial transcriptomic studies often lack sufficient sample size to compute robust statistical associations between a sample-level phenotype and cell types or spatial locations. In contrast, lower resolution methods such as bulk gene expression profiling have been applied at scale in large, annotated datasets, providing reliable signatures for phenotype associations. We introduce PhenoMapR, a semi-supervised method designed to integrate the phenotypic rigor of large-scale bulk expression studies with the cellular and spatial granularity of single-cell and spatial transcriptomics. PhenoMapR achieves this by deriving and mapping bulk gene expression signatures onto cells and spatial locations in a computationally efficient and scalable manner. The framework is broadly applicable across biological contexts, supporting the mapping of binary, continuous, and survival phenotypes derived from bulk expression studies across transcriptomic data modalities. This enables the identification of biologically-relevant cellular populations and spatial niches for experimental validation and therapeutic intervention.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.09.03.26362130v1?rss=1">
<title>
<![CDATA[
The impact of COVID-19 pandemic on health service utilization among patients with chronic non-communicable diseases in Ghana 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.09.03.26362130v1?rss=1"
</link>
<dc:creator>Tannor, E. K.</dc:creator>
<dc:creator>Newton, S.</dc:creator>
<dc:creator>Busse, R.</dc:creator>
<dc:creator>Gatorwu, S.</dc:creator>
<dc:creator>Safo, J. K.</dc:creator>
<dc:creator>Adjei, R.</dc:creator>
<dc:creator>Amuasi, J.</dc:creator>
<dc:creator>Quentin, W.</dc:creator>
<dc:date>2026-09-08</dc:date>
<dc:identifier>doi:10.64898/2026.09.03.26362130</dc:identifier>
<dc:title><![CDATA[The impact of COVID-19 pandemic on health service utilization among patients with chronic non-communicable diseases in Ghana]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-08</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundThe COVID-19 pandemic significantly disrupted health systems globally and in sub-Saharan Africa (SSA) leading to reduction of health service utilization (HSU). Patients with non- communicable diseases (NCDs) had increased morbidity and mortality during the COVID-19 pandemic. We sought to determine the changes and impact of the COVID-19 pandemic on HSU among patients with NCDs comparing an epicentre to a non-epicentre region in Ghana.

MethodsWe conducted a cross-sectional observational study of patients with NCD in the Ashanti and Northern regions in Ghana from 14th April 2024 to 31st July 2024. We distributed questionnaires to patients with NCD in selected facilities in the Northern and Ashanti regions of Ghana. The Andersens Behavioural Model was used as the conceptual framework to determine the factors affecting HSU. Multiple logistic regression was used to identify independent variables predicting reduction in HSU. P value of less than 0.05 was considered statistically significant.

ResultsThe study included 844 participants with NCDs equally sampled in the Ashanti and Northern regions of Ghana. The mean age of respondents was 61.4{+/-}11.6 years with 569(67%) females. Almost half 367 (43.5%) of all respondents reported COVID-19 led to a decrease in their HSU and over a third of respondents, 303(35.9%) missed their hospital appointments. The proportion of respondents reporting a decrease in HSU was significantly higher in the Northern region 276 (65.4%) than the Ashanti region 91 (21.6%), [p<0.001]. Reduction in HSU was associated with increasing age (aOR=0.97, 0.96 - 0.99, p<0.001), Northern region residence (aOR=9.60 CI 6.43 - 14.32, p<0.001), higher household income (aOR=1.36 CI 1.15-1.60, p<0.001), longer duration of NCD (aOR=1.03, CI 1.01 - 1.06, p=0.033) and possession of valid NHIS card (aOR=7.43, CI 2.44 - 22.57, p <0.001).

ConclusionThe COVID-19 pandemic led to reduction in HSU in Ghana. There was a significant reduction in NCDs in a non-epicentre region (Northern region) compared to the Ashanti region which was an epicenter region. Hence patients in non-epicentres should also be prioritized in pandemic situations.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.09.02.26362122v1?rss=1">
<title>
<![CDATA[
Early human capital, the COVID-19 food-insecurity shock, and adult mental health: a 22-year cohort study in Ethiopia, India, and Peru 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.09.02.26362122v1?rss=1"
</link>
<dc:creator>Diaz Flores, M. A.</dc:creator>
<dc:creator>Jimenez Rivera, W. M.</dc:creator>
<dc:creator>Pena Huaman, G. M.</dc:creator>
<dc:creator>Romero Molina, U.</dc:creator>
<dc:date>2026-09-08</dc:date>
<dc:identifier>doi:10.64898/2026.09.02.26362122</dc:identifier>
<dc:title><![CDATA[Early human capital, the COVID-19 food-insecurity shock, and adult mental health: a 22-year cohort study in Ethiopia, India, and Peru]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-08</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Mental disorders typically emerge before age 25, yet little is known about how childhood human capital and large economic shocks jointly shape mental health into adulthood in low-and middle-income countries (LMICs). We use seven rounds of the Young Lives study (2002-2024), which followed two birth cohorts in Ethiopia, India, Peru, and Vietnam, to examine (i) the long reach of early human capital, proxied by the height-for-age z-score in infancy; (ii) the medium-term association between household food insecurity during the COVID-19 pandemic and adult depressive (PHQ-8) and anxiety (GAD-7) symptoms measured at ages 22 and 29 in 2023-2024; and (iii) whether early human capital buffered the pandemic shock. We estimate value-added, latent-factor, dynamic panel, and mediation models with cluster-robust inference. Early height-for-age strongly predicts adult height (1.6 cm per standard deviation, p < 0.01) but not adult mental health or formal employment. Pandemic food insecurity predicts higher depressive (0.41 points, 0.12 standard deviations) and anxiety (0.41 points, 0.11 standard deviations) symptoms three to four years later (both p < 0.01); per step, the probability of clinically relevant anxiety (GAD-7 of 10 or more; base 7.6 percent) rises by 1.9 percentage points (p = 0.001) and of clinically relevant depression (PHQ-8 of 10 or more; base 5.6 percent) by 1.0 percentage point (p = 0.07). The gradient travels with the persistence of distress and of material hardship, is robust to attrition corrections and bounds, and its causal reading is explicitly bounded, since mental health was first measured during the pandemic itself. Exploratory analyses suggest the gradient differs across countries and may be larger in the older cohort, exposed at about age 26 rather than 19; these contrasts rest on few clusters and are not robust to multiple-comparison adjustment. Early human capital neither predicts adult mental health--a precise null of at most {+/-}0.03 standard deviations--nor moderates the gradient. Protecting household food security during aggregate shocks, especially for young adults, appears central to safeguarding mental health in LMICs.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.09.04.26362275v1?rss=1">
<title>
<![CDATA[
Association between ABO Blood Group and COVID-19 Pneumonia Severity: A Cross-Sectional Study from Ethiopia's First Designated COVID-19 Treatment Center 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.09.04.26362275v1?rss=1"
</link>
<dc:creator>Urgecha, E. B.</dc:creator>
<dc:creator>Tefera, F. A.</dc:creator>
<dc:creator>Alemu, Z. A.</dc:creator>
<dc:creator>Mekonen, S. T.</dc:creator>
<dc:creator>Orgecha, E. B.</dc:creator>
<dc:creator>Gidey, S. N.</dc:creator>
<dc:creator>Fissehatsion, F. A.</dc:creator>
<dc:date>2026-09-08</dc:date>
<dc:identifier>doi:10.64898/2026.09.04.26362275</dc:identifier>
<dc:title><![CDATA[Association between ABO Blood Group and COVID-19 Pneumonia Severity: A Cross-Sectional Study from Ethiopia's First Designated COVID-19 Treatment Center]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-08</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundCoronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, spreads rapidly and can cause severe acute respiratory failure; advanced age, chronic disease, and other comorbidities increase the risk of severe infection. By early 2022, more than 477 million cases and 6.11 million deaths had been reported globally. This study assessed the association between ABO blood group and severity of COVID-19 pneumonia among patients admitted to Eka Kotebe General Hospital, Addis Ababa, Ethiopia.

MethodsA hospital-based cross-sectional study was conducted using systematic random sampling; data were abstracted from patient records, and severity was modeled using ordinal logistic regression, with multicollinearity and the proportional odds assumption checked via the variance inflation factor and test of parallel lines, and model fit assessed by likelihood ratio chi-square and goodness-of-fit tests.

ResultsOf 355 patients included (100% response rate), 54.9% were male and 31.0% were older than 61 years (median age, 48 years; interquartile range, 33-65). Overall, 10.14% were asymptomatic, 24.79% had mild/moderate disease, 60.56% had severe disease, and 4.51% had critical disease. Pregnancy and presence of complications were significantly associated with severity (adjusted odds ratio, 0.15 [95% CI, 0.04-0.57] and 14.96 [95% CI, 4.14-54.01], respectively); ABO blood group showed no association with severity.

ConclusionThese findings demonstrate a substantial association between COVID-19 severity and complications and pregnancy, but not ABO blood group.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.09.04.26362260v1?rss=1">
<title>
<![CDATA[
Aggregation of mortality data by place and cause mask underlying trends in COVID-19 excess mortality 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.09.04.26362260v1?rss=1"
</link>
<dc:creator>Herdzik, K.</dc:creator>
<dc:creator>Sakrejda, K.</dc:creator>
<dc:creator>Wagner, A.</dc:creator>
<dc:creator>Zelner, J.</dc:creator>
<dc:date>2026-09-08</dc:date>
<dc:identifier>doi:10.64898/2026.09.04.26362260</dc:identifier>
<dc:title><![CDATA[Aggregation of mortality data by place and cause mask underlying trends in COVID-19 excess mortality]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-08</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Difficulties ascertaining the true burden of infection and mortality from SARS-CoV-2 hindered disease surveillance and healthcare resource allocation throughout the COVID-19 pandemic.

Although all-cause excess mortality estimates have long been deployed to avoid the challenges of case detection when testing availability is variable, aggregation of mortality by cause of death and spatial unit may mask underlying patterns and hide underlying associations with social factors. Furthermore, some non-infectious causes of death may have decreased during the pandemic, resulting in all-cause excess mortality capturing a net pandemic effect rather than the direct burden of Covid-19.

Using mortality data in the state of Michigan from January 2015 - November 2019, we calculated the expected mortality for December 2019 - November 2022 using negative binomial regression. Comparing these estimates to the observed mortality, we calculated the burden of excess mortality during the winter 2019 influenza season and COVID-19 pandemic, as divided into 7 distinct periods based on dominant viral strain and pharmaceutical and non-pharmaceutical interventions implemented. All analyses were performed with the data aggregated by cause of death and to the county level and repeated at both the county and census tract level disaggregated into two crude cause of death categories: acute respiratory infections (ARIs) and all other causes (non-acute respiratory infections, non-ARIs). We examined spatial heterogeneity of excess mortality by cause using the Theil index to determine if variation in excess mortality was driven by differences between or within counties.

The excess mortality rate from ARI peaked in the first phase of the pandemic, with a ratio of 10.7 observed to expected deaths (95% CrI: 10.3 - 11.1). However, the all- cause excess mortality rate rose only to 1.20 excess deaths per expected (95% CrI: 1.17 - 1.22) and the non- ARI excess mortality rate was unchanged. Comparing ARI excess mortality rates calculated at the county vs. census tract level demonstrated large and unpredictable variation, with county level estimates ranging from 0.42 to 1.2 times the tract level estimates. However, county level estimates of non-ARI and all- cause excess mortality ratios were consistently closer to tract level estimates. Within county variation of ARI mortality decreased during the pandemic and slowly returned to reference levels, suggesting spatial patterning of ARI mortality became more similar across census tracts as rates rose statewide. Social vulnerability was associated with an increased ARI excess mortality rate ratio at the census tract level during the first pandemic phase (EMRR: 1.1, 95% CrI: 1.08 - 1.13), but this effect was attenuated when aggregated to all-cause mortality or to the county level.

Our findings indicate that using county-level all-cause excess mortality as a proxy for ARI excess mortality obscured the burden of ARI death, particularly during the most acute phases of the COVID-19 pandemic. Relying on aggregated metric of all-cause mortality limits the power to detect large shifts in cause-specific mortality, and that limitation can be mitigated by even using coarse categories such as ARI vs. non-ARI deaths. Similarly, finer scale spatial units allow for the detection of local trends necessary to identify associated social factors.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.09.06.26362399v1?rss=1">
<title>
<![CDATA[
Using large language models to facilitate literature review and data extraction for infectious disease models: COVID-19 as a test case 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.09.06.26362399v1?rss=1"
</link>
<dc:creator>Yang, X.</dc:creator>
<dc:creator>Lee, C. Y.</dc:creator>
<dc:creator>Quilty, B. J.</dc:creator>
<dc:creator>Zhang, L.</dc:creator>
<dc:creator>Mu, Y.</dc:creator>
<dc:creator>Jit, M.</dc:creator>
<dc:date>2026-09-08</dc:date>
<dc:identifier>doi:10.64898/2026.09.06.26362399</dc:identifier>
<dc:title><![CDATA[Using large language models to facilitate literature review and data extraction for infectious disease models: COVID-19 as a test case]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-08</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Infectious disease transmission models are governed by parameters informed by systematic review of epidemiological literature. Large language models (LLMs) could facilitate this, but the reliability of the results to inform models has not been tested.

We built an open-source, end-to-end pipeline to simulate LLM performance in a hypothetical scenario where they were available to inform COVID-19 models developed during the first four months of 2020. It screened articles and extracted the reproduction number, serial interval, and incubation period from full-text PDFs. We applied it to 2,067 PubMed/medRxiv records published 31 December 2019-30 April 2020 using four models (GPT-5-mini, GPT-5.4, Claude Opus 4.8 and Gemini 2.5 Pro) and evaluated it against full-corpus human screening and 50-article extraction gold standards. We combined models post hoc, pooled the extracted values into an infectious disease (SEIR) model, and ran sensitivity analyses to test approaches to improve extraction accuracy.

Screening sensitivity was 0.72-0.95 and specificity 0.92-0.99. For articles reporting few values, extraction F1 was 0.90-0.96 with precision 0.91-1.00; across all articles, including those with dozens of stratified estimates, recall fell to 0.38-0.78. No fabricated values observed; errors were misassignments of values filed under the wrong parameter, or borrowed values treated as the studys own. Incomplete extraction from dense articles was mainly due to prompting and output format, not model capability. Ensembling allowed recall-precision trade-offs, and correctness increased with model agreement, from about 30% at one vote to 92-95% at four. The pipeline processed the corpus in hours versus an estimated 130-265 person-hours of manual effort.

Our results show that current models can extract transmission parameters from unstructured literature accurately enough to inform outbreak modelling. The bottleneck lies in task specification, and careful prompt and output schema design are key to reducing misassignment errors. Human effort is best directed at workflow development and provenance validation.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.09.07.26362459v1?rss=1">
<title>
<![CDATA[
Ensemble SHAP Aggregation and Attribution Variability in Clinical Machine Learning: A COVID-19 Mortality Study 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.09.07.26362459v1?rss=1"
</link>
<dc:creator>Dai, N.</dc:creator>
<dc:creator>Briceno, R. K.</dc:creator>
<dc:creator>Castaneda, A. N.</dc:creator>
<dc:creator>Tresierra, M. A.</dc:creator>
<dc:creator>Esteban, M. L.</dc:creator>
<dc:creator>Rosas, M. E.</dc:creator>
<dc:creator>Hinojosa, R. C.</dc:creator>
<dc:date>2026-09-08</dc:date>
<dc:identifier>doi:10.64898/2026.09.07.26362459</dc:identifier>
<dc:title><![CDATA[Ensemble SHAP Aggregation and Attribution Variability in Clinical Machine Learning: A COVID-19 Mortality Study]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-08</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
ObjectiveTo combine performance-weighted ensemble SHAP aggregation with resampling-based assessment of feature-importance variability and patient-level attribution alignment for interpreting COVID-19 mortality predictions.

MethodsWe analyzed a prospective cohort of 1,857 patients hospitalized with COVID-19 at two hospitals in Peru. Ten predictive algorithms were evaluated using five-fold cross-validation, and their mean AUROC values determined their attribution-aggregation weights. Within each model and training trial, signed SHAP values were normalized by the mean total absolute attribution across evaluation patients before performance-weighted aggregation. Feature importance was summarized across 30 resampled training trials using means and normal-approximation 95% confidence intervals. Patient-level attribution alignment was assessed using cosine similarity between signed feature-attribution vectors for corresponding patients, with whole-trial patient-correspondence randomization and Benjamini-Hochberg correction. Subgroup observations were reweighted toward the evaluated populations feature distributions for secondary comparisons of existing absolute SHAP values.

ResultsAmong the 1,857 included patients, 982 (52.9%) died during hospitalization. Random forest achieved the highest mean AUROC (0.925 {+/-} 0.010), followed by AdaBoost (0.919 {+/-} 0.017) and logistic regression (0.918 {+/-} 0.007), with variability reported as the SEM. Attribution profiles were more similar across repeated training trials of the same algorithm (mean Pearson r = 0.783; SEM, 0.004) than across algorithms within the same trial (mean Pearson r = 0.369; SEM, 0.006). The largest normalized attribution magnitudes were observed for dexamethasone use at home without oxygen support (6.186%; 95% CI, 5.795-6.577), PaO2/FiO2 ratio (3.014%; 95% CI, 2.787-3.242), shortness of breath (2.774%; 95% CI, 2.592-2.956), and FiO2 (2.560%; 95% CI, 2.284-2.836). Features differed in patient-level attribution alignment, indicating that importance magnitude and robustness provided complementary information. Among 1,763 eligible subgroup-feature comparisons, 64 had nominal one-sided p < 0.05, although none remained below 0.05 after Benjamini-Hochberg adjustment.

ConclusionsAlgorithms with similar predictive performance produced substantially different feature-attribution profiles. Normalized performance-weighted SHAP aggregation provided a representative relative-importance summary across algorithms, while resampling-based alignment assessment qualified the consistency of individual feature contributions. The resulting attribution patterns describe fitted-model behavior and should not be interpreted as causal clinical effects.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.09.07.26362431v1?rss=1">
<title>
<![CDATA[
Neural characterisation of persistent quantitative and qualitative COVID-19-related olfactory dysfunction: The COVORTS study 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.09.07.26362431v1?rss=1"
</link>
<dc:creator>Dijk, B. v.</dc:creator>
<dc:creator>Postma, E. M.</dc:creator>
<dc:creator>Leenders, L. M.</dc:creator>
<dc:creator>Smits, P.</dc:creator>
<dc:creator>Kamalski, D. M. A.</dc:creator>
<dc:creator>Smeets, P. A. M.</dc:creator>
<dc:creator>Boesveldt, S.</dc:creator>
<dc:date>2026-09-08</dc:date>
<dc:identifier>doi:10.64898/2026.09.07.26362431</dc:identifier>
<dc:title><![CDATA[Neural characterisation of persistent quantitative and qualitative COVID-19-related olfactory dysfunction: The COVORTS study]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-08</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The mechanism underlying persistent COVID-19-related olfactory dysfunction (OD) remains unknown. There are indications for both peripheral (within the nose) and central (in the brain) mechanisms. Patients can experience a decrease in olfactory ability (quantitative OD) or a distorted odour perception (qualitative OD). The mechanisms might differ between these two symptom presentations. In this (f)MRI study, we investigated structural and functional brain alterations in patients with persistent (> 1 month) quantitative OD (Sniffin Sticks score < 30.75, n=21) or parosmia (self-reported, n=27) following SARS-CoV-2 infection, aged 19-60 years and, on average, included 472 days after diagnosis (the COVORTS study). Additionally, a control group of 49 normosmic subjects aged 22-60 years was included. Olfactory bulb volume (OBV) was determined by manual segmentation; whole-brain and regional grey matter density (GMD) of olfactory-related areas was assessed using voxel-based morphometry; and odour-induced brain activation was examined with an olfactory fMRI task. When grouped together, patients with OD had a smaller OBV than controls (84.4 vs 95.3 mm3, p=0.026). The two patient groups did not differ in OBV. ROI analysis of olfactory-related brain regions at an exploratory threshold showed lower GMD in primary and secondary olfactory regions in patients compared to controls, which appears to be mainly driven by quantitative OD. No difference in odour-induced brain activation was found. The observed smaller olfactory bulbs, along with modest findings beyond this primary olfactory structure, provide important insights into potential mechanisms of persistent COVID-19-related OD and highlight the need for longer follow-up to evaluate further neural degradation or recovery.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.09.04.26361413v1?rss=1">
<title>
<![CDATA[
Clinical Phenotypes of Post-Acute Sequelae of SARS-CoV-2 (PASC) Infection: A Longitudinal Cohort Study from Karachi, Pakistan 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.09.04.26361413v1?rss=1"
</link>
<dc:creator>Khanum, I.</dc:creator>
<dc:creator>Ahmed, K.</dc:creator>
<dc:creator>Munir, T.</dc:creator>
<dc:creator>Zia, H.</dc:creator>
<dc:creator>Saif, W.</dc:creator>
<dc:creator>Sadia, H.</dc:creator>
<dc:creator>Mahmood, S. F.</dc:creator>
<dc:creator>Nasir, N.</dc:creator>
<dc:creator>Ghias, K.</dc:creator>
<dc:creator>Rabinowitz, P.</dc:creator>
<dc:creator>Van Voorhis, W.</dc:creator>
<dc:creator>Iqbal, N. T. T.</dc:creator>
<dc:date>2026-09-08</dc:date>
<dc:identifier>doi:10.64898/2026.09.04.26361413</dc:identifier>
<dc:title><![CDATA[Clinical Phenotypes of Post-Acute Sequelae of SARS-CoV-2 (PASC) Infection: A Longitudinal Cohort Study from Karachi, Pakistan]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-08</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Post-Acute Sequelae of SARS-CoV-2 infection (PASC), commonly referred to as Long COVID, is increasingly recognized as a significant public health concern. However, longitudinal studies examining its clinical course remain limited in South Asia, and the true burden of persistent symptoms in Pakistan is not well established. This study aimed to characterize the long-term clinical manifestations of PASC and investigate the relationship between symptom persistence, faecal viral shedding, and serotonin levels over a one-year follow-up period.

We conducted a prospective longitudinal study involving individuals diagnosed with PASC (n=60). Participants underwent serial assessments for clinical symptoms, stool SARS-CoV-2 RNA detection, and serotonin measurements in platelets rich plasma at multiple time points over 12 months. A symptom score was developed using 22 symptoms reported by more than 30% of participants.

Among the study population, 60% were female, with a mean age of 42.1 {+/-} 12.1 years. Two-thirds (66%) were overweight or obese, and 28.3% reported multiple SARS-CoV-2 reinfections. Longitudinal analysis demonstrated a significant reduction in overall symptom burden at 9 months ({beta} = -2.68, 95% CI: -3.81 to -1.55; p < 0.001) and 12 months ({beta} = -3.00, 95% CI: -4.13 to -1.87; p < 0.001) compared with baseline. Despite this overall improvement, several symptoms persisted throughout follow-up. The prevalence of myalgia remained largely unchanged (60% at baseline vs. 63% at 12 months), while musculoskeletal symptoms persisted at similar levels (59% vs. 60%). Neurocognitive symptoms declined from 40% to 31.3%, whereas psychological symptoms increased slightly from 40% to 45.8% over the study period.

Faecal viral shedding was detected in 56.7% of participants and demonstrated both intermittent and persistent patterns. Although no association was observed between faecal shedding and symptoms at baseline, significant associations emerged at six months, particularly for breathlessness, fatigue, weakness (77.8%), and joint pain (88.9%). Serotonin levels remained broadly comparable to those reported during acute COVID-19 infection.

These findings highlight the prolonged nature of PASC, with persistent symptoms such as myalgia, joint pain, weakness, and fatigue continuing for at least one year after infection. The persistence of symptoms, together with evidence of ongoing faecal viral shedding, suggests that viral persistence and sustained physiological disturbances may contribute to the long-term pathogenesis of Long COVID in a subset of affected individuals.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.09.06.26362366v1?rss=1">
<title>
<![CDATA[
The COVID-19 Trajectory in Israel: A Comprehensive Analysis of National Surveillance Data on Documented Infections, Test Positivity, and Vaccine-Effectiveness Estimates 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.09.06.26362366v1?rss=1"
</link>
<dc:creator>Ophir, Y.</dc:creator>
<dc:creator>Sevillya, G.</dc:creator>
<dc:date>2026-09-08</dc:date>
<dc:identifier>doi:10.64898/2026.09.06.26362366</dc:identifier>
<dc:title><![CDATA[The COVID-19 Trajectory in Israel: A Comprehensive Analysis of National Surveillance Data on Documented Infections, Test Positivity, and Vaccine-Effectiveness Estimates]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-08</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundIsrael was among the first countries to implement nationwide BNT162b2 vaccination and became an important source of real-world evidence during the COVID-19 pandemic. The present study aimed to characterize the long-term national epidemic trajectory and the evolution of vaccination-associated differences in documented infection across the course of the pandemic.

MethodsFive Israeli Ministry of Health datasets were analyzed from February 2020 through May 2023. National trends in documented infection and test positivity were characterized. Vaccinated- unvaccinated differences were examined using routine-surveillance case rates. To reduce potential bias from differences in prior-infection history and real-world testing intensity, a second age-adjusted analysis compared test positivity among individuals without documented prior infection.

ResultsThe two completed pre-rollout waves declined to [&le;]10% of their peaks within 32 and 43 days, whereas the winter 2020-2021 wave, already underway when vaccination began, required 68 days. Delta and Omicron peaks were 17% and approximately ninefold higher than the January 2021 peak. Routine-surveillance apparent vaccine effectiveness peaked at 94.4% in February 2021, declined to 61.5% by late May, and remained negative from February 2022 onward. The age-adjusted test-positivity analysis among individuals without documented prior infection yielded generally lower estimates, which remained negative from December 2021 onward.

ConclusionsOverall, the early vaccination-associated advantage against documented infection was not stable over extended follow-up. While these observational findings cannot establish causal vaccine effects or address severe outcomes, they underscore the importance of evaluating vaccine-effectiveness estimates over extended follow-up as population immunity, testing practices, and viral variants evolve.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.09.04.749277v1?rss=1">
<title>
<![CDATA[
Allosteric remodelling of the Ebola virus glycoprotein underlies differences in entry mechanisms across species 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.09.04.749277v1?rss=1"
</link>
<dc:creator>Calvaresi, V.</dc:creator>
<dc:creator>Kratochvil, J.</dc:creator>
<dc:creator>Bekauri, A.</dc:creator>
<dc:creator>Kukura, P.</dc:creator>
<dc:creator>Struwe, W. B.</dc:creator>
<dc:date>2026-09-08</dc:date>
<dc:identifier>doi:10.64898/2026.09.04.749277</dc:identifier>
<dc:title><![CDATA[Allosteric remodelling of the Ebola virus glycoprotein underlies differences in entry mechanisms across species]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-08</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
During Ebolavirus transit through the endo-lysosomal pathway, the glycoprotein GP undergoes a series of conformational rearrangements upon cathepsin cleavage and NPC1 receptor binding, culminating in host-virus membrane fusion. While these rearrangements underpin viral entry, their molecular mechanisms remain poorly understood. Here, we combine hydrogen/deuterium-exchange mass spectrometry and mass photometry to resolve structural dynamic and energetic transitions of GP of two major species, Zaire (EBOV) and Sudan (SUDV). We describe the allosteric axes that govern reorganization of the cleavage sites, opening of the receptor binding cavity and priming for fusion upon NPC1 engagement. We show that GP cathepsin cleavage and receptor binding exhibit different mechanisms and kinetics across species, and are allosterically coupled in a species-specific manner. We reveal that fusion priming is optimized via distinct routes in EBOV and SUDV GP. These data suggest that GP structural dynamics and allosteric remodelling underlie differences in entry mechanisms across Ebolavirus species.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.09.03.749134v1?rss=1">
<title>
<![CDATA[
Variant-specific nucleocapsid mutations shape host innate immune trajectories during SARS-CoV-2 infection 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.09.03.749134v1?rss=1"
</link>
<dc:creator>Berger, J. M.</dc:creator>
<dc:creator>Schroeder, J. M.</dc:creator>
<dc:creator>Soh, T. K.</dc:creator>
<dc:creator>Pekarek, N.</dc:creator>
<dc:creator>Breul, L.-M.</dc:creator>
<dc:creator>Doerner, S.</dc:creator>
<dc:creator>Bluemke, P.</dc:creator>
<dc:creator>Huang, J.</dc:creator>
<dc:creator>Bosse, J. B.</dc:creator>
<dc:creator>Pfefferle, S.</dc:creator>
<dc:creator>Uetrecht, C.</dc:creator>
<dc:date>2026-09-08</dc:date>
<dc:identifier>doi:10.64898/2026.09.03.749134</dc:identifier>
<dc:title><![CDATA[Variant-specific nucleocapsid mutations shape host innate immune trajectories during SARS-CoV-2 infection]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-08</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The SARS-CoV-2 nucleocapsid (N) protein is one of the most highly expressed proteins during infection and plays crucial roles in the protection and packaging of viral RNA, replication, suppression of the immune response and virus assembly. The N gene and the overlapping accessory open reading frame ORF9b have continually evolved throughout the circulation of the virus, likely due to ongoing adaptation to the human host. This genetic variability influences the interplay of the N protein and its interactors. Yet, little is known about how specific mutations within the N/ORF9b locus of Variants of Concern (VOCs) shape the progression and outcome of infection. Here, we use a multi-omics approach to decipher how these genetic alterations reprogram the host cell by creating Wuhan-Hu-1-based recombinant viruses carrying an isogenic backbone with respective N mutations from the VOCs (called rNs) and comparing their effects at the transcriptome and proteome levels. We found that the mutations induce distinct transcriptional and translational alterations: rN-Alpha drives a stealth-like infection characterized by sustained translation efficiency and specific evasion of the 2'-5'-oligoadenylate synthetase (OAS) innate immune sensor, whereas rN-Delta and rN-BA.2 trigger a highly elevated inflammatory response. For rN-Delta, hyperphosphorylation of the N-protein drives cellular stress culminating in necroptotic cell death. Because these viruses differ only within the N/ORF9b locus, N sequence variation emerges as a determinant of infection outcome in its own right, warranting increased surveillance attention.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.09.06.749687v1?rss=1">
<title>
<![CDATA[
MutCleaner: Cleaning and Standardizing Biological Mutation Datasets for Variant Effect Prediction 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.09.06.749687v1?rss=1"
</link>
<dc:creator>Shi, Z.</dc:creator>
<dc:creator>Tang, Y.</dc:creator>
<dc:creator>Yang, M.</dc:creator>
<dc:creator>Yu, S.</dc:creator>
<dc:creator>Shi, Y.</dc:creator>
<dc:creator>Xu, Y.</dc:creator>
<dc:date>2026-09-08</dc:date>
<dc:identifier>doi:10.64898/2026.09.06.749687</dc:identifier>
<dc:title><![CDATA[MutCleaner: Cleaning and Standardizing Biological Mutation Datasets for Variant Effect Prediction]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-08</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Summary: Protein mutation datasets are widely used in variant effect prediction and protein engineering, but datasets from different sources often lack consistent conventions for mutation representation, sequence representation, data organization, and experimental labels, making these resources difficult to integrate directly and limiting their use in downstream analyses and modeling. MutCleaner is an extensible Python framework that cleans, validates, and standardizes protein- and codon-level mutation datasets through composable cleaning pipelines, unified sequence and mutation data structures, and dataset-specific cleaners. It provides standardized resources covering 16 protein and codon mutation datasets with more than 12.14 million mutation records. Availability and implementation: MutCleaner is an open-source Python package released under the Apache License 2.0. The source code is available on https://github.com/xulab-research/MutCleaner, the package is distributed through https://pypi.org/project/mutcleaner/, and the documentation is available https://xulab-research.github.io/MutCleaner/.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.09.07.749793v1?rss=1">
<title>
<![CDATA[
Experimental validation of computationally prioritized bisphosphonates reveals no direct in vitro antiviral activity against SARS-CoV-2 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.09.07.749793v1?rss=1"
</link>
<dc:creator>Rehman, M. M.-U.-</dc:creator>
<dc:creator>Olliff, S.</dc:creator>
<dc:creator>McAuley, A.</dc:creator>
<dc:creator>Awasthi, A.</dc:creator>
<dc:creator>Chandrasekhar, K. V. G.</dc:creator>
<dc:creator>Sankranarayanan, M.</dc:creator>
<dc:creator>Vasan, S. S.</dc:creator>
<dc:date>2026-09-08</dc:date>
<dc:identifier>doi:10.64898/2026.09.07.749793</dc:identifier>
<dc:title><![CDATA[Experimental validation of computationally prioritized bisphosphonates reveals no direct in vitro antiviral activity against SARS-CoV-2]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-08</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
It is essential to experimentally evaluate antiviral efficacy predicted by molecular docking and related in silico approaches, which this study achieves for three bisphosphonates (alendronate, minodronate, zoledronate) and treprostinil, identified as potential antiviral therapies in our previous work. These investigational compounds had no detectable cytotoxicity at concentrations up to 25M in Vero E6 cells but also failed to show any antiviral effect against the PQ.8.1 isolate of SARS-CoV-2, when compared to control drugs (ensitrelvir, nirmatrelvir, and remdesivir). It appears that for bisphosphonates, any protective effect is likely due to other virus- or host-mediated mechanisms of action. This study demonstrates the importance of iterating between theoretical hypotheses and experiments to elucidate underlying mechanisms at play.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.09.04.749507v1?rss=1">
<title>
<![CDATA[
Ebola virus mRNAs contain RNA structures that are critical for viral infection and targetable by antisense oligonucleotides 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.09.04.749507v1?rss=1"
</link>
<dc:creator>Luo, M.</dc:creator>
<dc:creator>Olejnik, J.</dc:creator>
<dc:creator>Meier, K.</dc:creator>
<dc:creator>Hann, T.</dc:creator>
<dc:creator>Muhlberger, E.</dc:creator>
<dc:creator>Pyle, A. M.</dc:creator>
<dc:date>2026-09-08</dc:date>
<dc:identifier>doi:10.64898/2026.09.04.749507</dc:identifier>
<dc:title><![CDATA[Ebola virus mRNAs contain RNA structures that are critical for viral infection and targetable by antisense oligonucleotides]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-08</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Filoviruses, such as Ebola virus (EBOV), are highly pathogenic non-segmented negative-sense RNA viruses (nsNSVs) with limited therapeutic options. Filovirus RNA structures remain largely untapped due to the enhanced biosafety requirements for handling infectious virus. Here, we present the first in-cell secondary structure maps of four EBOV mRNAs (VP35, VP40, VP30, and VP24) using two orthogonal chemical probing approaches: SHAPE-MaP and fbDMS-MaP. We find that EBOV mRNA coding sequences (CDS) are highly structured, much like +ssRNA viruses, whereas untranslated regions (UTRs) are significantly less structured. This suggests that high CDS structure contents are general features of viral translation templates, and that nsNSVs have evolved separate regulatory function at the RNA structure level that extends beyond using distinct mRNAs and genomes. These structure maps are consistent with formation of mRNA 5' hairpin structures during infection and reveal numerous additional RNA structures within the CDS, 3' UTRs, and at CDS-UTR junctions. To assess functionality, we disrupted these structures with locked nucleic acid (LNA) antisense oligonucleotides. Disrupting the TSS hairpins in VP35, VP30, and VP24 decreased infection by >60%, indicating these mRNA structures are critical for infection. LNA targeting of the newly identified structures reduced EBOV infection by 31% to 88%, thereby linking RNA structural integrity to viral function. Synonymous mutation rates and covariation analysis provided evolutionary support across mammalian filoviruses for the functional RNA elements observed. Collectively, these results demonstrate EBOV mRNAs contain numerous conserved RNA motifs contributing to viral infection, and that these elements represent promising targets for development of pan-filoviral therapeutics.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.09.03.749172v1?rss=1">
<title>
<![CDATA[
Increased receptor binding capability of the SARS-CoV-2 saltational variant PJ.2.1 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.09.03.749172v1?rss=1"
</link>
<dc:creator>He, P.</dc:creator>
<dc:creator>Li, B.</dc:creator>
<dc:creator>Guo, C.</dc:creator>
<dc:creator>Yu, L.</dc:creator>
<dc:creator>Yu, Y.</dc:creator>
<dc:creator>Jian, F.</dc:creator>
<dc:creator>Shao, F.</dc:creator>
<dc:creator>Cao, Y.</dc:creator>
<dc:date>2026-09-08</dc:date>
<dc:identifier>doi:10.64898/2026.09.03.749172</dc:identifier>
<dc:title><![CDATA[Increased receptor binding capability of the SARS-CoV-2 saltational variant PJ.2.1]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-08</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The recently identified SARS-CoV-2 saltational variant PJ.2.1, a highly mutated descendant of MC.10.1, has achieved rapid intercontinental spread since its detection in May 2026. Here, we show that PJ.2.1 exhibits exceptionally high human ACE2-binding capability, significantly outperforming contemporary variants such as NB.1.8.1, XFG, and BA.3.2.2. However, despite acquiring over 25 spike mutations, PJ.2.1 remains antigenically similar to the circulating JN.1 family and does not display strong humoral immune evasion. Neutralization profiling indicates that PJ.2.1 possesses heightened neutralization sensitivity to human plasma and RBD-targeting antibodies, especially against cryptic-site-targeting class 4 and class 5 antibodies. This distinct sensitivity profile strongly suggests an altered spike structural dynamic that favors a receptor-accessible "up" conformation. While PJ.2.1 currently lacks the extreme immune evasion capabilities of other contemporary strains, its robust baseline receptor binding strength mirrors the early evolutionary trajectory of BA.2.86 to JN.1. This high receptor binding affinity provides a structural buffer that could facilitate the rapid acquisition of potent immune-evasive mutations, necessitating continued genomic, epidemiological, and virological surveillance of PJ.2.1.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.09.07.749787v1?rss=1">
<title>
<![CDATA[
Interferon redundancy counteracts proteolytic inactivation by SARS-CoV-2 3CL main protease 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.09.07.749787v1?rss=1"
</link>
<dc:creator>Grin, P. M.</dc:creator>
<dc:creator>de Jesus, H. C. R.</dc:creator>
<dc:creator>Pablos, I.</dc:creator>
<dc:creator>Kappelhoff, R.</dc:creator>
<dc:creator>Butler, G. S.</dc:creator>
<dc:creator>Charaf, B.</dc:creator>
<dc:creator>Overall, C. M.</dc:creator>
<dc:date>2026-09-08</dc:date>
<dc:identifier>doi:10.64898/2026.09.07.749787</dc:identifier>
<dc:title><![CDATA[Interferon redundancy counteracts proteolytic inactivation by SARS-CoV-2 3CL main protease]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-08</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Interferons (IFNs) are secreted during virus infection and induce antiviral responses through receptor-mediated phosphorylation of signal transducer and activator of transcription (STAT) proteins, leading to IFN-stimulated gene expression with antiviral activity. We previously reported that the SARS-CoV-2 main protease, 3CLpro, is secreted from infected cells through gasdermin D/E pores and retains proteolytic activity in human serum against extracellular substrates. Here, we show that 3CLpro selectively cleaves glycosylated IFN-L1, IFN-L2, and a rare naturally occurring variant of IFN-{gamma} (Arg160Gln), but does not cleave wild-type IFN-{gamma}, IFN-L3, IFN-L4, IFN-alpha proteins or IFN-{beta}. We identified sites of O-linked glycosylation of IFN-L1 at Thr137 and one or more threonines or serine in the sequence 24TSKPTTT30, and N-linked glycosylation at Asn65 that were indispensable for signaling. Unexpectedly, O-glycosylation was also required for the cleavage and inactivation of IFN-L1 by 3CLpro at two sites. Cleavage reduced STAT1 phosphorylation and impaired the induction of the IFN-stimulated proteins MX1, OAS2, and IFIT1. Although 3CLpro cleaved IFN-L2 proximal to its N-terminus at ARLH32{downarrow}GALP, cleavage neither disrupted signaling nor antiviral activity against SARS-CoV-2 and vesicular stomatitis virus. We further show that matrix metalloproteinases (MMPs) 2, 7, 8, and 12 degrade 3CLpro, whereas 3CLpro shows no activity against these MMPs.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.09.02.26362081v1?rss=1">
<title>
<![CDATA[
Laemple: A Benchmarking Framework for Virus Lineage Deconvolution Tools for SARS-CoV-2 from Wastewater 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.09.02.26362081v1?rss=1"
</link>
<dc:creator>Schedl, A.</dc:creator>
<dc:creator>Bergthaler, A.</dc:creator>
<dc:creator>Amman, F.</dc:creator>
<dc:date>2026-09-07</dc:date>
<dc:identifier>doi:10.64898/2026.09.02.26362081</dc:identifier>
<dc:title><![CDATA[Laemple: A Benchmarking Framework for Virus Lineage Deconvolution Tools for SARS-CoV-2 from Wastewater]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-07</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
1BackgroundCorrect and accurate deconvolution of SARS-CoV-2 lineages from wastewater sequencing data is a challenging task, given the intricacy of wastewater amplicon-sequencing data and the ever-growing complexity of the lineage classification. Existing benchmarking studies made use of artificial spike-in compositions, thereby falling short of reflecting the prevailing complexity of wastewater samples.

ResultsWe present a modular, expandable, simulation-based benchmarking framework as a reproducible Snakemake workflow, named Laemple, to evaluate the performance of virus lineage deconvolution tools. Using in silico simulated data sets of varying complexity and sequencing quality, we demonstrate its utility by evaluating seven publicly available tools, based on their precision, sensitivity, and reproducibility. Freyja showed robust sensitivity and consistent performance across diverse data set complexities, alongside user-friendly installation and documentation, while VaQuERo demonstrated the highest precision.

ConclusionsOur results reveal substantial variation in tool performance across conditions, emphasizing the need to benchmark with diverse and complex scenarios. This framework enables informed tool selection for researchers and public health agencies and allows developers to stress-test their tools during development and maintenance, i.e., updating the lineage definition for newly emerging virus lineages. To this end, Laemple was designed in a modular fashion for customization and future expansion to support ongoing software development across all stages of the application life-cycle management.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.09.02.748812v1?rss=1">
<title>
<![CDATA[
Allergic airway inflammation protects against SARS-CoV-2 and MERS-CoV disease but promotes fatal SARS-CoV-1 immunopathology 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.09.02.748812v1?rss=1"
</link>
<dc:creator>Ardanuy, J.</dc:creator>
<dc:creator>Garrett, G.</dc:creator>
<dc:creator>Dillen, C.</dc:creator>
<dc:creator>Liu, M.</dc:creator>
<dc:creator>Taylor, L.</dc:creator>
<dc:creator>Keegan, A.</dc:creator>
<dc:creator>Diamond, M.</dc:creator>
<dc:creator>Frieman, M.</dc:creator>
<dc:date>2026-09-07</dc:date>
<dc:identifier>doi:10.64898/2026.09.02.748812</dc:identifier>
<dc:title><![CDATA[Allergic airway inflammation protects against SARS-CoV-2 and MERS-CoV disease but promotes fatal SARS-CoV-1 immunopathology]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-07</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Epidemiological, clinical, and experimental data suggest that allergic asthma may have protective effects against severe Coronavirus Disease 2019 (COVID-19) but are often conflicting between different models of infection and epidemiological analyses. Allergic asthma is characterized by type 2 (T2) inflammation, mucus hypersecretion, and airway remodeling. We used a house dust mite (HDM) respiratory exposure model to determine how preexisting allergic inflammation alters the pathogenesis of three highly pathogenic coronaviruses, SARS-CoV-1, SARS-CoV-2, and MERS-CoV. HDM treatment induced canonical features of allergic asthma, including goblet cell hyperplasia, mucin hypersecretion, eosinophil recruitment, M2 macrophage polarization, and induction of IL-13. Across multiple SARS-CoV-2 variants, HDM treated mice exhibited reduced viral titers, less weight loss, diminished lung immunopathology, and improved survival rates. Similar protection was observed in a mouse model of MERS-CoV, with reduced lethality, lower viral burden, and blunted cytokine storm signatures in HDM treated mice. In contrast, allergic airway inflammation exacerbated SARS-CoV-1 pathogenesis, as HDM-treated mice developed fulminant alveolar inflammation, severe weight loss, elevated pro-inflammatory cytokines and chemokines, and increased mortality despite having reduced virus titer. Thus, in mice, allergic airway inflammation exerts opposing virus specific effects on coronavirus pathogenesis. These results reconcile conflicting epidemiological and mechanistic studies across coronavirus epidemics and highlight the need to consider host allergic status as a key variable influencing disease outcome from emerging coronaviruses.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.09.02.26361948v1?rss=1">
<title>
<![CDATA[
Surgical Critical Care Outcomes Before and After the Onset of the COVID-19 Pandemic: A Single-Center Retrospective Comparative Audit 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.09.02.26361948v1?rss=1"
</link>
<dc:creator>Ali, S. M. H.</dc:creator>
<dc:creator>Yasin, U.</dc:creator>
<dc:creator>Ather, O.</dc:creator>
<dc:creator>Malik, A.</dc:creator>
<dc:date>2026-09-06</dc:date>
<dc:identifier>doi:10.64898/2026.09.02.26361948</dc:identifier>
<dc:title><![CDATA[Surgical Critical Care Outcomes Before and After the Onset of the COVID-19 Pandemic: A Single-Center Retrospective Comparative Audit]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-06</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
This audit aimed to determine whether the pattern of presenting abdominal pathology, procedures performed, and clinical outcomes in our surgical intensive care unit (SICU) changed during the COVID-19 period. We reviewed a total of 356 patients who were admitted to the SICU with 1st March 2020 taken as the reference cutoff date. Two hundred and five (57.6%) cases occurred in the Pre-COVID interval and 151 (42.4%) in the Post-COVID interval. Patients admitted to SICU Post-COVID were significantly older than those admitted Pre-COVID (54.2 vs. 48.3 years, p = 0.005). Hospital and SICU length of stay were unchanged across the pandemic (p = 0.824 and 0.601 respectively). The procedure case-mix shifted significantly (p = 0.014): appendectomy, gastrectomy/sleeve gastrectomy and thoracic procedures fell, while exploratory laparotomy rose, consistent with reduced elective/minimally-invasive activity and a shift toward emergency open surgery. Appendiceal disease was recorded significantly less often as the presenting diagnosis Post-COVID (p = 0.016), and intestinal obstruction showed a non-significant upward trend (p = 0.071). SICU mortality and overall admission outcome were unchanged across the pandemic (p = 1.000 and 0.664).
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.09.01.747870v1?rss=1">
<title>
<![CDATA[
The orphan receptor IL-17RD is a negative regulator of RIG-I-like receptor-dependent antiviral innate immunity and restrains SARS-CoV-2-induced lung inflammation 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.09.01.747870v1?rss=1"
</link>
<dc:creator>El-Mortada, F.</dc:creator>
<dc:creator>Roy, J.</dc:creator>
<dc:creator>Girondel, C.</dc:creator>
<dc:creator>Do, F.</dc:creator>
<dc:creator>Dos Santos Pereira Andrade, A. C.</dc:creator>
<dc:creator>Lacasse, E.</dc:creator>
<dc:creator>Dubuc, I.</dc:creator>
<dc:creator>Roux, P. P.</dc:creator>
<dc:creator>St-Jean, G.</dc:creator>
<dc:creator>Demey, B.</dc:creator>
<dc:creator>Labrecque, N.</dc:creator>
<dc:creator>Flamand, L.</dc:creator>
<dc:creator>Meloche, S.</dc:creator>
<dc:creator>Servant, M. J.</dc:creator>
<dc:date>2026-09-03</dc:date>
<dc:identifier>doi:10.64898/2026.09.01.747870</dc:identifier>
<dc:title><![CDATA[The orphan receptor IL-17RD is a negative regulator of RIG-I-like receptor-dependent antiviral innate immunity and restrains SARS-CoV-2-induced lung inflammation]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-03</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Detection of viral RNA by the RIG-I-like receptors (RLRs) RIG-I and MDA5 triggers assembly of a MAVS-dependent signalosome that activates the TBK1-IRF3 and IKK{beta}-NF-{kappa}B axes together with the JNK and p38 MAPK modules, driving type I and type III interferon (IFN) and inflammatory cytokine production. Because unrestrained activity of this pathway is a major cause of immunopathology, host-encoded negative regulators are essential, yet the full complement of these brakes remains incompletely defined. Here we identify interleukin-17 receptor D (IL-17RD, also known as SEF), an orphan member of the IL-17 receptor family previously characterized as an antagonist of FGF and Toll-like receptor signaling, as a negative regulator of RLR-driven antiviral innate immunity. Using a CRISPR-engineered and shRNA-depleted human airway epithelial-derived lung carcinoma A549 cell line, we show that loss of IL-17RD amplifies and prolongs phosphorylation of TBK1 and IRF3 in response to poly I:C transfection and to infection with encephalomyocarditis virus (EMCV) or Sendai virus (SeV), and likewise potentiates the IKK{beta}-I{kappa}B module and the TAK1-JNK1/2 and p38 MAPK branches. This translates into increased nuclear accumulation of IRF3 and p65, and markedly elevated induction of IFNB1, IFNL1-3, CCL5, IL6, and NFKBIA transcripts, as well as secreted IFN-{beta} and IL-6. Silencing IL-17RD in ACE2-expressing A549 cells similarly derepresses the antiviral and inflammatory transcriptional programme following SARS-CoV-2 infection. Epistasis experiments place IL-17RD at the level of MAVS, downstream of the RLR sentinels. Mechanistically, IL-17RD localizes to the ER-to-Golgi intermediate compartment (ERGIC), the membrane platform on which the MAVS signalosome is present, and associates with RIG-I, MDA5, MAVS, TBK1 and IRF3. Its re-expression in depleted cells redistributes RLR effectors and TRAF proteins across low-molecular-weight signalosome fractions, reducing the amount of IRF3 recruited to the 670 kDa MAVS signalosome complex. Complementation of IL-17RD-deficient cells also indicates that the intracellular TIR subdomain is sufficient to confer this antagonistic activity. Finally, Il17rd-/- mice display a splenic transcriptome enriched for antiviral response signatures, and, following intranasal infection with a moderate dose of SARS-CoV-2, they mount an exaggerated pulmonary cytokine response and develop significantly greater lung inflammation and fibrosis than wild-type littermates. Together, these data establish IL-17RD as a bona fide brake on the RLR-MAVS axis that limits virus-induced immunopathology, and identify the SEFIR/TIR subdomain as the module responsible for this activity.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.09.01.748480v1?rss=1">
<title>
<![CDATA[
Identification of a SARS-CoV-2 Spike RNA-Cleaving DNAzyme and Optimization of Its AS1411 Chimera 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.09.01.748480v1?rss=1"
</link>
<dc:creator>Unlu, Z. B.</dc:creator>
<dc:creator>Portakal, H. S.</dc:creator>
<dc:creator>Doluca, O.</dc:creator>
<dc:date>2026-09-03</dc:date>
<dc:identifier>doi:10.64898/2026.09.01.748480</dc:identifier>
<dc:title><![CDATA[Identification of a SARS-CoV-2 Spike RNA-Cleaving DNAzyme and Optimization of Its AS1411 Chimera]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-03</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Sequence-specific cleavage of viral RNA by deoxyribozymes offers a direct approach for suppressing viral gene expression, although limited cellular accessibility remains a major barrier to their functional application. In this study, a panel of eight deoxyribozymes representing different catalytic motifs and target regions was designed against SARS-CoV-2 Spike RNA and comparatively evaluated through time-dependent in vitro cleavage assays. Substantial target-site-dependent differences were observed even among candidates sharing the same catalytic core, demonstrating that catalytic performance was strongly influenced by the selected RNA target region. Among the tested sequences, 8-17-769 exhibited the fastest and most reproducible cleavage profile and the highest observed rate constants, and was therefore selected as the catalytic module for subsequent chimera development. To evaluate its activity in a cellular context, 8-17-769 was combined with the nucleolin-binding aptamer AS1411 in two opposite linear orientations. In an A549-based Spike expression model, both AS1411-containing chimeras were associated with reduced S gene expression, with 8-17-769-AS1411 producing the strongest response, corresponding to an approximately tenfold reduction relative to the reference group and reaching statistical significance (p < 0.05). The functional difference between the two orientations was further examined structurally. Circular dichroism spectroscopy showed that 8-17-769-AS1411 more closely preserved the spectral characteristics of the individual components, while computational analyses indicated a dynamic organization more similar to the free deoxyribozyme-RNA complex and a nucleolin-compatible docking configuration. Collectively, these findings identify 8-17-769 as a lead Spike RNA-cleaving deoxyribozyme and demonstrate that the linear organization of aptamer and catalytic modules can substantially influence the structural and functional properties of aptamer-deoxyribozyme chimeras.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.09.01.748598v1?rss=1">
<title>
<![CDATA[
Multivalent Anti-ACE2 Nanobodies Confer Broad Pan-Sarbecovirus Protection 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.09.01.748598v1?rss=1"
</link>
<dc:creator>Bakasis, A. D.</dc:creator>
<dc:creator>Patejak, R.</dc:creator>
<dc:creator>Fridy, P. C.</dc:creator>
<dc:creator>Jenkins, J.</dc:creator>
<dc:creator>Aldis, M.</dc:creator>
<dc:creator>Baharani, V. A.</dc:creator>
<dc:creator>Sriram, L.</dc:creator>
<dc:creator>Molloy, K. R.</dc:creator>
<dc:creator>Chait, B. T.</dc:creator>
<dc:creator>Rout, M. P.</dc:creator>
<dc:creator>Cross, F. R.</dc:creator>
<dc:creator>Bieniasz, P. D.</dc:creator>
<dc:creator>Hatziioannou, T.</dc:creator>
<dc:date>2026-09-03</dc:date>
<dc:identifier>doi:10.64898/2026.09.01.748598</dc:identifier>
<dc:title><![CDATA[Multivalent Anti-ACE2 Nanobodies Confer Broad Pan-Sarbecovirus Protection]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-03</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The continual emergence of SARS-CoV-2 variants that rapidly evade conventional spike-directed neutralizing antibodies, together with the ongoing risk of cross-species spillover and new sarbecovirus outbreaks, underscores the need to develop broadly acting, escape-resistant therapeutic agents. Here, we optimized a nanobody discovery pipeline incorporating competition-based yeast surface display assays to isolate single-chain variable heavy chain-only antibody domains (VHHs or nanobodies) that bind human ACE2 and inhibit SARS-CoV-2 entry. Dimeric VHHs, as well as bivalent and tetravalent Fc-fusion proteins exhibited markedly increased antiviral activity, blocking a broad panel of SARS-CoV-2 variants and diverse sarbecoviruses at low-nanomolar to picomolar concentrations. These agents did not affect ACE2 enzymatic function or cell surface expression. The VHH-Fc fusion proteins had favorable pharmacokinetics and conferred prophylactic protection in mouse models of both SARS-CoV-2 and SARS-CoV infection, showcasing their potential as broadly acting receptor-targeted biologics against pandemic-threat viruses.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.08.31.26356614v1?rss=1">
<title>
<![CDATA[
Prevalence and Functional Outcomes of Post-Exertional Malaise among Adults with prior COVID-19: Results from a Representative Survey of New York City Residents 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.08.31.26356614v1?rss=1"
</link>
<dc:creator>Packard, S. E.</dc:creator>
<dc:creator>Russo, T.</dc:creator>
<dc:creator>Parrott, J.</dc:creator>
<dc:creator>Sisti, J.</dc:creator>
<dc:creator>Lans, A.</dc:creator>
<dc:date>2026-09-02</dc:date>
<dc:identifier>doi:10.64898/2026.08.31.26356614</dc:identifier>
<dc:title><![CDATA[Prevalence and Functional Outcomes of Post-Exertional Malaise among Adults with prior COVID-19: Results from a Representative Survey of New York City Residents]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-02</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
ObjectiveTo estimate the prevalence of Post-Exertional Malaise (PEM) among adults with prior COVID-19 and associated mental health and disability outcomes.

MethodsWe conducted a cross-sectional analysis of data from a survey of 9,620 adults with prior COVID-19 in New York City, collected May - June 2024. PEM was measured with the DePaul Symptom Questionnaire - Post Exertional Malaise, categorized by symptom duration (< 14 vs. [&ge;]14 hours). Weighted prevalence estimates were stratified by socio-demographic and clinical characteristics. Modified Poisson regression was used to assess the association of PEM with depression, anxiety, and disability.

ResultsThe prevalence of PEM symptoms was 20.9% overall and 4.0% with symptom duration [&ge;] 14 hours, representing over 800,000 New Yorkers affected and over 150,000 who meet a diagnostic criterion for ME/CFS. PEM prevalence was higher among women, transgender and non-binary adults, people of color, and lower educational attainment, chronic comorbidities, or disabilities. PEM was associated with 3 - 4 times higher prevalence of mental health outcomes and 4 - 5 times higher disability scores.

ConclusionsPEM symptoms were common and strongly associated with disability and adverse mental health. Screening, pathways to care, and supportive policies are needed to mitigate long-term consequences, particularly among marginalized populations.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.08.28.26359302v1?rss=1">
<title>
<![CDATA[
Impaired memory B-cell formation after mRNA-based COVID-19 booster vaccination in patients with inflammatory bowel disease receiving anti-TNF treatment 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.08.28.26359302v1?rss=1"
</link>
<dc:creator>Gill, P. A.</dc:creator>
<dc:creator>Bradbury, L. R.</dc:creator>
<dc:creator>Wang, A.</dc:creator>
<dc:creator>Hogg, J.</dc:creator>
<dc:creator>Demase, K.</dc:creator>
<dc:creator>McKenzie, J.</dc:creator>
<dc:creator>Fryer, H. A.</dc:creator>
<dc:creator>Geers, D.</dc:creator>
<dc:creator>Zaeck, L. M.</dc:creator>
<dc:creator>Boo, I.</dc:creator>
<dc:creator>Hogarth, M. P.</dc:creator>
<dc:creator>Drummer, H. E.</dc:creator>
<dc:creator>de Vries, R. D.</dc:creator>
<dc:creator>O'Hehir, R. E.</dc:creator>
<dc:creator>Sparrow, M. P.</dc:creator>
<dc:creator>van Zelm, M. C.</dc:creator>
<dc:date>2026-09-02</dc:date>
<dc:identifier>doi:10.64898/2026.08.28.26359302</dc:identifier>
<dc:title><![CDATA[Impaired memory B-cell formation after mRNA-based COVID-19 booster vaccination in patients with inflammatory bowel disease receiving anti-TNF treatment]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-02</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundPatients receiving anti-TNF treatment for chronic inflammatory disease display impaired antibody responses, but it remains unclear how immune memory formation is affected. We evaluated antibody responses and memory B cells (Bmem) after COVID-19 booster vaccination in inflammatory bowel disease (IBD) patients receiving anti-TNF treatment.

MethodologyBlood was sampled at baseline, 1, and 6 months after WH1/BA.5 bivalent or XBB.1.5 monovalent vaccination from 27 IBD patients receiving intravenous anti-TNF and 44 controls. Neutralizing antibodies were measured using an infectious virus assay. SARS-CoV-2 spike receptor binding domain (RBD)-specific serum IgG was quantified by ELISA, and RBD-specific Bmem were immunophenotyped by flow cytometry using recombinant proteins from ancestral, Omicron BA.1, BA.5, XBB.1.5, and JN.1 variants.

ResultsSerum IgG to vaccine RBD and neutralizing antibodies in patients increased pre to 1 month post-vaccination, but were lower than controls. Ancestral-, BA.5- and XBB.1.5-specific Bmem increased after vaccination but were significantly lower in patients than controls. Within RBD-specific Bmem, frequencies of recently activated CD21lo cells were increased after vaccination, and were higher in patients than controls. Fewer antigen-specific Bmem in patients expressed IgG4, and more expressed IgG3 or IgD following vaccination. Following vaccination, more RBD-specific Bmem recognized multiple viral variants. However, patients had fewer Bmem that could bind to subvariants than controls.

ConclusionAntibody and Bmem responses to COVID-19 booster vaccination in anti-TNF-treated IBD patients displayed reduced capacity, durability and cross-reactivity, suggesting impaired immune memory for protection against breakthrough infection. This supports the recommendation for annual booster vaccination to prevent severe disease and viral spread.

HighlightsO_LIIBD patients on anti-TNF biologics mount antibody responses and form vaccine-specific memory B cells following WH1/BA.5 bivalent or XBB.1.5 monovalent mRNA COVID-19 booster vaccination.
C_LIO_LIVaccine-specific antibody responses and memory B cell formation in patients are significantly lower than in controls at 1- and 6 months after vaccination, indicative of poorer peak response and durability.
C_LIO_LIDespite multiple vaccinations, vaccine-specific memory B cells from patients display phenotypic alterations and reduced recognition of multiple SARS-CoV-2 Omicron subvariants, potentially a consequence of impaired germinal center responses in patients.
C_LI
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.08.27.26361302v1?rss=1">
<title>
<![CDATA[
Predicting COVID-19 hospitalisation and common disease risk from comorbid diagnoses in 13 million individuals 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.08.27.26361302v1?rss=1"
</link>
<dc:creator>Liu, H.</dc:creator>
<dc:creator>Mizani, M. A.</dc:creator>
<dc:creator>Zhao, Y.</dc:creator>
<dc:creator>Wood, A.</dc:creator>
<dc:creator>Inouye, M.</dc:creator>
<dc:creator>Price, A. L.</dc:creator>
<dc:creator>Jiang, X.</dc:creator>
<dc:creator>CVD-COVID-UK/COVID-IMPACT Consortium,</dc:creator>
<dc:date>2026-09-01</dc:date>
<dc:identifier>doi:10.64898/2026.08.27.26361302</dc:identifier>
<dc:title><![CDATA[Predicting COVID-19 hospitalisation and common disease risk from comorbid diagnoses in 13 million individuals]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-01</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Predicting disease risk from prior diagnoses is fundamental to clinical decision-making, particularly during health emergencies such as the COVID-19 pandemic, when individuals with long-term conditions may be disproportionately vulnerable to adverse outcomes. Despite intense interest in developing models to predict disease risk from prior diagnoses 1-3, most prediction models do not estimate effects of each prior diagnosis on disease risk conditional on other diagnoses, limiting interpretability and clinical utility. We developed the Comorbidity Risk Score (CRS), trained on 13 million individuals (age 40-69) from linked electronic health record (EHR) datasets of the entire population of England, to predict COVID-19 hospitalisation and 87 other disease outcomes. CRS was trained at close to saturated sample size and precisely estimated the effects of 212 prior diagnoses on the 88 disease outcomes, conditional on all other prior diagnoses. Correlations of CRS effect sizes across outcomes (e.g. 0.76 for myocardial infarction vs. hyperlipidaemia) matched the corresponding genetic correlations (e.g. 0.79 for myocardial infarction vs. hyperlipidaemia), confirming that comorbidity architectures capture disease aetiology. On average, CRS identified 5% of the population with 3.4-fold higher disease risk, including myocardial infarction (4.4-fold), lung cancer (6.5-fold), and COVID-19 hospitalisation (6.3-fold). Using prior diagnoses alone, CRS outperformed state-of-the-art clinical COVID-19 models 4. Furthermore, CRS (N=13 million) substantially outperformed state-of-the-art AI 1 (N=0.5 million) and linear 3 (N=0.5 million) models in predicting disease risk, suggesting that training sample size outweighs model complexity. CRS attained near-perfect transferability across self-reported ethnicities (e.g., Black vs. White: AUROC ratio = 97.3%). Finally, CRS distinguished independently predictive comorbidities from indirect associations, e.g., lipid metabolism disorder was a strong predictor of myocardial infarction risk but not ischaemic stroke, after conditioning on other prior diagnoses. In conclusion, CRS provides a comprehensive resource for understanding the impact of comorbidities on COVID-19 and other future diseases, revealing disease aetiology while enabling powerful prediction of disease risk.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.29.747976v1?rss=1">
<title>
<![CDATA[
Mind the gap between functional groups and surface of magnetic nanoparticles for highly specific magnetic-based protein assays in biological medium 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.29.747976v1?rss=1"
</link>
<dc:creator>Amin, R.</dc:creator>
<dc:creator>Wang, Y.</dc:creator>
<dc:creator>Wolgast, F.</dc:creator>
<dc:creator>Chowdhury, M. S.</dc:creator>
<dc:creator>Lehmler, N.</dc:creator>
<dc:creator>Schubert, M.</dc:creator>
<dc:creator>Schilling, M.</dc:creator>
<dc:creator>Viereck, T.</dc:creator>
<dc:creator>Lak, A.</dc:creator>
<dc:date>2026-09-01</dc:date>
<dc:identifier>doi:10.64898/2026.08.29.747976</dc:identifier>
<dc:title><![CDATA[Mind the gap between functional groups and surface of magnetic nanoparticles for highly specific magnetic-based protein assays in biological medium]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-01</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Magnetic readout-based assays are compatible with unprocessed biological samples as unbound background molecules do not interfere with magnetic signal. Yet, a true challenge is their poor specificity and susceptibility of magnetic nanoparticles (MNPs) to clusters in complex biological media, hampering their true advancement. Here, we demonstrate that the spatial organization of functional groups at the external periphery of custom magnetic nanoparticles by harnessing ultra-dense double-stranded DNA results in an efficient antibody conjugation with good accessibility toward antigen. By labeling our MNPs with anti-S protein neutralizing IgG antibody, we showcase the detection of S1 subunit of SARS-CoV-2 Spike protein in a wash-free fashion in less than five minutes in nM regime using magnetic particle spectrometer. By mixing our IgG-labelled MNPs with DMEM cell culture (10-20% FBS serum), we sense the S1 proteins in a one-pot fashion with high specificity. Our results show that by having the ultra-dense dsDNA shell on MNPs, the entropic cost of an irreversible protein binding to particle surface is high, thus allowing the formation of dynamic protein corona on the DNA shell that can be replaced with S1 protein with high affinity. When the azide moieties are placed at the close proximity of MNPs by using non-functional dsDNA, antibody conjugation becomes inefficient, to a level not sufficient for S1 protein detection. Our study highlights the importance of spatial organization of functional moieties on the nanoscale on magnetic nanoparticles for highly specific assays in biologically complex media.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.30.747997v1?rss=1">
<title>
<![CDATA[
Structure-inspired design of Nsp8-based protein inhibitors to suppress SARS-CoV-2 replication 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.30.747997v1?rss=1"
</link>
<dc:creator>Sterbova, P.</dc:creator>
<dc:creator>Lin, H. H.</dc:creator>
<dc:creator>Tu, I.-P.</dc:creator>
<dc:creator>Chang, W.-h.</dc:creator>
<dc:date>2026-09-01</dc:date>
<dc:identifier>doi:10.64898/2026.08.30.747997</dc:identifier>
<dc:title><![CDATA[Structure-inspired design of Nsp8-based protein inhibitors to suppress SARS-CoV-2 replication]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-01</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
SARS-CoV-2 relies on a conserved RNA-dependent RNA polymerase (RdRp) complex composed of nsp12 and its cofactors nsp7 and nsp8 to replicate its RNA genome. Whereas most antiviral strategies target viral enzymes or surface proteins directly, an alternative approach is to disrupt the assembly or function of an essential viral molecular machine using a defective component derived from the pathogen itself. Here, guided by structural analyses of the nsp12-nsp7-nsp8 replication complex, we designed truncated nsp8 proteins that retain the ability to associate with nsp12 but are defective in engaging RNA. Using a purified nsp12-nsp7-nsp8 system capable of RNA primer extension, we show that selected truncated nsp8 variants inhibit polymerase activity when introduced into an otherwise functional complex. These results are consistent with a competitive mechanism in which the defective nsp8 variants associate with nsp12 and interfere with incorporation or function of wild-type nsp8, thereby compromising formation of a productive replication complex. To further explore this strategy, we used structure-guided in silico analysis of the nsp8-nsp12 interface to identify interaction hotspots and screened corresponding single-amino-acid substitutions. Several variants exhibited enhanced inhibitory activity in the reconstituted polymerase assay. Together, these findings establish a proof-of-concept strategy in which a structurally engineered, pathogen-derived protein can act as a dominant-negative inhibitor of an essential viral replication machinery. This approach provides a framework for developing protein- or peptide-based inhibitors that target conserved protein-protein interactions within viral replication complexes.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.27.741511v1?rss=1">
<title>
<![CDATA[
Widespread SARS-CoV-2 infection in free-ranging Neotropical bats suggests repeated human-to-bat spillback 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.27.741511v1?rss=1"
</link>
<dc:creator>Armijos-Rivera, J.</dc:creator>
<dc:creator>Parra, G.</dc:creator>
<dc:creator>Bravo-Bonilla, M.</dc:creator>
<dc:creator>Gonzalez-Maldonado, M.</dc:creator>
<dc:creator>Roman-Caceres, D.</dc:creator>
<dc:creator>Vasquez-Tituana, A.</dc:creator>
<dc:creator>Valdivieso, J.</dc:creator>
<dc:creator>Tinoco, F.</dc:creator>
<dc:creator>Villavicencio, A.</dc:creator>
<dc:creator>Aguirre, N.</dc:creator>
<dc:creator>Cisneros-Vidal, R.</dc:creator>
<dc:creator>Romero, V.</dc:creator>
<dc:creator>Garces, J.</dc:creator>
<dc:creator>de Mora, D.</dc:creator>
<dc:creator>Bruno, A.</dc:creator>
<dc:creator>Moreno, A.</dc:creator>
<dc:creator>Tolini, C.</dc:creator>
<dc:creator>Bavagnoli, L.</dc:creator>
<dc:creator>Gomulski, L. M.</dc:creator>
<dc:creator>Scolari, F.</dc:creator>
<dc:creator>Crespan, E.</dc:creator>
<dc:date>2026-09-01</dc:date>
<dc:identifier>doi:10.64898/2026.08.27.741511</dc:identifier>
<dc:title><![CDATA[Widespread SARS-CoV-2 infection in free-ranging Neotropical bats suggests repeated human-to-bat spillback]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-01</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Bats harbor exceptional coronavirus diversity and are considered ancestral sources of several human pathogens. As SARS-CoV-2 transitioned from pandemic emergence to global endemicity in humans, concern has shifted from wildlife-to-human spillover toward reverse zoonosis. However, infection of free-ranging bat populations under natural conditions has not previously been demonstrated. Here, we report widespread detection of SARS-CoV-2 RNA in wild Neotropical bats sampled across Andean and Amazonian ecosystems of Southern Ecuador. RT-qPCR screening of 126 individuals, representing nine taxa, detected SARS-CoV-2 RNA in 34.12% of bats across multiple sites. Partial to near-complete viral genomes recovered from five individuals showed >99% nucleotide identity to contemporary human SARS-CoV-2 lineages and clustered within multiple global phylogenetic clades. Mixed-effects modeling revealed pronounced species-level heterogeneity, a positive association between elevation and infection probability, and higher infection probability in females compared with males. The close phylogenetic affinity of bat-derived genomes to circulating human variants and their distribution across multiple lineages suggest repeated anthropogenic spillback rather than sustained bat-specific circulation. These results expand current understanding of the ecological footprint of the COVID-19 pandemic and highlight the importance of integrating wildlife surveillance into long-term One Health strategies for emerging infectious diseases.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.28.747769v1?rss=1">
<title>
<![CDATA[
Identification of a pan-orthoebolavirus-reactive antibody from an rVSV-EBOV vaccinated individual 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.28.747769v1?rss=1"
</link>
<dc:creator>Tarnow, P.</dc:creator>
<dc:creator>Cohen-Dvashi, H.</dc:creator>
<dc:creator>Rohde, C.</dc:creator>
<dc:creator>Kraehling, V.</dc:creator>
<dc:creator>Ullrich, L.</dc:creator>
<dc:creator>Gieselmann, L.</dc:creator>
<dc:creator>Zar Shuker, H.</dc:creator>
<dc:creator>Amatya, S.</dc:creator>
<dc:creator>Fathi, A.</dc:creator>
<dc:creator>Kupke, A.</dc:creator>
<dc:creator>Kreer, C.</dc:creator>
<dc:creator>BSL-4 Animal Facility Team,</dc:creator>
<dc:creator>Koch, M.</dc:creator>
<dc:creator>Addo, M. M.</dc:creator>
<dc:creator>Becker, S.</dc:creator>
<dc:creator>Diskin, R.</dc:creator>
<dc:creator>Zehner, M.</dc:creator>
<dc:creator>Klein, F.</dc:creator>
<dc:date>2026-09-01</dc:date>
<dc:identifier>doi:10.64898/2026.08.28.747769</dc:identifier>
<dc:title><![CDATA[Identification of a pan-orthoebolavirus-reactive antibody from an rVSV-EBOV vaccinated individual]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-09-01</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Orthoebolaviruses such as Ebola virus (EBOV), Sudan virus (SUDV) and Bundibugyo virus (BDBV) can cause severe disease with high case-fatality rates. While licensed EBOV vaccines and therapeutic antibodies protect against EBOV infection, no single monoclonal antibody currently provides broad protection across multiple orthoebolaviruses. Here, we analyzed the humoral immune response of an rVSV-EBOV vaccinee to identify pan-orthoebolavirus-neutralizing antibodies. Using BDBV- and SUDV-glycoproteins for single B cell-sorting, we identified B10, which neutralized authentic EBOV and SUDV, with potent activity against SUDV compared with established cross-reactive antibodies. Structural analysis mapped antibody B10 binding to the pan-orthoebolavirus conserved GP2-stalk/HR2 region, associated with asymmetric trimer destabilization and spike opening. In vivo, B10 showed significant prophylactic efficacy in an EBOV mouse model and partial protection with antiviral activity in a SUDV mouse model. Together, these findings demonstrate that rVSV-EBOV vaccination induced the development of a broadly orthoebolavirus-neutralizing antibody that holds exeptional therapeutic potential.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.08.28.26361631v1?rss=1">
<title>
<![CDATA[
Clinical features of COVID-19 patients hospitalized at the Tashkent State Medical University and risk factors for intensive care unit admission: a cross-sectional study from Uzbekistan, Central Asia 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.08.28.26361631v1?rss=1"
</link>
<dc:creator>Rakhimov, B.</dc:creator>
<dc:creator>Choi, J.</dc:creator>
<dc:creator>Kim, K.</dc:creator>
<dc:creator>Tuychiev, L.</dc:creator>
<dc:creator>Shadmanov, A.</dc:creator>
<dc:creator>Mamatkulov, B.</dc:creator>
<dc:date>2026-08-31</dc:date>
<dc:identifier>doi:10.64898/2026.08.28.26361631</dc:identifier>
<dc:title><![CDATA[Clinical features of COVID-19 patients hospitalized at the Tashkent State Medical University and risk factors for intensive care unit admission: a cross-sectional study from Uzbekistan, Central Asia]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-31</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundThe clinical course of coronavirus disease 2019 (COVID-19), and the ability to anticipate which patients will require intensive care, were poorly characterized in Central Asia during the first pandemic wave. We aimed to describe the clinical features of hospitalized COVID-19 patients at the Tashkent State Medical University, Uzbekistan, and to identify risk factors for intensive care unit (ICU) admission.

MethodsIn this single-centre cross-sectional study, we reviewed the records of 2500 consecutive patients hospitalized between 11 April and 8 August 2020. Patients were grouped as asymptomatic or symptomatic, and symptomatic patients were compared by ICU versus non-ICU status. Groups were compared with chi-square or Fishers exact and Mann-Whitney U tests. Univariable and multivariable logistic regression identified risk factors for ICU admission.

ResultsOf 2500 patients (median age 36 years; 60.9% male), 989 (39.6%) were asymptomatic and 1511 (60.4%) symptomatic. In total, 129 (5.2%) were admitted to the ICU and 38 (1.5%) died. ICU patients were older (median 56 vs 40.5 years) and more often had bilateral pneumonia, oxygen desaturation and cardiometabolic comorbidity. In the multivariable model (AUC 0.82), the independent predictors of ICU admission were ischemic heart disease (aOR 4.20), shortness of breath (aOR 3.22), hypertensive heart disease (aOR 2.93) and male sex (aOR 2.00).

ConclusionsOlder age, cardiometabolic comorbidity and respiratory compromise identified patients at high ICU risk. As one of the first clinical COVID-19 descriptions from Uzbekistan, these data provide a baseline for preparedness in Central Asia.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.08.27.26361498v1?rss=1">
<title>
<![CDATA[
A Multivariable Plasma Extracellular Vesicle Surface Profile Associated with Post-COVID-19 Syndrome 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.08.27.26361498v1?rss=1"
</link>
<dc:creator>Erhart, D. K.</dc:creator>
<dc:creator>Ressin, H.</dc:creator>
<dc:creator>Balz, L. T.</dc:creator>
<dc:creator>Chatterjee, S.</dc:creator>
<dc:creator>Lule, D.</dc:creator>
<dc:creator>Mueller, S.</dc:creator>
<dc:creator>Lewerenz, J.</dc:creator>
<dc:creator>Muench, J.</dc:creator>
<dc:creator>Tumani, H.</dc:creator>
<dc:creator>Gross, R. M.</dc:creator>
<dc:date>2026-08-31</dc:date>
<dc:identifier>doi:10.64898/2026.08.27.26361498</dc:identifier>
<dc:title><![CDATA[A Multivariable Plasma Extracellular Vesicle Surface Profile Associated with Post-COVID-19 Syndrome]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-31</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Post-COVID-19 syndrome (PCS) is characterized by fatigue, neurological impairment and systemic symptoms. This heterogeneity of symptoms hinders biomarker development. Here, we profiled extracellular-vesicle (EV) surface markers in plasma and CSF from 61 participants with PCS (COVIDpost), 80 recovered controls (COVIDreco), and 10 participants with non-SARS-CoV-2 post-viral syndromes. EVs were analysed by bead-based multiplex flow cytometry using tetraspanin-directed (TSPN) and phosphatidylserine-directed lactadherin (PS) detection. Amongst 37 targets covering tetraspanins and vasculature-, immunity- and stemness-associated markers, none met a 1% false-discovery-rate threshold. However, L1-regularized logistic regression under fully nested 5x5 cross-validation identified a distributed plasma EV profile, with mean out-of-fold areas under the receiver operating characteristic curve (AUCs) of 0.788 (95% CI 0.715-0.852) for TSPN and 0.716 (95% CI 0.636-0.792) for PS detection. Across the pooled COVIDpost and COVIDreco population, EV classification scores covaried with clinical group differences, but did not track clinical severity within either cohort. These PCS-EV classification scores decreased at one-year follow-up in COVIDpost participants. Our findings identify an internally cross-validated multivariable EV surface profile associated with COVIDpost versus COVIDreco status and support independent validation and exploration of EV-based biomarkers in post-viral fatigue syndromes.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.08.27.26361488v1?rss=1">
<title>
<![CDATA[
Acute Protein Responses Control SARS-CoV-2-specific Neurocognitive and General Post-Viral Sequelae 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.08.27.26361488v1?rss=1"
</link>
<dc:creator>Liou, T. G.</dc:creator>
<dc:creator>Andrews, R. J.</dc:creator>
<dc:creator>Bass, B. L.</dc:creator>
<dc:creator>Battey, H.</dc:creator>
<dc:creator>Buonfiglio, L. G. V.</dc:creator>
<dc:creator>Cahill, B. C.</dc:creator>
<dc:creator>Cox, J. E.</dc:creator>
<dc:creator>Gibson, S.</dc:creator>
<dc:creator>Hartsell, S. C.</dc:creator>
<dc:creator>Hatton, N.</dc:creator>
<dc:creator>Hazel, M.</dc:creator>
<dc:creator>Helms, M. N.</dc:creator>
<dc:creator>Jensen, J. L.</dc:creator>
<dc:creator>Kartsonaki, C.</dc:creator>
<dc:creator>Kupfer, J.</dc:creator>
<dc:creator>Li, Y.</dc:creator>
<dc:creator>Lopes, F. B. T. P.</dc:creator>
<dc:creator>Manuel, A.</dc:creator>
<dc:creator>Marchetti, M.</dc:creator>
<dc:creator>Marvin, J. E.</dc:creator>
<dc:creator>Middleton, E. A.</dc:creator>
<dc:creator>Mimche, P.</dc:creator>
<dc:creator>Packer, K. A.</dc:creator>
<dc:creator>Paine, R.</dc:creator>
<dc:creator>Szczesniak, R. D.</dc:creator>
<dc:creator>Sturrock, A. B.</dc:creator>
<dc:creator>Tandar, A.</dc:creator>
<dc:creator>Tarbet, B.</dc:creator>
<dc:creator>Ulrich, A.</dc:creator>
<dc:creator>Warner, D.</dc:creator>
<dc:creator>Warren, K.</dc:creator>
<dc:creator>Weis, A. M.</dc:creator>
<dc:creator>Zimmerman, E.</dc:creator>
<dc:creator>Yoon, S.</dc:creator>
<dc:creator>Ownbey, M.</dc:creator>
<dc:creator>Youngquist, S. T.</dc:creator>
<dc:creator>Adler, F. R.</dc:creator>
<dc:date>2026-08-31</dc:date>
<dc:identifier>doi:10.64898/2026.08.27.26361488</dc:identifier>
<dc:title><![CDATA[Acute Protein Responses Control SARS-CoV-2-specific Neurocognitive and General Post-Viral Sequelae]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-31</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Post-acute infection syndromes (PAIS) follow viral syndromes including post-acute sequelae of COVID19 (PASC) which complicates 10-25% of SARS-CoV-2 infections. These syndromes lack precise explanatory mechanisms. We studied 173 human saliva proteomes during respiratory viral syndromes, seeking associations bewteen 44 clinically-relevant protein expression patterns and subsequent sequelae counts. Exploratory models adjusted by extensive clinical annotations found interactions between 23 acutely-responsive proteins and SARSCoV-2 infection that inversely predicted subsequent neurocognitive sequelae. An overlapping 19 acutely-responsive proteins during any acute respiratory viral syndrome inversely predicted general fatigue-related sequelae. Altogether, 29 proteins, derived from interferon stimulated genes (ISG), were uniformly beneficial, including 13 predictive of both neurocognitive and general sequelae. The proteins suggested both shared early pathobiology and virus-specific protective responses that shaped resolution of acute disease and different PAIS. Acutely elevated protective ISG proteins associated with reduced post-viral symptoms identify investigational starting points for novel mechanisms, diagnostics and therapeutics for PASC and PAIS.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.08.28.26361657v1?rss=1">
<title>
<![CDATA[
Understanding RSV Resurgence Following COVID-19 in Ontario, Canada: Evaluating the Roles of Contact Patterns and Maternal Immunity 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.08.28.26361657v1?rss=1"
</link>
<dc:creator>Parpia, A.</dc:creator>
<dc:creator>Wright, J.</dc:creator>
<dc:creator>Gharouni, A.</dc:creator>
<dc:creator>Thampi, N.</dc:creator>
<dc:creator>Fitzpatrick, T.</dc:creator>
<dc:date>2026-08-31</dc:date>
<dc:identifier>doi:10.64898/2026.08.28.26361657</dc:identifier>
<dc:title><![CDATA[Understanding RSV Resurgence Following COVID-19 in Ontario, Canada: Evaluating the Roles of Contact Patterns and Maternal Immunity]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-31</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundRespiratory syncytial virus (RSV) remains a leading cause of hospitalization in infancy, with severe outcomes influenced by both contact patterns and passive immunity. Non-pharmaceutical interventions (NPIs) during the COVID-19 pandemic suppressed RSV circulation and reduced opportunities for maternal immune boosting, potentially altering protection among newborns. We evaluated whether incorporating time-varying maternal immunity improves the ability of an age-structured transmission model to predict post-pandemic RSV hospitalization patterns in infants.

MethodsWe analyzed population-based RSV hospitalizations among Ontario (Canada) infants (<1 year) from July 2, 2017 to June 25, 2024, using linked administrative databases. A deterministic compartmental model across seven age classes was calibrated against pre-pandemic data using Latin Hypercube Sampling. We compared a model incorporating time-varying contact rates alone against a specification that additionally included time-varying maternal immunity.

ResultsBoth specifications accurately reproduced pre-pandemic seasonality and macro-level post-pandemic resurgence features. The constant maternal immunity model showed slightly better accuracy in capturing the 2021/22 peak compared to the time-varying maternal immunity specification. However, both qualitatively captured the continued near-absence of RSV and the observed peak was captured within the 95% credible intervals. While both models precisely captured the timing and overwhelming surge of admissions that occurred in 2022/23, they failed to capture the premature peak timing and magnitude in 2023/24.

ConclusionsIncorporating time-varying maternal immunity did not improve model accuracy post-pandemic. While maternal protection is essential for evaluating infant immunizations, population-level contact shifts primarily shaped post-pandemic RSV seasonality, indicating that models must account for these mechanisms of RSV transmission dynamics.

SummaryUsing population-based Ontario hospitalization data, we evaluated whether incorporating time-varying maternal immunity improves an age-structured transmission model s ability to reproduce infant RSV disease patterns. While maternal immunity did impact post-pandemic RSV resurgences, we found that population-level contact pattern shifts were primarily responsible.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.08.25.26361355v1?rss=1">
<title>
<![CDATA[
Rural-urban disparities and associated factors of SARS-CoV-2 infection in Zambia: A convergent mixed-methods study using the Proximate Determinant Framework. 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.08.25.26361355v1?rss=1"
</link>
<dc:creator>Wantakisha, E. W. R.</dc:creator>
<dc:creator>Nyirenda, S.</dc:creator>
<dc:creator>Narayani, M.</dc:creator>
<dc:date>2026-08-31</dc:date>
<dc:identifier>doi:10.64898/2026.08.25.26361355</dc:identifier>
<dc:title><![CDATA[Rural-urban disparities and associated factors of SARS-CoV-2 infection in Zambia: A convergent mixed-methods study using the Proximate Determinant Framework.]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-31</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundRural-urban disparities in SARS-CoV-2 infection epidemiology remain poorly quantified and understood in Zambia despite differences in healthcare access, services and preventive interventions. This study examined the geographical distribution and associated factors of SARS-CoV-2 cases across selected rural and urban districts of Zambia.

MethodsA convergent mixed-methods study comprised of quantitative survey and qualitative interviews was conducted in; Ndola (Urban), Kafue (Peri-urban) and Lufwanyama (Rural). The proximate determinant framework guided variable selection and interpretation. Quantitative combined (Hospital-surveillance data with community survey), while qualitative included In-depth interviews. Participants were sampled using multistage sampling technique. Quantitative data were analysed using STATA version 17, while qualitative data were analysed thematically. Findings were integrated through triangulation.

ResultsA total of 528 participants were included, with a median age 31 years (15-71). Overall SARS-CoV-2 positivity was 12.6%, varying across rural (16.5%), peri-urban (14.9%), and urban (9.9%) settings, though residence was not associated with infection (P<0.132). Participants aged [&ge;]49 years had significantly higher odds of infection (aOR=8.78; 95% CI:1.15-66.99), whereas secondary education (aOR=0.37; 95% CI:0.16-0.86) and hospital-based testing (aOR=0.37; 95% CI:0.15-0.92) were associated with lower odds of infection. Vaccine uptake was highest in urban areas but was not independently associated with infection. Qualitative findings revealed marked rural-urban differences in perceived susceptibility, testing access, vaccine decision-making, and adherence to preventive measures, explaining several quantitative observations.

ConclusionSARS-CoV-2 infection across rural and urban settings in Zambia was influenced by demographic, behavioral, and health-system factors rather than geographic residence alone. These findings highlight the need for context-specific prevention strategies, equitable access to testing, strengthened community surveillance, and targeted risk communication to improve preparedness and response for future respiratory disease outbreaks.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.08.29.26361724v1?rss=1">
<title>
<![CDATA[
Temporal inequalities in the global COVID-19 vaccine rollout: a cross-national observational study of delivery, health-system capacity, and time to coverage 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.08.29.26361724v1?rss=1"
</link>
<dc:creator>Lee, H.-W.</dc:creator>
<dc:creator>Huang, Y.-H.</dc:creator>
<dc:creator>McAndrew, T. C.</dc:creator>
<dc:date>2026-08-31</dc:date>
<dc:identifier>doi:10.64898/2026.08.29.26361724</dc:identifier>
<dc:title><![CDATA[Temporal inequalities in the global COVID-19 vaccine rollout: a cross-national observational study of delivery, health-system capacity, and time to coverage]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-31</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
IntroductionBy the end of 2023, many low-income countries had not reached 50% COVID-19 vaccine coverage, while most high-income countries had exceeded 80%. It remains unclear whether receiving vaccine deliveries translated into faster population coverage. We examined cross-national inequalities in the timing of the vaccine rollout and whether deliveries through the COVID-19 Vaccines Global Access (COVAX) facility were associated with subsequent national uptake.

MethodsWe conducted an observational study of 218 countries and territories using country-level data up to December 2023. We used generalized additive mixed models to identify country-level correlates of coverage at an early and a later stage of the pandemic, survival analysis to compare the time to 50% coverage between COVAX Advance Market Commitment (AMC) and non-AMC countries, and an event study to estimate the association between the timing of the first COVAX delivery and subsequent monthly coverage in AMC countries.

ResultsAMC-supported countries reached 50% coverage substantially more slowly than non-AMC countries. The hazard of reaching the threshold was 0.17 times that of non-AMC countries at month 1 (95% CI 0.07 to 0.41) and 0.53 times at month 18 (95% CI 0.33 to 0.85). One year after rollout began, 65.9% of AMC countries (95% CI 56.7 to 76.6) had not reached 50% coverage, compared with 21.1% of non-AMC countries (95% CI 15.1 to 29.5). The timing of COVAX deliveries was not significantly associated with subsequent national uptake in any post-delivery month. In the early stage of rollout, higher maternal mortality was associated with lower coverage, while a larger urban population was associated with higher coverage. By the end of the observation period, larger household size was associated with lower coverage, while higher health expenditure and a larger urban population were associated with higher coverage.

ConclusionReceiving COVAX deliveries was not, on its own, associated with faster coverage. Coverage differences were more consistently associated with country-level structural and health-system characteristics, while we found no significant association with the timing of the first COVAX delivery. Achieving vaccine equality likely requires strengthening the capacity of health systems to convert deliveries into administered doses, and preparedness efforts should invest in last-mile delivery capacity ahead of future emergencies.

Key messagesO_ST_ABSWhat is already known on this topicC_ST_ABSLow-income countries lagged far behind high-income countries in COVID-19 vaccine coverage, and although COVAX was created to narrow this gap, few studies examined whether receiving deliveries translated into faster population uptake.

What this study addsAcross 218 countries and territories, AMC-supported countries reached 50% coverage substantially more slowly than non-AMC countries, and the timing of COVAX deliveries showed no significant association with subsequent national uptake. Coverage was more consistently associated with country-level structural factors, namely maternal mortality and urban population in the early stage and household size, health expenditure and urban population by the end of the period.

How this study might affect research, practice or policyVaccine delivery alone may be insufficient to accelerate coverage. Preparedness efforts should invest in the health-system capacity needed to convert deliveries into administered doses, and should measure success by how quickly populations are protected rather than by doses shipped.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.26.747300v1?rss=1">
<title>
<![CDATA[
Mucosal vaccine-elicited IgA is protective against zoonotic Betacoronavirus challenge 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.26.747300v1?rss=1"
</link>
<dc:creator>Seo, J.</dc:creator>
<dc:creator>Buck, E.</dc:creator>
<dc:creator>Machani, B.</dc:creator>
<dc:creator>Murillo, O.</dc:creator>
<dc:creator>Maharjan, B.</dc:creator>
<dc:creator>Filler, R.</dc:creator>
<dc:creator>Saunders, K. O.</dc:creator>
<dc:creator>Wilen, C.</dc:creator>
<dc:creator>Israelow, B.</dc:creator>
<dc:creator>Martinez, D. R.</dc:creator>
<dc:date>2026-08-28</dc:date>
<dc:identifier>doi:10.64898/2026.08.26.747300</dc:identifier>
<dc:title><![CDATA[Mucosal vaccine-elicited IgA is protective against zoonotic Betacoronavirus challenge]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-28</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Current vaccines for respiratory viruses are primarily administered intramuscularly. Messenger RNA-lipid nanoparticle (LNP)-based intramuscular vaccination for respiratory coronaviruses induces strong systemic IgG antibody responses; they do not consistently elicit IgA in the upper and lower respiratory tracts. Using a synthetic consensus spike protein aimed to broadening immunity against SARS-like viruses, SarbConS, coupled to ferritin nanoparticles co-delivered with mastoparan-7 and an FDA-approved CpG adjuvant, we intranasally boost SARS-CoV-2-immune animals. This intranasal boosting strategy elicits durable mucosal IgA responses in the respiratory tract, along with robust systemic IgG responses, and demonstrates durable protection against SARS-CoV-2 and zoonotic SARS-like viruses from bats and pangolins. Intranasal delivery of mastoparan-7 and CpG with MERS-CoV spike protein similarly elicits MERS-CoV-specific mucosal IgA and protects against MERS-CoV challenge in mice. Moreover, we observe durable protection against these genetically divergent zoonotic SARS-like viral challenges compared to intramuscular mRNA-LNP or unadjuvanted intranasal spike boosters. Intranasal SarbConS-ferritin nanoparticle intranasal vaccination similarly elicited durable mucosal IgA and antigen-specific memory B cell responses in the airways. The protective efficacy of M7-CpG adjuvanted SarbConS ferritin nanoparticle intranasal boosters was abolished in IgA knockout mice, suggesting a requirement for IgA in mediating respiratory mucosal vaccine-mediated protection against coronavirus infection. Altogether, our results demonstrate that respiratory mucosal vaccination can elicit durable and cross-protective mucosal IgA responses against genetically diverse zoonotic coronaviruses with implications for improved mucosal vaccines for highly transmissible respiratory viral pathogens.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.24.746724v1?rss=1">
<title>
<![CDATA[
Defining Operational UV-C Dose Requirements for Autonomous Disinfection of Clinically Relevant Pathogens Across Healthcare and High-Touch Surfaces 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.24.746724v1?rss=1"
</link>
<dc:creator>Wu, I. K. F.</dc:creator>
<dc:creator>Vajaria, N. R.</dc:creator>
<dc:creator>Viruega, L. V. S.</dc:creator>
<dc:creator>Wisebourt, E.</dc:creator>
<dc:creator>Solis-Reyes, P. F.</dc:creator>
<dc:creator>Ryu, K.</dc:creator>
<dc:creator>Ilasin, E. R.</dc:creator>
<dc:creator>Shi, A. Y.</dc:creator>
<dc:creator>Friesen, N. J.</dc:creator>
<dc:creator>Fariha, K. A.</dc:creator>
<dc:creator>Barr, S. D.</dc:creator>
<dc:date>2026-08-27</dc:date>
<dc:identifier>doi:10.64898/2026.08.24.746724</dc:identifier>
<dc:title><![CDATA[Defining Operational UV-C Dose Requirements for Autonomous Disinfection of Clinically Relevant Pathogens Across Healthcare and High-Touch Surfaces]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-27</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Background: Autonomous ultraviolet-C (UV-C) disinfection systems are increasingly used to supplement manual environmental cleaning, yet evidence-based guidance defining pathogen-specific UV-C dose requirements across representative surfaces remains limited. Aim: To characterize operational UV-C dose requirements for clinically relevant pathogens across diverse high-touch and healthcare surfaces and determine how experimentally derived microbial inactivation can inform operational exposure parameters. Methods: SARS-CoV-2, adenovirus, Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella pneumoniae, Enterococcus faecalis, Candida auris, and Clostridioides difficile spores were exposed to defined UV-C doses on representative high-touch materials or stainless steel under standardized conditions, including a 10% fetal bovine serum organic soil challenge. Microbial inactivation was quantified by viable recovery. Dose-response analysis and operational modelling were used where supported by the experimental data. Findings: UV-C exposure significantly reduced viable recovery of all pathogens, with substantial differences in the exposure conditions associated with microbial inactivation. SARS-CoV-2 exhibited substantial inactivation at doses as low as 2.6 mJ/cm2, whereas the highest evaluated doses were 1,800 mJ/cm2 for C. difficile spores and 3600 mJ/cm2 for C. auris. For C. auris, multi-dose data estimated that approximately 1,410 mJ/cm2 was associated with a 2-log10 reference reduction, enabling distance-dependent exposure-time predictions. Conclusion: Experimentally quantified UV-C exposures produced substantial microbial inactivation across diverse pathogen classes and surfaces. Integrating delivered dose with microbial reduction provides a quantitative framework for translating laboratory efficacy into operational parameters for autonomous UV-C disinfection.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.24.746754v1?rss=1">
<title>
<![CDATA[
HIDE-Deconv: A hierarchical deconvolution framework for multiscale characterization of cellular remodeling 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.24.746754v1?rss=1"
</link>
<dc:creator>Goertler, F.</dc:creator>
<dc:creator>Voelkl, D.</dc:creator>
<dc:creator>Bolz, S.</dc:creator>
<dc:creator>Rayford, A.</dc:creator>
<dc:creator>Stevenson, T.</dc:creator>
<dc:creator>Sterr, T.</dc:creator>
<dc:creator>Mensching-Buhr, M.</dc:creator>
<dc:creator>Seifert, N.</dc:creator>
<dc:creator>Altenbuchinger, M.</dc:creator>
<dc:creator>Arp, J.</dc:creator>
<dc:creator>Schuster, C.</dc:creator>
<dc:creator>Tausche, J.</dc:creator>
<dc:creator>Engel, L.</dc:creator>
<dc:creator>Zacharias, H. U.</dc:creator>
<dc:date>2026-08-26</dc:date>
<dc:identifier>doi:10.64898/2026.08.24.746754</dc:identifier>
<dc:title><![CDATA[HIDE-Deconv: A hierarchical deconvolution framework for multiscale characterization of cellular remodeling]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-26</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Most deconvolution methods estimate cellular composition at a single level of cellular resolution despite biological processes often manifesting within fine-grained cellular subpopulations. We present HIDE-Deconv, a hierarchical deconvolution framework that jointly optimizes cellular compositions across multiple levels of a cell-type hierarchy while maintaining consistency between resolutions. In benchmark experiments, HIDE-Deconv achieved the highest overall predictive performance among evaluated methods. Analyses of lung adenocarcinoma, sepsis, COVID-19 and systemic lupus erythematosus revealed biologically relevant cellular remodeling that remained concealed at broader levels of cellular resolution. HIDE-Deconv is available as an open-source framework at https://github.com/dvoelkl/HIDE-deconv.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.25.746971v1?rss=1">
<title>
<![CDATA[
Tree-aware conditional language modeling recovers mutational patterns of viral evolution 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.25.746971v1?rss=1"
</link>
<dc:creator>Polunina, P. V.</dc:creator>
<dc:creator>Maier, W.</dc:creator>
<dc:creator>Rubin, A. F.</dc:creator>
<dc:date>2026-08-26</dc:date>
<dc:identifier>doi:10.64898/2026.08.25.746971</dc:identifier>
<dc:title><![CDATA[Tree-aware conditional language modeling recovers mutational patterns of viral evolution]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-26</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The evolutionary accessibility of a protein mutation depends on the sequence background in which it arises and its lineage history, yet most protein language models estimate sequence plausibility without explicitly considering the ordered sequence changes through which descendants arise. We developed evoPLM-Tree, a tree-aware conditional autoregressive language model that predicts descendant protein sequences from ancestral sequences together with phylogenetically derived evolutionary features. We demonstrated our approach using SARS-CoV-2 spike protein, pairing sequences from early Omicron lineages according to their positions on a mutation-annotated phylogeny, and evaluating model performance on sequence pairs from later lineages. Prompt-masking experiments showed that incorporating phylogenetic context substantially increased reliance on the supplied input information compared with a sequence-only model. Generated descendant sequences accurately reproduced the positional distribution of mutations observed during viral evolution, with strong correlations between predicted and observed mutation-frequency profiles for both the receptor-binding domain (Spearman's {rho} = 0.823) and the full spike protein ({rho} = 0.736). Although prediction accuracy for individual substitutions decreased with increasing evolutionary distance, the model consistently captured aggregate mutational patterns across the spike protein. Model-assigned mutation probabilities were also enriched among substitutions experimentally tolerated in deep mutational scanning assays of Omicron BA.2 receptor-binding domain expression (1.19-fold enrichment) and ACE2 binding (1.04-fold enrichment), despite the model being trained solely on observed ancestor-descendant sequence pairs and associated phylogenetic context features. These results demonstrate that explicitly providing protein language models with phylogenetic context during sequence generation can recover lineage-specific mutational patterns and yields probabilistic predictions consistent with experimentally measured functional constraints. evoPLM-Tree provides a framework for modeling protein evolution along phylogenetic lineages and prioritizing plausible future mutations from genomic surveillance data.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.25.746999v1?rss=1">
<title>
<![CDATA[
A rapidly deployable CRISPR-Cas3 diagnostic platform for emerging RNA viruses 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.25.746999v1?rss=1"
</link>
<dc:creator>Nakamura, J.</dc:creator>
<dc:creator>Miyazaki, K.</dc:creator>
<dc:creator>Torii, S.</dc:creator>
<dc:creator>Kitajima, M.</dc:creator>
<dc:creator>Mikamo, K.</dc:creator>
<dc:creator>Kimihira, T.</dc:creator>
<dc:creator>Morimoto, L.</dc:creator>
<dc:creator>Ashayqa, H.</dc:creator>
<dc:creator>Ito, J.</dc:creator>
<dc:creator>Takeshita, K.</dc:creator>
<dc:creator>Kosugi, S.</dc:creator>
<dc:creator>Minegishi, Y.</dc:creator>
<dc:creator>Ito, M.</dc:creator>
<dc:creator>Hirano, R.</dc:creator>
<dc:creator>Ishida, S.</dc:creator>
<dc:creator>Yoshimi, K.</dc:creator>
<dc:creator>Halfmann, P. J.</dc:creator>
<dc:creator>Kawaoka, Y.</dc:creator>
<dc:creator>Mashimo, T.</dc:creator>
<dc:date>2026-08-26</dc:date>
<dc:identifier>doi:10.64898/2026.08.25.746999</dc:identifier>
<dc:title><![CDATA[A rapidly deployable CRISPR-Cas3 diagnostic platform for emerging RNA viruses]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-26</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Rapidly converting viral genome information into deployable molecular tests remains a major challenge in outbreak preparedness. We developed CONAN-SWIFT (Simple Workflow for Isothermal Field Testing), a sequence-to-test platform that integrates computational assay design, reverse-transcription loop-mediated isothermal amplification, CRISPR-Cas3 detection, reagent lyophilization and lateral-flow readout. Sequence-guided assays for Andes virus and Bundibugyo virus were established within approximately three weeks and extended to four additional filoviruses. A web-based designer supported crRNA selection, and systematic RT-LAMP primer optimization improved amplification performance. Recombinant Escherichia coli-expressed Cascade enabled standardized preparation of lyophilized Cas3-detection reagents, which were combined with a battery-operated isothermal device. The portable system detected as few as 10 input RNA copies per reaction within approximately 40 min. It also detected viral RNA and biologically contained, replication-incompetent Ebola virus in spiked human blood and concentrated wastewater. These findings establish the analytical feasibility of a rapidly adaptable CRISPR-Cas3 engineering framework for decentralized detection of emerging RNA viruses.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.24.746785v1?rss=1">
<title>
<![CDATA[
A Medicinal Chemistry-Centered Evaluation of AlphaFold 3 and Boltz-2 Across Diverse Binding Modalities 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.24.746785v1?rss=1"
</link>
<dc:creator>Chen, K.</dc:creator>
<dc:creator>Qi, Z.</dc:creator>
<dc:creator>Lozano Ramos, O.</dc:creator>
<dc:creator>Li, H.</dc:creator>
<dc:creator>Ma, M.</dc:creator>
<dc:creator>Gannarapu, M. R.</dc:creator>
<dc:creator>Bi, F.</dc:creator>
<dc:creator>Li, A.</dc:creator>
<dc:creator>Li, H.</dc:creator>
<dc:creator>XIONG, R.</dc:creator>
<dc:date>2026-08-26</dc:date>
<dc:identifier>doi:10.64898/2026.08.24.746785</dc:identifier>
<dc:title><![CDATA[A Medicinal Chemistry-Centered Evaluation of AlphaFold 3 and Boltz-2 Across Diverse Binding Modalities]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-26</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
AlphaFold 3 (AF3) and Boltz-2 are state-of-the-art AI-based tools for biomolecular structure prediction, but whether their predictions provide useful guidance for lead optimization, SAR interpretation, and virtual screening remains insufficiently characterized. We benchmarked their performance using newly determined soluble epoxide hydrolase co-crystal structures and matched activity data together with a curated post-training-cutoff dataset spanning kinases, allosteric modulators, covalent systems, PROTACs, molecular glues, fragments, membrane proteins, RNA binders, and activity-cliff pairs. Both models recovered canonical orthosteric enzyme and kinase complexes, including key DFG/C conformational states, whereas allosteric, membrane-protein, and induced-proximity complexes remained challenging. Pharmacophore RMSD was often lower than overall ligand RMSD, indicating preservation of key recognition features despite imperfect whole-ligand alignment. AF3 minPAE correlated with pose accuracy, and very low minPAE values (<0.85 A) were strongly enriched for accurate poses. Model confidence scores were not associated with experimental activity, whereas Boltz-2 predicted affinity captured relative activity trends and distinguished the activity-cliff pair, although its performance varied across ligand series.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.25.746949v1?rss=1">
<title>
<![CDATA[
CAPRIN1 localizes to CD63-positive MVB-like SARS-CoV-2 egress compartments and limits cytopathic effects 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.25.746949v1?rss=1"
</link>
<dc:creator>Woloszyn, J. S.</dc:creator>
<dc:creator>Schroeder, J.</dc:creator>
<dc:creator>Berger, J. M.</dc:creator>
<dc:creator>Kotova, E.</dc:creator>
<dc:creator>Schaeper, R.</dc:creator>
<dc:creator>Pfefferle, S.</dc:creator>
<dc:creator>Uetrecht, C.</dc:creator>
<dc:creator>Soh, T. K.</dc:creator>
<dc:creator>Bosse, J. B.</dc:creator>
<dc:date>2026-08-26</dc:date>
<dc:identifier>doi:10.64898/2026.08.25.746949</dc:identifier>
<dc:title><![CDATA[CAPRIN1 localizes to CD63-positive MVB-like SARS-CoV-2 egress compartments and limits cytopathic effects]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-26</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Stress granules (SGs) are cytoplasmic condensates that assemble under cellular stress, including viral infection. The best-characterized evasion strategy in SARS-CoV-2 infection involves the viral nucleocapsid (N) protein hijacking the SG core protein G3BP1, thereby preventing SG assembly. By performing network analysis of N protein interactomes, we identified CAPRIN1 as an underexplored candidate, despite its central role alongside G3BP1 in SG assembly. Here, we provide the first high-resolution spatial and functional data on CAPRIN1 in SARS-CoV-2 infection. Using ultrastructure expansion microscopy (U-ExM), we localized CAPRIN1 and viral egress markers to enlarged, CD63- and LAMP1-positive, multivesicular body (MVB)-like egress compartments, refining the current model of SARS-CoV-2 egress. CAPRIN1 was found on both the limiting membrane of these compartments and within the intraluminal vesicles, a pattern distinct from G3BP1. Knockout of CAPRIN1 increased infection-associated cell death, promoted an aberrant cell-death phenotype, and enhanced syncytia formation. Together, our data reveal distinct activities of CAPRIN1 during infection and identify the egress compartments as MVB-like, raising the possibility that SARS-CoV-2 repurposes more than one cellular pathway for egress.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.25.746963v1?rss=1">
<title>
<![CDATA[
A Selenium-Deficient Mouse Model of Mouse-Adapted SARS-CoV-2 Demonstrates Variant Emergence Observed in SARS-CoV-2 Pandemic Variants 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.25.746963v1?rss=1"
</link>
<dc:creator>Graham, M. E.</dc:creator>
<dc:creator>Oluwasemowo, O.</dc:creator>
<dc:creator>Murugesh, D. K.</dc:creator>
<dc:creator>Rangel, M. V.</dc:creator>
<dc:creator>Kimbrel, J. A.</dc:creator>
<dc:creator>Avila-Herrera, A.</dc:creator>
<dc:creator>Thiessen, J.</dc:creator>
<dc:creator>Zemla, A.</dc:creator>
<dc:creator>Phillips, A. M.</dc:creator>
<dc:creator>Collette, N.</dc:creator>
<dc:creator>Weilhammer, D.</dc:creator>
<dc:creator>Borucki, M. K.</dc:creator>
<dc:date>2026-08-26</dc:date>
<dc:identifier>doi:10.64898/2026.08.25.746963</dc:identifier>
<dc:title><![CDATA[A Selenium-Deficient Mouse Model of Mouse-Adapted SARS-CoV-2 Demonstrates Variant Emergence Observed in SARS-CoV-2 Pandemic Variants]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-26</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Host selenium deficiency has been shown to generate novel genetic variants in RNA viruses. With the predicted rise of selenium deficiency globally, we sought to determine if host selenium deficiency can be a predictive factor for RNA virus variant emergence. We utilized a selenium-deficient BALB/c mouse model to investigate how host selenium status influences the emergence of viral variants in mouse-adapted SARS-CoV-2. Mice were maintained on control or selenium-deficient diets and subjected to sequential rounds of diet-matched viral passage to generate diet-specific virus populations. Deep sequencing of passaged viral populations revealed that selenium-deficient passage drove a marked increase in inter-host genomic heterogeneity and produced a distinct mutational profile relative to control passage. Eighteen mutations were identified as unique to selenium-deficient passage, including variants previously observed during natural human SARS-CoV-2 evolution. These mutations were largely maintained at sub-consensus frequencies, indicating that selenium deficiency can expand the viral quasispecies landscape that enrichs reservoirs of adaptive potential. To determine how this altered mutant spectrum affected pathogenesis, we challenged normal diet-fed adult and aged BALB/c mice with control- or selenium-deficient-passaged virus. Although overt differences in weight loss, survival, and viral burden were generally modest, selenium-deficient-passaged virus induced pronounced increases in antiviral cytokine expression. Together, these findings identify host selenium deficiency as a driver of RNA virus population diversification and show that nutritionally stressed animal models can reproducibly generate mutations observed in nature.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.24.746878v1?rss=1">
<title>
<![CDATA[
rVSV-EBOV vaccination protects ferrets from lethal Bundibugyo virus disease 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.24.746878v1?rss=1"
</link>
<dc:creator>Wight, J.</dc:creator>
<dc:creator>Liu, G.</dc:creator>
<dc:creator>Chan, M.</dc:creator>
<dc:creator>Medina, S. J.</dc:creator>
<dc:creator>Lu, D.</dc:creator>
<dc:creator>Cao, W.</dc:creator>
<dc:creator>Krosta, S. J.</dc:creator>
<dc:creator>Tierney, K.</dc:creator>
<dc:creator>Azaransky, K.</dc:creator>
<dc:creator>Banadyga, L.</dc:creator>
<dc:date>2026-08-26</dc:date>
<dc:identifier>doi:10.64898/2026.08.24.746878</dc:identifier>
<dc:title><![CDATA[rVSV-EBOV vaccination protects ferrets from lethal Bundibugyo virus disease]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-26</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
An uncontrolled and rapidly growing outbreak of Bundibugyo virus (BDBV) is currently gripping the Democratic Republic of the Congo and threatening health security across Central Africa. There are no available BDBV-specific vaccines, although emerging evidence suggests that the Ebola virus-specific vaccine, rVSV-EBOV (also known by its tradename ERVEBO), may offer cross-protective immunity. To directly address this question, we evaluated the efficacy of rVSV-EBOV in the uniformly lethal ferret model of BDBV infection. All vaccinated animals survived BDBV challenge and exhibited minimal clinical signs of infection, presumably as a result of a moderate--but protective--humoral immune response. These findings provide critical evidence further supporting the cross-protective efficacy of rVSV-EBOV, and they suggest a potential role for this vaccine in mitigating the ongoing BDBV outbreak.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.21.746284v1?rss=1">
<title>
<![CDATA[
Microenvironment-informed inference of transcriptional progression geometry 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.21.746284v1?rss=1"
</link>
<dc:creator>Kobara, S.</dc:creator>
<dc:creator>Rahman, S. A.</dc:creator>
<dc:creator>Ribeiro, S. P.</dc:creator>
<dc:creator>Coopersmith, C. M.</dc:creator>
<dc:creator>Kamaleswaran, R.</dc:creator>
<dc:date>2026-08-24</dc:date>
<dc:identifier>doi:10.64898/2026.08.21.746284</dc:identifier>
<dc:title><![CDATA[Microenvironment-informed inference of transcriptional progression geometry]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-24</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
We present BIOCURRENT, a causal inference framework that reconstructs donor-specific pseudotime geometry in transcriptomic data. By modeling gene expression as a function of baseline characteristics, microenvironmental context, and latent pseudotime, BIOCURRENT enables comparison of compressed or expanded progression intervals across transcriptional state transitions. We introduce $DeltaDelta T$, a geometry-based estimator that quantifies differences in pseudotime intervals across conditions, enabling evaluation of changes in pseudotime intervals under hypothetical modulation of microenvironmental programs. Applications to thymic T-cell developmental lineages and to COVID-19 immune dysregulation reveal condition- and donor-specific distortions of progression intervals. Counterfactual simulation links microenvironmental context to changes in specific intracellular state transition intervals. By localizing deviations in pseudotime geometry, BIOCURRENT identifies whether shifts in transcriptomic programs emerge early or later along transcriptomic coordinates and reveals upstream programs associated with these distortions. Such localization supports transcriptional stage-aware mechanistic hypotheses and suggests candidate intervention checkpoints in complex biological systems.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.21.746147v1?rss=1">
<title>
<![CDATA[
Scarless SARS-CoV-2 Genome Engineering and Variant Analysis 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.21.746147v1?rss=1"
</link>
<dc:creator>Dabrowska, A.</dc:creator>
<dc:creator>Cuell, A.</dc:creator>
<dc:creator>Basu, R.</dc:creator>
<dc:creator>Vishwakarma, J.</dc:creator>
<dc:creator>Delgado, R.</dc:creator>
<dc:creator>Barreto Duran, E.</dc:creator>
<dc:creator>Liu, X.</dc:creator>
<dc:creator>He, L.</dc:creator>
<dc:creator>Xiang, Y.</dc:creator>
<dc:creator>Ye, C.</dc:creator>
<dc:creator>Martinez-Sobrido, L.</dc:creator>
<dc:creator>Harris, R. S.</dc:creator>
<dc:date>2026-08-24</dc:date>
<dc:identifier>doi:10.64898/2026.08.21.746147</dc:identifier>
<dc:title><![CDATA[Scarless SARS-CoV-2 Genome Engineering and Variant Analysis]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-24</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
In addition to causing cold and flu-like symptoms, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) can also cause chronic longer-term diseases. Antiviral drugs, especially used combinatorially, have the potential to reduce the severity of individual infections and prevent the development of chronic disease. One of the safest and most versatile reverse genetics systems for SARS-CoV-2 studies is a bacterial artificial chromosome (BAC)-based system harboring the WA1 strain full-length genome and attenuating deletions in the accessory open reading frame 3a and 7b proteins (ORF3a and ORF7b, respectively). Here, a scarless genome engineering technique called En Passant mutagenesis was used to change one amino acid in the viral main protease (Mpro P132) into the residue present in contemporary Omicron strains (H132), in order to more accurately study protease inhibitors and resistance mechanisms. This recombinant, attenuated viral system yields antiviral EC50 values for the active component of approved drugs including nirmatrelvir (Paxlovid) and ensitrelvir (Xocova) and, importantly, also enables a parallel assessment of drug efflux. For instance, the antiviral potency of nirmatrelvir improves 50-fold by inhibiting the P-Glycoprotein (P-Gp) transporter with ritonavir or tariquidar, whereas the potency of ensitrelvir is unaffected. This system also enables the safe isolation and characterization of viral variants with reduced sensitivity to drugs, as evidenced by Mpro M49L compromising the efficacy of ensitrelvir. Together, these systems combine to provide safe, reliable, and quantitative approaches for Mpro variant analysis and drug testing without the biosafety concerns of conducting these experiments using wildtype isolates.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.10.743937v1?rss=1">
<title>
<![CDATA[
Pathogenesis and natural history of the Bundibugyo species of Orthoebolavirus in nonhuman primates 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.10.743937v1?rss=1"
</link>
<dc:creator>Fenton, K.</dc:creator>
<dc:creator>Pigeaud, D.</dc:creator>
<dc:creator>Turcinovic, J.</dc:creator>
<dc:creator>Prasad, A.</dc:creator>
<dc:creator>Agans, K.</dc:creator>
<dc:creator>Dobias, N.</dc:creator>
<dc:creator>O'Toole, R.</dc:creator>
<dc:creator>Lona, A.</dc:creator>
<dc:creator>Woolsey, C.</dc:creator>
<dc:creator>Borisevich, V.</dc:creator>
<dc:creator>Deer, D.</dc:creator>
<dc:creator>Geisbert, J.</dc:creator>
<dc:creator>Basler, C.</dc:creator>
<dc:creator>Cross, R. W.</dc:creator>
<dc:creator>Geisbert, T.</dc:creator>
<dc:date>2026-08-12</dc:date>
<dc:identifier>doi:10.64898/2026.08.10.743937</dc:identifier>
<dc:title><![CDATA[Pathogenesis and natural history of the Bundibugyo species of Orthoebolavirus in nonhuman primates]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-12</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The current outbreak of Bundibugyo virus (BDBV) in Africa is a global public health concern particularly as there are no licensed medical countermeasures (MCM). Well characterized animal models that accurately replicate human BDBV infection are needed to develop effective MCM. We exposed 21 cynomolgus monkeys (CM) to BDBV to examine the progression and natural history of BDBV disease (BVD). BVD was more protracted than reported for Ebola and Sudan infection in CM with a lower lethality rate of 67% consistent with lower human BVD mortality rates. IHC and spatial proteomics identified CD209+, CD68+, and/or HLA-DR+ macrophages and dendritic cells as early targets of BDBV. These infected cells frequently colocalized with fibrin and infiltrating MPO+ neutrophils and S100A9+ myeloid-derived suppressor cells, consistent with the development of an active inflammatory response and early coagulopathy. Transcriptomic and proteomic analyses of the circulating immune response correspondingly reflected a cytokine-driven hyperinflammatory state in CM that succumbed to disease. Surviving animals resolved systemic inflammation by the study endpoint; however, BDBV antigen was identified in immune privileged tissues with lesion-associated inflammation aligning with known post-Ebola sequela in humans. This data should assist in identifying weaknesses in the disease course that can be exploited to develop new MCM.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.04.740108v1?rss=1">
<title>
<![CDATA[
Engineering growth-coupled metabolic biosensors for disease prognosis and diagnosis using full growth trajectories 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.04.740108v1?rss=1"
</link>
<dc:creator>Ahavi, P.</dc:creator>
<dc:creator>Hoang, T.-N.-A.</dc:creator>
<dc:creator>Meyer, P.</dc:creator>
<dc:creator>Epaulard, O.</dc:creator>
<dc:creator>Le Gouellec, A.</dc:creator>
<dc:creator>Faulon, J.-L.</dc:creator>
<dc:date>2026-08-12</dc:date>
<dc:identifier>doi:10.64898/2026.08.04.740108</dc:identifier>
<dc:title><![CDATA[Engineering growth-coupled metabolic biosensors for disease prognosis and diagnosis using full growth trajectories]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-12</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Although metabolomics has shown considerable promise for biomarker discovery, and the development of diagnostic and prognostic applications, its translation into routine clinical practice remains limited by analytical complexity, cost, throughput, and standardization challenges. These limitations underscore the need for complementary tools, particularly in resource-limited settings. In this study, we developed a workflow for the engineering and characterization of growth-coupled metabolic sensors capable of disease detection (healthy vs. infected) and outcome prediction (mild vs. severe), which we illustrated using COVID-19 as a proof-of-concept application. We first generated a biomarker-guided library of 34 candidate sensors leveraging both auxotrophic phenotypes and less stringent metabolic dependencies. We then screened the library against patient plasma pools, identifying 19 sensor candidates with diagnostic and/or prognostic potential, including 14 with prognostic potential. Lastly, a selected subset of candidates was further evaluated on a patient cohort using two newly developed analytical frameworks designed to extract additional information from bacterial growth curves. The best-performing sensors achieved a balanced accuracy of 0.88{+/-} 0.06 for prognostic prediction (outer-test AUC = 0.89, 5-fold cross-validation, n = 37) and 1.00 for diagnostic classification (outer-test AUC = 1.00, 5-fold cross-validation, n = 56). Collectively, these findings establish a proof of concept for translating disease-associated plasmatic metabolic signatures into low-cost, growth-coupled biosensors with diagnostic and prognostic capabilities.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.09.743817v1?rss=1">
<title>
<![CDATA[
SARS-CoV-2 ORF8 modulates the upper respiratory tract inflammatory response to facilitate transmission 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.09.743817v1?rss=1"
</link>
<dc:creator>Ciabattoni, G. O.</dc:creator>
<dc:creator>Bartlett, S.</dc:creator>
<dc:creator>McGrath, M. E.</dc:creator>
<dc:creator>Frieman, M. B.</dc:creator>
<dc:creator>Dittmann, M.</dc:creator>
<dc:creator>Ortigoza, M. B.</dc:creator>
<dc:date>2026-08-11</dc:date>
<dc:identifier>doi:10.64898/2026.08.09.743817</dc:identifier>
<dc:title><![CDATA[SARS-CoV-2 ORF8 modulates the upper respiratory tract inflammatory response to facilitate transmission]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-11</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The ability of respiratory viruses to exploit host immune responses to promote transmission is a defining feature of pandemics. SARS-CoV-2 remains a major global public health threat because of its persistent evolution and capacity to counteract evolving immune defenses. Although the immune evasion properties of the SARS-CoV-2 Spike protein are well characterized, the contributions of other viral proteins to transmission remain poorly understood. Here, we used the infant mouse model to define the role of the accessory protein ORF8 in SARS-CoV-2 spread. We demonstrate that ORF8 supports efficient upper respiratory tract (URT) infection, infectious virus shedding, and host-to-host transmission. Mice infected with a recombinant SARS-CoV-2 strain lacking ORF8 (r{Delta}ORF8) had less infectious virus recovered from URT tissues and nasal secretions and transmitted less efficiently than mice infected with the isogenic ancestral strain rWA-1, which contains an intact ORF8. Recombinant viruses encoding naturally occurring ORF8 mutations exhibited distinct transmission phenotypes, with ORF8-deficient viruses resembling r{Delta}ORF8. Infection with ORF8-sufficient viruses induced greater macrophage recruitment, inflammatory cytokine production, and type-I interferon (IFN-I) signaling programs than ORF8-deficient viruses. Intranasal IFN{beta} supplementation partially restored URT shedding by r{Delta}ORF8-infected mice and rescued transmission to contacts, whereas blockade of the type I interferon receptor (IFNAR) in rWA-1-infected index mice reduced contact infection and transmission. Together, these findings demonstrate that ORF8 promotes SARS-CoV-2 transmission by engaging an IFN-I-associated inflammatory and secretory program in the URT that supports virus shedding from the infected host. These data identify ORF8 as a viral determinant of host mucosal responses that promote contagiousness.

ImportanceEfficient host-to-host transmission underlies the success of respiratory viruses. Although SARS-CoV-2 research has largely focused on the Spike protein, accessory proteins can also shape viral fitness and spread. We previously identified ORF8 as a determinant of SARS-CoV-2 transmission. Here we show that ORF8 promotes SARS-CoV-2 infectious viral shedding and transmission by engaging IFN-I-associated inflammatory and secretory responses in the URT. These findings reveal how a SARS-CoV-2 accessory protein can exploit mucosal antiviral responses to increase host contagiousness.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.10.744019v1?rss=1">
<title>
<![CDATA[
A Time-Resolved Single-Cell Atlas Reveals Infection-Status, Age-, and Sex-Dependent Immune Responses Drive Viral Disease Severity 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.10.744019v1?rss=1"
</link>
<dc:creator>Chen, L.</dc:creator>
<dc:creator>Qiu, A.</dc:creator>
<dc:creator>Kim, J.</dc:creator>
<dc:creator>Abu Hussein, N.</dc:creator>
<dc:creator>Lu, M.</dc:creator>
<dc:creator>Agaronyan, K.</dc:creator>
<dc:creator>Sun, K.</dc:creator>
<dc:creator>Yuan, Y.</dc:creator>
<dc:creator>Zhao, A.</dc:creator>
<dc:creator>Heda, G.</dc:creator>
<dc:creator>Lu, X.</dc:creator>
<dc:creator>Kitsios, G.</dc:creator>
<dc:creator>Rizzo, A. N.</dc:creator>
<dc:creator>Bain, W.</dc:creator>
<dc:creator>Nyunoya, T.</dc:creator>
<dc:creator>Suber, T.</dc:creator>
<dc:creator>Evankovich, J.</dc:creator>
<dc:creator>Shah, F.</dc:creator>
<dc:creator>Dela Cruz, C. S.</dc:creator>
<dc:creator>Manning, E.</dc:creator>
<dc:creator>Sharma, L.</dc:creator>
<dc:date>2026-08-11</dc:date>
<dc:identifier>doi:10.64898/2026.08.10.744019</dc:identifier>
<dc:title><![CDATA[A Time-Resolved Single-Cell Atlas Reveals Infection-Status, Age-, and Sex-Dependent Immune Responses Drive Viral Disease Severity]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-11</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The majority of mortality during viral infections occurs in older males; however, underlying mechanisms by which age and sex shape antiviral immunity and pathological inflammatory responses remain incompletely understood. Here, we performed time-resolved single-cell RNA sequencing across 16 conditions spanning age, sex, and four stages of influenza infection in mice, generating a high-resolution atlas. Aged mice demonstrate delayed antiviral and inflammatory responses in multiple myeloid cells, impairing viral clearance, which delays recovery. Similarly, endothelial cells from aging mice show prolonged inflammatory and antiviral gene signatures. Altered gene signatures in immune and endothelial cells result in a shift in endothelial-immune interactions in the aged lung. Further, the infection status of the cell is a major driver of transcriptional state, with infected myeloid cells exhibiting broad upregulation of genes, including interferon-stimulated, inflammatory, complement, and oxidative stress-related genes. To assess whether these age-associated transcriptional patterns are conserved in humans, we examined BAL cells obtained from healthy individuals and COVID-19 patients, and found that immune cells from aged COVID-19 patients had elevated antiviral and pro-inflammatory gene expression compared to cells from young patients. Our analyses of sex differences identified that multiple myeloid cell types in aged male mice, but not in young male mice, show persistent inflammatory responses at later stages of infection, a likely mechanism contributing to elevated mortality in older males. These data reveal how infection status of the cell, age, and sex interact to drive persistent inflammation and impaired resolution, providing a foundational resource for designing age- and sex-specific therapeutic strategies.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.10.743964v1?rss=1">
<title>
<![CDATA[
RheoScale 2.0: Revealing the Hidden Roles of Protein Positions via Substitution Patterns 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.10.743964v1?rss=1"
</link>
<dc:creator>Liu, D.</dc:creator>
<dc:creator>Sreenivasan, S.</dc:creator>
<dc:creator>Gray, C. J.</dc:creator>
<dc:creator>Cleveland, H. C.</dc:creator>
<dc:creator>Swint-Kruse, L.</dc:creator>
<dc:date>2026-08-11</dc:date>
<dc:identifier>doi:10.64898/2026.08.10.743964</dc:identifier>
<dc:title><![CDATA[RheoScale 2.0: Revealing the Hidden Roles of Protein Positions via Substitution Patterns]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-11</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
A central challenge in molecular biology is understanding how amino acid substitutions modulate various features of protein function and stability. To illuminate the complexities of this relationship, high-throughput (HTP) assays are increasingly used to assess site-saturating mutagenesis libraries. A common downstream analysis is to average the set of twenty outcomes at each amino acid position for comparison with structural and evolutionary features. Average values clearly identify positions that tolerate most substitutions (neutral positions) and positions where most substitutions abolish activity (toggle positions). However, average values conceal the existence of rheostat positions, where different amino acid substitutions sample a wide range of outcomes. To quantitatively identify rheostat positions, we previously developed a histogram-based analysis that we here expand by: (i) incorporating new position classes observed in experimental studies of rheostat positions; (ii) formalizing a hierarchy of class assignments; (iii) refining error-based identification of neutral positions; and (iv) statistically assessing the robustness of class assignments to changes in experimental and computational parameters. RheoScale 2.0 is implemented in Excel and newly implemented in Python for facile integration with existing HTP pipelines; all parameters are customizable. Example analyses are shown for three HTP datasets of the SARS-CoV-2 papain-like protease. Results illustrate two aspects that influence interpretation of HTP data: First, position assignments (and substitution outcomes) depend highly on the measured feature. Second, many protein positions play multiple roles in the sequence-structure-function relationship. The recognition of varied position roles will advance understanding of pathogen evolution, protein engineering, and variant interpretation for personalized medicine.

SummaryRheoScale 2.0 improves how high-throughput mutational data are interpreted by identifying protein positions where amino acid substitutions act like biological dimmer switches. By enabling more nuanced assignment of position behavior, beyond neutral or deleterious outcomes, this analysis framework advances studies of sequence-structure-function relationships and has broad relevance for understanding protein evolution, engineering proteins with desired properties, and interpreting variants linked to human disease.

SOFTWARE AVAILABILITYhttps://github.com/liskinsk/RheoScale-calculator
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.10.743971v1?rss=1">
<title>
<![CDATA[
LC3C-ATG4D regulatory axis supports coronavirus replication organelle formation independently of canonical autophagy 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.10.743971v1?rss=1"
</link>
<dc:creator>Vlachova, S.</dc:creator>
<dc:creator>Iovine, L.</dc:creator>
<dc:creator>Marano, V.</dc:creator>
<dc:creator>Polishchuk, E.</dc:creator>
<dc:creator>Cillo, M.</dc:creator>
<dc:creator>Donnici, L.</dc:creator>
<dc:creator>Machado, P.</dc:creator>
<dc:creator>Swuec, P.</dc:creator>
<dc:creator>Settembre, C.</dc:creator>
<dc:creator>Grumati, P.</dc:creator>
<dc:creator>De Francesco, R.</dc:creator>
<dc:creator>Herhaus, L.</dc:creator>
<dc:creator>Cortese, M.</dc:creator>
<dc:date>2026-08-11</dc:date>
<dc:identifier>doi:10.64898/2026.08.10.743971</dc:identifier>
<dc:title><![CDATA[LC3C-ATG4D regulatory axis supports coronavirus replication organelle formation independently of canonical autophagy]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-11</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Coronaviruses hijack host membranes to assemble ER-derived double-membrane vesicles (DMVs) that shield viral RNA replication from the cell intrinsic surveillance. Although DMVs morphologically resemble autophagosomes, whether and how autophagy factors actively support their biogenesis has remained elusive. Here, we identify a non-canonical requirement for the autophagy protein LC3C in {beta}-coronavirus replication. Loss of LC3s impaired viral RNA replication, whereas genetic ablation of ATG7 did not, indicating that canonical ATG7-dependent lipidation is dispensable in this context. Reconstitution experiments showed that only LC3C substantially restored replication in LC3-deficient cells and that LC3C phospho-mutants, differing in accessibility to ATG4-mediated processing, displayed distinct proviral activities. Additionally, ATG4D, the main protease responsible for maintaining the LC3 non-lipidated pool, is selectively required for viral replication. Both ATG4D and LC3s depletion triggers formation of aberrant DMV-like structures and potently suppresses SARS-CoV-2 replication. Ultrastructural analysis of nsp3-nsp4-induced membranes showed that depletion of LC3s or ATG4 proteases altered DMV abundance and morphology, supporting a role for the LC3C-ATG4D axis in replication organelle biogenesis. These data establish that {beta}-coronaviruses repurpose ATG4D-driven LC3C de-lipidation for non-canonical LC3 recruitment to replication organelles, identifying the lipidation state of LC3 as a molecular determinant of replication organelle biogenesis and efficient viral replication.

HighlightsThe manuscript shows that {beta}-coronavirus replication depends on LC3 proteins and particularly on LC3C in reconstitution experiments, that this dependency is independent of ATG7-mediated lipidation, and that ATG4D promotes efficient replication and replication organelle morphology. Together, the data support a model in which a non-canonical LC3C-ATG4D pathway contributes to DMV biogenesis and viral RNA replication.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.07.743616v1?rss=1">
<title>
<![CDATA[
Multiomic and Spatial Profiling of Colorectal Tissue Reveals Viral Persistence and Immune Dysregulation in Long COVID 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.07.743616v1?rss=1"
</link>
<dc:creator>LaFranchi, B.</dc:creator>
<dc:creator>Maison, D. P.</dc:creator>
<dc:creator>Vinden, J.</dc:creator>
<dc:creator>Rodriguez, A. E.</dc:creator>
<dc:creator>Tout, A.</dc:creator>
<dc:creator>Grimbert, L.</dc:creator>
<dc:creator>Velazquez, E.</dc:creator>
<dc:creator>Vudali, U.</dc:creator>
<dc:creator>Poblano, B. A.</dc:creator>
<dc:creator>Dalhuisen, T.</dc:creator>
<dc:creator>Cattle, J.</dc:creator>
<dc:creator>Figueroa, T.</dc:creator>
<dc:creator>Fudotan, Y.</dc:creator>
<dc:creator>Luna, M. A.</dc:creator>
<dc:creator>Ryder, D.</dc:creator>
<dc:creator>Deswal, M.</dc:creator>
<dc:creator>Abel, B. S.</dc:creator>
<dc:creator>Lynch, J.</dc:creator>
<dc:creator>Lipford, A.</dc:creator>
<dc:creator>Razi, N.</dc:creator>
<dc:creator>Steifman, C. B.</dc:creator>
<dc:creator>McCann, H. N.</dc:creator>
<dc:creator>Kataria, N.</dc:creator>
<dc:creator>Girling, V.</dc:creator>
<dc:creator>Thomas, R.</dc:creator>
<dc:creator>Wang, C.</dc:creator>
<dc:creator>Deitchman, A. N.</dc:creator>
<dc:creator>Patel, S.</dc:creator>
<dc:creator>Traglia, M.</dc:creator>
<dc:creator>Tseng, Z. H.</dc:creator>
<dc:creator>Szabo, G.</dc:creator>
<dc:creator>Laszik, Z.</dc:creator>
<dc:creator>Farrow, A.</dc:creator>
<dc:creator>Sumimoto, N.</dc:creator>
<dc:creator>Servellita, V.</dc:creator>
<dc:creator>Hoh, R.</dc:creator>
<dc:creator>Fehrman, E. A.</dc:creator>
<dc:creator>Kelly, J. D.</dc:creator>
<dc:creator>Martin, J. N.</dc:creator>
<dc:creator>Deeks, S. G.</dc:creator>
<dc:creator>Chiu, C. Y.</dc:creator>
<dc:creator>Somsouk, M.</dc:creator>
<dc:creator>Peluso, M. J.</dc:creator>
<dc:creator>Henrich, T. J.</dc:creator>
<dc:date>2026-08-10</dc:date>
<dc:identifier>doi:10.64898/2026.08.07.743616</dc:identifier>
<dc:title><![CDATA[Multiomic and Spatial Profiling of Colorectal Tissue Reveals Viral Persistence and Immune Dysregulation in Long COVID]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-10</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Long COVID (LC) - a chronic condition characterized by persistent, debilitating symptoms following SARS-CoV-2 infection - has emerged as a major public health challenge. Although many interrelated mechanisms have been proposed as drivers of LC, the root causes have yet to be identified, posing significant challenges for therapeutic development. While many blood-based studies have been conducted, they have not yielded conclusive mechanistic insights into LC pathogenesis. Attention has therefore turned toward direct tissue investigation, with the gastrointestinal (GI) tract becoming a major focus due to evidence that virus or viral components can persist at this site for months to years following an episode of COVID-19. Here, we performed a high-dimensional characterization of colorectal tissue and peripheral blood in a highly characterized cohort of 44 people with LC and 13 recovered controls. We profiled SARS-CoV-2 persistence, host immune responses, and tissue inflammation using bulk and single-cell RNA sequencing, nCounter RNA probe hybridization, quantitative PCR, metagenomic next-generation sequencing, plasma proteomics, high-dimensional spectral flow cytometry, in situ-hybridization/immunohistochemistry, and single-cell digital spatial omics. Our results support a model in which LC is driven by long-term immune dysregulation and perturbations of the regulatory gut immune environment which imply ongoing viral persistence, although direct viral detection was only observed in a subset of participants. Specifically, we identify a tissue-based transcriptional environment in which SARS-CoV-2 activates innate myeloid immune signaling, driving chronic inflammation while simultaneously downregulating pathways responsible for immune-mediated clearance of infected cells, including antigen presentation, phagocytosis, cytotoxic immune cell trafficking, and granzyme production. Importantly, signatures in peripheral blood are considerably weaker than those observed in tissue. Together, these findings provide a direct biological rationale for therapeutic strategies in LC aimed at enhancing or redirecting cytotoxic immune function to overcome immune dysregulation and clear persistent viral reservoirs.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.06.743418v1?rss=1">
<title>
<![CDATA[
Protective pan-betacoronavirus neutralizing antibodies by vaccination 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.06.743418v1?rss=1"
</link>
<dc:creator>Zhou, P.</dc:creator>
<dc:creator>Feng, Z.</dc:creator>
<dc:creator>He, W.-t.</dc:creator>
<dc:creator>Zhu, Y.</dc:creator>
<dc:creator>Yuan, M.</dc:creator>
<dc:creator>Li, X.</dc:creator>
<dc:creator>Zhang, Y.</dc:creator>
<dc:creator>Vo, L.</dc:creator>
<dc:creator>Capozzola, T.</dc:creator>
<dc:creator>Callaghan, S.</dc:creator>
<dc:creator>Mishra, N.</dc:creator>
<dc:creator>Avillion, G.</dc:creator>
<dc:creator>Dueker, K.</dc:creator>
<dc:creator>Liang, B.</dc:creator>
<dc:creator>Roy Chowdhury, R.</dc:creator>
<dc:creator>Nedellec, R.</dc:creator>
<dc:creator>Lee, W.-H.</dc:creator>
<dc:creator>Allen, J. D.</dc:creator>
<dc:creator>Walsh, A.</dc:creator>
<dc:creator>Melo, M.</dc:creator>
<dc:creator>McAnarney, E. T.</dc:creator>
<dc:creator>Kumar, N. A.</dc:creator>
<dc:creator>Rinaldi, W.</dc:creator>
<dc:creator>Ferguson, M.</dc:creator>
<dc:creator>Crispin, M. M.</dc:creator>
<dc:creator>Ward, A. B.</dc:creator>
<dc:creator>Irvine, D. J.</dc:creator>
<dc:creator>Alameh, M.-G.</dc:creator>
<dc:creator>Weissman, D.</dc:creator>
<dc:creator>Baric, R.</dc:creator>
<dc:creator>Gralinski, L. E.</dc:creator>
<dc:creator>Wilson, I.</dc:creator>
<dc:creator>Burton, D. R.</dc:creator>
<dc:creator>Andrabi, R.</dc:creator>
<dc:date>2026-08-07</dc:date>
<dc:identifier>doi:10.64898/2026.08.06.743418</dc:identifier>
<dc:title><![CDATA[Protective pan-betacoronavirus neutralizing antibodies by vaccination]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-07</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
The continued emergence of betacoronaviruses underscores the urgent need for vaccines that provide broadly protective immunity. Here, we present an epitope-focused vaccine strategy targeting the conserved S2 stem-helix region of the spike fusion machinery, a broadly neutralizing antibody-(bnAb) epitope shared across betacoronaviruses yet partially occluded on the native spike. Immunization of non-human primates with engineered S2 stem-helix nanoparticle immunogens, alone or followed by a SARS-CoV-2 BA.1 spike mRNA boost, elicited broadly cross-reactive antibody responses against sarbecoviruses, merbecoviruses, and embecoviruses and neutralized SARS-CoV-2, multiple variants, other sarbecoviruses, and MERS-CoV. Vaccine-elicited monoclonal antibodies displayed broad in-vitro neutralizing activity and protected against both SARS-CoV-2 and MERS-CoV in-vivo. Structural analyses revealed conserved features between rhesus and human stem-helix bnAbs, supporting the translational potential. Overall, our findings provide proof-of-concept that epitope-focused nanoparticle immunogens can target partially occluded, immunoquiescent bnAb epitopes, laying the groundwork for pan-betacoronavirus vaccines that provide broad protection and strengthen pandemic preparedness.

ONE SENTENCE SUMMARYEpitope-focused S2 stem-helix nanoparticle immunogens elicit protective broadly neutralizing antibodies (bnAbs) against diverse betacoronaviruses in non-human primates, establishing a framework for development of pan-betacoronavirus vaccines.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.07.743473v1?rss=1">
<title>
<![CDATA[
Phylogeny-aided detection of contamination in nearly 5 million SARS-CoV-2 genomes 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.07.743473v1?rss=1"
</link>
<dc:creator>Anoufa, O.</dc:creator>
<dc:creator>Ly-Trong, N.</dc:creator>
<dc:creator>Goldman, N.</dc:creator>
<dc:creator>De Maio, N.</dc:creator>
<dc:date>2026-08-07</dc:date>
<dc:identifier>doi:10.64898/2026.08.07.743473</dc:identifier>
<dc:title><![CDATA[Phylogeny-aided detection of contamination in nearly 5 million SARS-CoV-2 genomes]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-07</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Contamination can occur during genome sequencing when a contaminant genome is accidentally mixed with the intended genome to be sequenced. Contamination can lead to incorrect consensus genome calling, disrupting analyses of pathogen evolution and transmission. To investigate the extent of this issue, we developed PhyCD, a phylogeny-aided computational approach to investigate contamination in SARS-CoV-2 genome sequencing data. PhyCD masks consensus genome positions associated with suspicious sequencing read coverage drops, then leverages pandemic-scale phylogenetic placement techniques to identify putative contamination events. Applying PhyCD to nearly 5 million SARS-CoV-2 genomes, we identified 10,942 putative contamination events under conservative parameters. Across the flagged genomes, PhyCD flagged -- and so permits masking of -- a total of 64,753 substitutions that could cause errors in downstream genome data analyses.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.04.742335v1?rss=1">
<title>
<![CDATA[
Developing and Characterizing a Murine Model of In Utero Transmission of Ebola Virus 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.04.742335v1?rss=1"
</link>
<dc:creator>Van Ert, H. A. A. M.</dc:creator>
<dc:creator>Henderson, C.</dc:creator>
<dc:creator>Smith, B. J.</dc:creator>
<dc:creator>Richards, P.</dc:creator>
<dc:creator>Kardin, E.</dc:creator>
<dc:creator>Eubank, E.</dc:creator>
<dc:creator>Fakhimi, M.</dc:creator>
<dc:creator>Liebermann, M.</dc:creator>
<dc:creator>Messingham, K.</dc:creator>
<dc:creator>Santillan, M.</dc:creator>
<dc:creator>Schultz, M.</dc:creator>
<dc:creator>Marzi, A.</dc:creator>
<dc:creator>Maury, W.</dc:creator>
<dc:date>2026-08-05</dc:date>
<dc:identifier>doi:10.64898/2026.08.04.742335</dc:identifier>
<dc:title><![CDATA[Developing and Characterizing a Murine Model of In Utero Transmission of Ebola Virus]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-05</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Ebola virus (EBOV) disease (EVD) is a hemorrhagic disease caused by EBOV infection. EVD outcomes in pregnant women are similar to non-pregnant women however, EVD is associated with negative fetal outcomes in [~]99% of cases. There is a critical need for a tractable small animal model to study maternal/fetal transmission of EBOV. We utilized interferon /{beta} receptor knock out mice infected and authentic EBOV or the model virus, recombinant vesicular stomatitis virus encoding EBOV glycoprotein (rVSV/EBOV). Infection with either virus during late pregnancy resulted in placental infection and vertical transmission to the fetus within 2-3 days. Robust levels of maternal and fetal proinflammatory cytokines were evident by day 5 after EBOV infection. Within the placenta, trophoblasts and endothelial cells were viral antigen positive. Elimination of the endosomal receptor NPC1 in junctional zone trophoblasts reduced placental infection and virus transmission to the fetus. These studies establish an infectious model that provides EBOV trafficking and pathogenesis insights during pregnancy.

TeaserThis model provides key insights into how viral trafficking and maternal immune responses drive adverse fetal outcomes during gestational Ebola virus infection.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.05.742966v1?rss=1">
<title>
<![CDATA[
Viral Protease Nsp5 Hijacks La Autoantigen to Orchestrate the Translation to Replication Transition in SARS-CoV-2 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.05.742966v1?rss=1"
</link>
<dc:creator>Sahu, R.</dc:creator>
<dc:creator>Raheja, H.</dc:creator>
<dc:creator>Gaurav S N, G.</dc:creator>
<dc:creator>Paul, S.</dc:creator>
<dc:creator>V, S. S.</dc:creator>
<dc:creator>Ghosh, P. K.</dc:creator>
<dc:creator>Rajmani, R. S.</dc:creator>
<dc:creator>Das, S.</dc:creator>
<dc:date>2026-08-05</dc:date>
<dc:identifier>doi:10.64898/2026.08.05.742966</dc:identifier>
<dc:title><![CDATA[Viral Protease Nsp5 Hijacks La Autoantigen to Orchestrate the Translation to Replication Transition in SARS-CoV-2]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-05</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Viruses genetically encode proteins to regulate their life cycle. To translate this genetic information, most viruses exploit host translation machinery. Host dependency leads to competition between viral RNA and host mRNAs. Most viruses overcome it by inhibiting cap-dependent translation of host mRNAs and shifting its own translation into cap-independent mode. This switch is largely orchestrated by host RNA binding proteins (RBPs) by binding to viral 5UTRs. Here we demonstrate that human La autoantigen (La protein) specifically binds to GCAC sequence near the initiator AUG within the 5UTR of SARS-CoV-2 RNA promoting viral non-structural protein synthesis by cap independent translation, while suppressing replication early in infection. Interestingly, around 18-24 h post-infection, the viral protease Nsp5 cleaves La at a conserved LQ site, abrogating its 5'UTR interaction, which correlates with reduced polysome association and increased viral RNA availability for replication. MD simulation and docking study suggests that the cleavage disrupts La dimerization and truncates its C-terminal intrinsically disordered region, reducing RNA-binding affinity and conformational stability required for translation-competent ribonucleoprotein complexes. Results put forward a unique mechanism by which Nsp5-mediated proteolysis of La drives the temporal switch from translation to replication of SARS-CoV-2.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.05.742921v1?rss=1">
<title>
<![CDATA[
MEGA-ODE: Learning Biologically Structured and Navigable Continuous Perturbation Dynamics from Sparse Omics 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.05.742921v1?rss=1"
</link>
<dc:creator>Xiang, Y.</dc:creator>
<dc:creator>Li, Y.</dc:creator>
<dc:creator>Tian, C.</dc:creator>
<dc:creator>Gu, R.</dc:creator>
<dc:creator>He, F.</dc:creator>
<dc:creator>Wen, H.</dc:creator>
<dc:creator>Xie, L.</dc:creator>
<dc:creator>Zhou, P.</dc:creator>
<dc:date>2026-08-05</dc:date>
<dc:identifier>doi:10.64898/2026.08.05.742921</dc:identifier>
<dc:title><![CDATA[MEGA-ODE: Learning Biologically Structured and Navigable Continuous Perturbation Dynamics from Sparse Omics]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-05</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Perturbation-omics experiments usually measure only a subset of molecular feature, intervention and time space, leaving many response trajectories, perturbation effects and disease- or differentiation-associated transitions unobserved. Here we present MEGA-ODE, a graph-constrained continuous-time framework for reconstructing sparse dynamic omics landscapes, predicting unmeasured molecular states and prioritizing virtual perturbations toward defined biological endpoints. MEGA-ODE integrates molecular-network priors, graph neural ordinary differential equations and context-adaptive mixture-of-experts routing. In L1000 transcriptomic perturbations and CPPA proteomic drug-response data, MEGA-ODE improved held-out-feature and unseen-perturbation prediction over baseline methods, and in SARS-CoV-2 infection time-series data it remained competitive for future-time-point forecasting. In a COVID-19 patient cohort, predicted intermediate profiles improved retrospective disease-stage stratification relative to observed profiles alone, while expert programs highlighted immune and inflammatory signals associated with severity. Across the MAPK drug-response and stem-cell differentiation case studies, graph- and expert-level attributions prioritized perturbation-associated MAPK edges, developmental regulators and TF-target relationships supported by independent promoter-proximal ChIP-seq overlap. In hESC-to-definitive-endoderm differentiation, MEGA-ODE prioritized candidate transcription-factor perturbations predicted to shift 12-36 h profiles toward 96 h definitive-endoderm marker signatures, framing trajectory navigation as a concrete hypothesis-generation task. Together, these results support biologically structured continuous-time modeling for prediction, interpretation and virtual-perturbation prioritization from sparse temporal omics data.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.03.742639v1?rss=1">
<title>
<![CDATA[
Adjuvanted mucosal vaccination enhances protection and prevents influenza virus transmission in the guinea pig model. 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.03.742639v1?rss=1"
</link>
<dc:creator>Yan, V.</dc:creator>
<dc:creator>Park, S.-C.</dc:creator>
<dc:creator>Wiest, M. J.</dc:creator>
<dc:creator>Laghlali, G.</dc:creator>
<dc:creator>d'Acunzo, J. N.</dc:creator>
<dc:creator>Chung, C.</dc:creator>
<dc:creator>Levican, J.</dc:creator>
<dc:creator>El-Ayache, F.</dc:creator>
<dc:creator>Wong, P. T.</dc:creator>
<dc:creator>Schotsaert, M.</dc:creator>
<dc:date>2026-08-04</dc:date>
<dc:identifier>doi:10.64898/2026.08.03.742639</dc:identifier>
<dc:title><![CDATA[Adjuvanted mucosal vaccination enhances protection and prevents influenza virus transmission in the guinea pig model.]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-04</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Influenza virus infects the respiratory mucosa, highlighting the importance of mucosal immunity for early protection and transmission control. Here, we evaluated whether intranasal (IN) vaccination with recombinant trimeric hemagglutinin protein from A/Michigan/45/2015 (triHA) formulated with a combined mucosal adjuvant, nanoemulsion plus IVT, an RNA-based RIG-I agonist (NE/IVT), could protect guinea pigs against heterologous A/Netherlands/602/2009 challenge and reduce viral transmission. To compare mucosal and parenteral immunization, IN triHA/NE/IVT was benchmarked against IN triHA alone, IM triHA/AddaVax (IM triHA/Advx), and standard IM quadrivalent inactivated influenza vaccine (QIV). We also tested whether IN triHA/NE/IVT could boost IM QIV- primed immunity and included animals previously infected with A/Michigan/45/2015 to model pre-existing infection- induced immunity. Transmission was assessed by co-housing naive sentinels with vaccinated, challenged donors. IN triHA/NE/IVT induced systemic humoral responses comparable to IM triHA/Advx while generating superior nasal mucosal IgA responses. Unexpectedly, IM triHA/AddaVax also induced detectable, albeit lower, mucosal IgG and IgA, contrasting with prior mouse data and highlighting species-specific differences. IN triHA/NE/IVT boosting after IM QIV enhanced serum IgG and mucosal IgA compared with QIV prime-boost alone and increased cross-neutralizing activity against antigenically distinct A/Victoria/4897/2022. Both IN triHA/NE/IVT and IN Michigan/15 prior- infection prevented detectable viral shedding after challenge, and naive sentinels co-housed with IN triHA/NE/IVT- vaccinated donors remained seronegative. Together, these findings support NE/IVT as a potential mucosal platform capable of inducing robust systemic and mucosal immunity and boosting IM vaccine-primed responses.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.02.742375v1?rss=1">
<title>
<![CDATA[
Epitope-Focused Immunogens Confer Broad Protection against Coronaviruses 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.02.742375v1?rss=1"
</link>
<dc:creator>Li, M.</dc:creator>
<dc:creator>Chen, Q.</dc:creator>
<dc:creator>Seo, J.</dc:creator>
<dc:creator>Liu, Y.</dc:creator>
<dc:creator>Peng, F.</dc:creator>
<dc:creator>Huang, K.</dc:creator>
<dc:creator>Dai, Z.</dc:creator>
<dc:creator>Chen, C.</dc:creator>
<dc:creator>Zhang, Z.</dc:creator>
<dc:creator>Zhao, J.</dc:creator>
<dc:creator>Wang, Z.</dc:creator>
<dc:creator>Yuan, F.</dc:creator>
<dc:creator>Ma, X.</dc:creator>
<dc:creator>Martinez, D. R.</dc:creator>
<dc:creator>Li, D.</dc:creator>
<dc:date>2026-08-04</dc:date>
<dc:identifier>doi:10.64898/2026.08.02.742375</dc:identifier>
<dc:title><![CDATA[Epitope-Focused Immunogens Confer Broad Protection against Coronaviruses]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-04</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Variable regions in coronavirus spike dominate antibody responses elicited by infection or conventional vaccination and limit induction of broad neutralization. In contrast, conserved S2 elements, including the stem helix (SH) and fusion peptide proximal region (FPPR), are promising but subdominant targets of protective immunity. Here, we employed computational design to generate de novo epitope-focused immunogens that precisely present the SH and FPPR epitopes. Formulated as combinatorial immunogens, this vaccine elicited consistent serum responses with broad reactivity across known human coronaviruses and induced epitope-specific antibodies with broad neutralizing activity. As a heterologous boost, epitope-focused immunogens protected mice against challenge with phylogenetically distinct coronaviruses, including bat SARS-related RsSHC014-CoV and MERS-CoV, establishing a generalizable strategy for precision immune focusing and advancing universal coronavirus vaccine development.
]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.02.742305v1?rss=1">
<title>
<![CDATA[
A single Omicron mutation reshapes ORF3a-driven host-cell remodelling 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.02.742305v1?rss=1"
</link>
<dc:creator>De Lucas, A.</dc:creator>
<dc:creator>Padilla-Blanco, M.</dc:creator>
<dc:creator>Merino-Herran, U.</dc:creator>
<dc:creator>Mendoza-Garcia, L.</dc:creator>
<dc:creator>Perez-Berna, A. J.</dc:creator>
<dc:creator>Lopez-Ayllon, B. D.</dc:creator>
<dc:creator>Scagnetti Zambrano, C.</dc:creator>
<dc:creator>Grigas, J.</dc:creator>
<dc:creator>Alboniga, O. E.</dc:creator>
<dc:creator>Montesinos, J.</dc:creator>
<dc:creator>Chichon, J.</dc:creator>
<dc:creator>Fernandez, O.</dc:creator>
<dc:creator>Mamprin, K.</dc:creator>
<dc:creator>Fernandez-Rodriguez, R.</dc:creator>
<dc:creator>Falcon-Perez, J. M.</dc:creator>
<dc:creator>Martin-Cofreces, N. B.</dc:creator>
<dc:creator>Garcia-Garcia, T.</dc:creator>
<dc:creator>Garrido, J. J.</dc:creator>
<dc:creator>Oliva, M. A.</dc:creator>
<dc:creator>MONTOYA, M.</dc:creator>
<dc:date>2026-08-04</dc:date>
<dc:identifier>doi:10.64898/2026.08.02.742305</dc:identifier>
<dc:title><![CDATA[A single Omicron mutation reshapes ORF3a-driven host-cell remodelling]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-04</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
SARS-CoV-2 ORF3a remodels host membranes, but the structural basis and metabolic consequences of this process remain unclear. Here, we combine complementary imaging approaches to define ORF3a function at nanometric scale, identifying underlying mechanisms, and determining how Omicron variant rewire this activity. ORF3a from the ancestral Wuhan strain disrupts Golgi cisternae, drives the formation of ORF3a dense vesicles, remodels mitochondrial architecture, and promotes lipid droplet expansion. Multi-omics analyses further reveal selective triacylglycerol accumulation linked to DGAT1 upregulation, which we validate pharmacologically through DGAT1 inhibition. In contrast, Omicron ORF3a variant, despite carrying only the Thr223Ile substitution within the {beta}7-{beta}8 loop at the bottom of the  cytosolic domain, induced a dramatic phenotypic shift: ORF3a localizes to multivesicular bodies, preserves Golgi architecture, and fails to induce lipid accumulation. All together, these results identify ORF3a as a regulator of membrane organization and lipid homeostasis, showing how minimal sequence variation rewires host-cell remodelling.

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O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=107 SRC="FIGDIR/small/742305v1_ufig1.gif" ALT="Figure 1">
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]]></description>
</item>
<item rdf:about="https://www.biorxiv.org/content/10.64898/2026.08.02.742360v1?rss=1">
<title>
<![CDATA[
Upregulation of distinct miRNAs in SARS-CoV-2 infected individuals: A differential signature of circulating miRNAs 
]]>
</title>
<link>
https://www.biorxiv.org/content/10.64898/2026.08.02.742360v1?rss=1"
</link>
<dc:creator>Santos de Santana Silva, I. T.</dc:creator>
<dc:creator>Rocha Gadelha, S.</dc:creator>
<dc:creator>Ferraz Fehlberg, H.</dc:creator>
<dc:creator>Barbosa Ferreira, F.</dc:creator>
<dc:creator>de Melo Silva, M.</dc:creator>
<dc:creator>Rezende, R. P.</dc:creator>
<dc:creator>Albuquerque, G. R.</dc:creator>
<dc:creator>Melo Mariano, A. P.</dc:creator>
<dc:creator>Teixeira Dias, J. C.</dc:creator>
<dc:creator>Barbosa Costa, G.</dc:creator>
<dc:creator>Martins Kaneto, C.</dc:creator>
<dc:date>2026-08-04</dc:date>
<dc:identifier>doi:10.64898/2026.08.02.742360</dc:identifier>
<dc:title><![CDATA[Upregulation of distinct miRNAs in SARS-CoV-2 infected individuals: A differential signature of circulating miRNAs]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-08-04</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
COVID-19 exhibits a broad clinical spectrum, from asymptomatic to severe cases, underscoring the need for molecular biomarkers to support surveillance and early intervention. Here, we profiled circulating microRNAs (miRNAs) in plasma samples from individuals with asymptomatic/mild COVID-19 and uninfected controls. Seven miRNAs were significantly upregulated in infected patients (miR-126, miR-146b-5p, miR-223-5p, miR-144-3p, miR-22, miR-146a, and miR-30c). ROC curve analysis revealed heterogeneous diagnostic performance: miR-30c achieved the highest overall discriminatory accuracy (AUC = 0.771) with maximum sensitivity (100.0%), while miR-126 provided the highest specificity (100.0%, AUC = 0.763). Other miRNAs, including miR-146b-5p, miR-223-5p, miR-146a, miR-144-3p, and miR-22, showed intermediate accuracy (AUCs 0.684-0.719), whereas miR-21-5p and miR-155 displayed limited discriminatory power (AUCs 0.606 and 0.517, respectively). Predictive interaction network analysis indicated that the upregulated miRNAs target key immune-related genes (CXCL12, IRAK1, TRAF6, STAT1, JAK1, NOTCH1, SMAD4, and BCL2L11), and functional enrichment revealed convergence with transcriptomic profiles from SARS-CoV-2-infected Calu-3 cells, including FOXO3, JAK2, STAT1, and SIRT1. Collectively, these findings point out for potential miRNA signatures associated with mild, non-hospitalized COVID-19 in a predominantly vaccinated cohort but requiring further investigation as molecular markers of early host responses in larger, independent, and clinically diverse cohorts.

ImportanceCOVID-19 produces a wide range of outcomes, from no symptoms to severe illness, and clinicians still lack simple molecular tools to help identify infections or anticipate a patients course early in the disease. miRNAs are small molecules circulating in blood that help control gene activity, and because their levels change during infection, they can be considered potential biomarkers candidates for blood-based tests. Here, we measured nine circulating miRNAs in individuals with mild COVID-19 and in uninfected individuals, thus finding that seven of them were consistently higher in infected patients, with some distinguishing the two groups quite well. This study also links these miRNAs to genes involved in the immune response against SARS-CoV-2. Our findings, generated in a modestly sized cohort, support further investigation of blood-based microRNA panels as potential candidates to help identify infection and clarify early host responses to SARS-CoV-2, pending validation in larger and more clinically diverse cohorts.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.06.10.26355375v1?rss=1">
<title>
<![CDATA[
Hantavirus Disease in Uruguay: Trends and Mortality Before and During the COVID-19 Pandemic. 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.06.10.26355375v1?rss=1"
</link>
<dc:creator>criscuolo, z.</dc:creator>
<dc:creator>Blanco, L.</dc:creator>
<dc:creator>Ferrara, F.</dc:creator>
<dc:creator>Ciaccio, K.</dc:creator>
<dc:creator>Gomez Carassale, L.</dc:creator>
<dc:creator>Gonzalez Reyes, M.</dc:creator>
<dc:creator>Machado Rivero, B.</dc:creator>
<dc:creator>Sosa Dias, F.</dc:creator>
<dc:creator>Facal Castro, J. A.</dc:creator>
<dc:date>2026-06-11</dc:date>
<dc:identifier>doi:10.64898/2026.06.10.26355375</dc:identifier>
<dc:title><![CDATA[Hantavirus Disease in Uruguay: Trends and Mortality Before and During the COVID-19 Pandemic.]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-06-11</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
IntroductionHantavirus disease is an emerging and potentially severe zoonosis of global distribution. In Uruguay, it is transmitted by rodents inhabiting peridomestic, suburban, and rural areas. Global incidence is estimated at 150,000 to 200,000 cases per year, with up to 300 annual cases in the Americas. Since 1997, Uruguays Ministry of Public Health (MPH) has monitored Hantavirus cardiopulmonary syndrome (HCPS), the most common clinical presentation in the region. By 2019, a total of 271 cases had been identified in the country, with an estimated mortality rate of nearly 50%.

ObjectivesTo describe the clinical, epidemiological, and occupational characteristics of patients with Hantavirus disease in Uruguay during the pre-pandemic (2018-2019) and pandemic (2020-2021) periods.

MethodsA descriptive, cross-sectional, observational study was conducted, including all serologically confirmed cases of Hantavirus infection reported to the MPH between 2018 and 2021. Clinical and demographic data were extracted from the mandatory reporting form for zoonotic diseases. Incidence and case fatality rates were calculated, and factors associated with fatal outcomes were analyzed.

ResultsA total of 58 confirmed cases were identified between 2018 and 2021. Most patients were male (62%), with a mean age of 36.5 years (SD 16). A decline in incidence was observed during 2020-2021, with no significant change in case fatality. Direct rodent exposure was the most frequently associated risk factor. Montevideo and Canelones were the most affected departments. Renal and pulmonary involvement were significantly associated with mortality.

ConclusionHantavirus remains a relevant public health concern in Uruguay. Although a decrease in incidence was observed during the COVID-19 pandemic years, case fatality rates remained high. The findings underscore the need for sustained surveillance and early recognition, particularly in urbanizing regions.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.06.08.26355201v1?rss=1">
<title>
<![CDATA[
A Clinical Predictor of Lung Molecular Endotype Identifies Heterogeneity in Corticosteroid Response in Severe COVID-19: an Emulated Target Trial 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.06.08.26355201v1?rss=1"
</link>
<dc:creator>Sines, B.</dc:creator>
<dc:creator>Hagan, R.</dc:creator>
<dc:creator>Jiang, X.</dc:creator>
<dc:creator>Pavlechko, E.</dc:creator>
<dc:creator>McClain, S.</dc:creator>
<dc:creator>Hunt, X.</dc:creator>
<dc:creator>Florou-Moreno, J.</dc:creator>
<dc:creator>Acquadro, J.</dc:creator>
<dc:creator>Risa, G.</dc:creator>
<dc:creator>Valsaraj, V.</dc:creator>
<dc:creator>Schisler, J.</dc:creator>
<dc:creator>Wolfgang, M. C.</dc:creator>
<dc:date>2026-06-10</dc:date>
<dc:identifier>doi:10.64898/2026.06.08.26355201</dc:identifier>
<dc:title><![CDATA[A Clinical Predictor of Lung Molecular Endotype Identifies Heterogeneity in Corticosteroid Response in Severe COVID-19: an Emulated Target Trial]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-06-10</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundCorticosteroids reduce mortality in severe COVID-19 requiring oxygen or invasive mechanical ventilation, yet emerging data suggest that SARS-CoV-2-associated acute lung injury is biologically heterogeneous and that treatment response may vary across molecularly defined disease states. Lung-derived molecular endotypes of severe COVID-19-associated acute lung injury have been described, but direct molecular profiling is not routinely available at the bedside. We evaluated whether a clinical predictor of previously defined lung molecular endotype identifies heterogeneity in corticosteroid treatment effect among mechanically ventilated patients with COVID-19.

MethodsWe utilized a single-center cohort of 5,000 patients with COVID-19 treated at the University of North Carolina Hospital between January 1, 2020, and December 31, 2022, to emulate a target trial assessing the effect of corticosteroid receipt on mortality, length of stay, and incident organ support. Confounding was addressed through inverse probability of treatment weighting (IPTW). Outcomes for severely ill patients requiring mechanical ventilation were compared to the RECOVERY trial results, with subsequent moderation analysis and stratified analysis by clinically predicted lung molecular endotype and vaccination status. The primary outcome was 28-day mortality. Secondary Outcomes were time to discharge alive and progression to additional organ support.

ResultsThis emulated target trial showed a directionally favorable but non-statistically significant association between corticosteroid treatment and reduced 28-day mortality in patients requiring mechanical ventilation for SARS-CoV-2 infection. A clinical predictor of lung molecular endotype moderated the effect of corticosteroids on 28-day mortality (p-value for interaction 0.038) and identified distinct predicted endotype-specific treatment effect. Corticosteroid treatment was associated with lower 28-day mortality in the predicted Hyper-Inflammatory endotype (OR 0.62, 95% CI 0.39, 0.99) but not in the predicted Metabolic Dysregulation endotype (OR 1.15, 95% CI 0.82, 1.61). We did not detect significant effect modification by vaccination status (p-value for interaction 0.65), although inference was limited by the small, vaccinated subgroup (28-mortality OR 0.78, 95% CI 0.37, 1.65 in vaccinated vs 0.94, 95% CI 0.70, 1.26 in unvaccinated).

ConclusionsIn this target trial emulation of mechanically ventilated patients with severe COVID-19, corticosteroid treatment showed a directionally favorable but non-statistically significant association with reduced 28-day mortality in the overall cohort. However, a clinical predictor of lung molecular endotype identified significant heterogeneity in treatment effect, with benefit concentrated in the predicted Hyper-Inflammatory endotype and no apparent benefit in the predicted Metabolic Dysregulation endotype. These findings support prospective validation of clinically deployable endotype-guided corticosteroid treatment strategies in acute lung injury and ARDS.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.06.09.26355274v1?rss=1">
<title>
<![CDATA[
A risk-of-contagion index using a Bayesian based model for the COVID-19 epidemic in Mexico 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.06.09.26355274v1?rss=1"
</link>
<dc:creator>Corona-Moreno, R.</dc:creator>
<dc:creator>Acuna-Zegarra, M. A.</dc:creator>
<dc:creator>Santana-Cibrian, M.</dc:creator>
<dc:creator>Velasco-Hernandez, J. X.</dc:creator>
<dc:date>2026-06-10</dc:date>
<dc:identifier>doi:10.64898/2026.06.09.26355274</dc:identifier>
<dc:title><![CDATA[A risk-of-contagion index using a Bayesian based model for the COVID-19 epidemic in Mexico]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-06-10</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
During the COVID-19 pandemic, limited testing capacity and reporting delays complicated epidemic surveillance and decision-making in Mexico. We calibrated covidestim, a Bayesian nowcasting model, to estimate the total SARS-CoV-2 infections from reported cases and deaths using Mexican surveillance data. Disease-progression distribution priors were calibrated using Mexico City records and validated through comparisons with national seroprevalence surveys, hospitalization data, and annual reported severe-case rates across all states.

Using the reconstructed estimates of active infections, we implemented an event-based risk framework that quantifies the probability of encountering at least one infectious individual in gatherings of different sizes. This probability was subsequently translated into a four-level epidemiological traffic-light indicator and computed at both state and municipality levels. The resulting estimates revealed substantial spatial heterogeneity that is obscured by state-level aggregation, particularly in states with marked differences between urban and rural municipalities.

To evaluate consistency with public-health indicators, we compared the proposed risk classification with the official Mexican epidemiological traffic-light system, considering interpretable gathering sizes relevant to public-health decision making.

Weekly reports derived from this framework were delivered to policymakers in the State of Queretaro in Mexico, as an anticipation tool for school reopening and public-space management. This demonstrates that this Bayesian reconstruction of infections combined with event-based risk metrics can provide an interpretable and generalizable municipality-level complement to routine surveillance systems, particularly in regions with limited testing capacity and heterogeneous local transmission dynamics.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.06.09.26355264v1?rss=1">
<title>
<![CDATA[
Estimating COVID-19 Cumulative Incidence from Seroprevalence Surveys accounting for Time-Varying Seroreversion: A Fully Bayesian Methodology 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.06.09.26355264v1?rss=1"
</link>
<dc:creator>Owusu-Boaitey, N.</dc:creator>
<dc:creator>Meyer, M. J.</dc:creator>
<dc:creator>Herrera-Esposito, D.</dc:creator>
<dc:creator>Bottcher, L.</dc:creator>
<dc:creator>Lukz, M.</dc:creator>
<dc:creator>Cook, S.</dc:creator>
<dc:creator>Stoto, M. A.</dc:creator>
<dc:creator>Kraemer, J. D.</dc:creator>
<dc:date>2026-06-10</dc:date>
<dc:identifier>doi:10.64898/2026.06.09.26355264</dc:identifier>
<dc:title><![CDATA[Estimating COVID-19 Cumulative Incidence from Seroprevalence Surveys accounting for Time-Varying Seroreversion: A Fully Bayesian Methodology]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-06-10</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Seroprevalence surveys reveal the extent of humoral immunity against pathogens such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and under some circumstances represent cumulative incidence of prior infection. However, antibody waning-or seroreversion- biases these estimates by reducing assay sensitivity in a time-varying manner. Because assay sensitivity decays over time, naively using serosurveys can substantially bias estimates of SARS-CoV-2 cumulative incidence and fatality rates. The Bayesian assay-specific, time-varying sensitivity adjustment developed in this paper can reliably correct for this bias and account for the delay between infection and serosurvey. In seroprevalence studies conducted in the United States in 2020, adjusting for time-varying sensitivity increased cumulative incidence by up to 1.4-fold, with an adjustment of 1.08 for a national study. Our estimates contrast with a previously published 2-fold adjustment that did not account for assay design. This suggests that previous analyses overestimated cumulative incidence by applying seroreversion corrections that did not account for assay-specific effects, or underestimated cumulative incidence by not applying seroreversion corrections. These biases imply fatality rate underestimation and overestimation, respectively. Our model provides a framework for design-specific time-varying sensitivity corrections in seroprevalence surveys for other pathogens.

Topicdiagnostic sensitivity, seroprevalence, SARS-CoV-2, COVID-19
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.06.01.26354267v1?rss=1">
<title>
<![CDATA[
Polypore Mushroom Mycelia for Treatment of Active COVID-19 Infection: A Randomized Clinical Trial 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.06.01.26354267v1?rss=1"
</link>
<dc:creator>Saxe, G.</dc:creator>
<dc:creator>Shubov, A.</dc:creator>
<dc:creator>Smith, C. N.</dc:creator>
<dc:creator>Golshan, S.</dc:creator>
<dc:creator>Shekhtman, T.</dc:creator>
<dc:creator>Wilson, S.</dc:creator>
<dc:creator>Slater, D.</dc:creator>
<dc:creator>Bair, Z. J.</dc:creator>
<dc:creator>Beathard, C.</dc:creator>
<dc:creator>Davis, R. A.</dc:creator>
<dc:creator>MacElhern, L.</dc:creator>
<dc:creator>Kao, L. K.</dc:creator>
<dc:creator>Senowitz, P.</dc:creator>
<dc:creator>Gosnell, N.</dc:creator>
<dc:creator>Buchholz, D.</dc:creator>
<dc:creator>Aguilar-Carreno, H.</dc:creator>
<dc:date>2026-06-09</dc:date>
<dc:identifier>doi:10.64898/2026.06.01.26354267</dc:identifier>
<dc:title><![CDATA[Polypore Mushroom Mycelia for Treatment of Active COVID-19 Infection: A Randomized Clinical Trial]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-06-09</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Use of fungal mycelia, which has antiviral properties, constitutes a novel strategy for addressing existing and newly emerging viral diseases. We evaluated safety and feasibility of fungal mycelia (Fomitopsis officinalis and Trametes versicolor, FoTv) for treatment of COVID-19 and assessed its antiviral effects and potential to reduce symptoms. In a randomized, double-blind, placebo-controlled, dual site (UCSD/UCLA medical centers) clinical trial we examined non-hospitalized patients who contracted mild-to-moderate COVID-19 [&le;] 96 hours, and experienced symptom onset [&le;] nine days, before enrollment. FoTv was safe, well-tolerated, and feasible for COVID-19 treatment. Minor differences in biochemical markers were observed between groups (26 FoTv, 24 Placebo). FoTv significantly reduced the number and severity of symptoms, particularly sore throat/cough, and in vitro SARS-CoV-2 (pseudovirus) cellular infection. In conclusion, FoTv was safe and reduced COVID-19 symptoms and cellular viral infection. Future studies should investigate therapeutic benefits of fungal mycelia for SARS-CoV-2 and other viruses. Clinicaltrials.gov registration:NCT04667247.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.06.05.26353587v1?rss=1">
<title>
<![CDATA[
Computational and Experimental Antibody Affinity and Diagnostic Accuracy Quantification of SARS-CoV-2 SD2 Major Disulfide Loop Analog 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.06.05.26353587v1?rss=1"
</link>
<dc:creator>Pollo, B. A. L. V.</dc:creator>
<dc:creator>Perias, G. A.</dc:creator>
<dc:creator>Aguimatang, R. H.</dc:creator>
<dc:creator>Espiritu, A. P.</dc:creator>
<dc:creator>Ching, D.</dc:creator>
<dc:creator>Idolor, M. I.</dc:creator>
<dc:creator>King, R. A.</dc:creator>
<dc:creator>Climacosa, F. M.</dc:creator>
<dc:creator>Caoili, S. E.</dc:creator>
<dc:date>2026-06-08</dc:date>
<dc:identifier>doi:10.64898/2026.06.05.26353587</dc:identifier>
<dc:title><![CDATA[Computational and Experimental Antibody Affinity and Diagnostic Accuracy Quantification of SARS-CoV-2 SD2 Major Disulfide Loop Analog]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-06-08</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
IntroductionSynthetic oligopeptides provide a rapid and cost-efficient approach to developing antibodies and diagnostics for emerging viral variants.

MethodsThis study computationally and experimentally characterized a synthetic peptide analog of the SARS-CoV-2 spike subdomain 2 major disulfide loop (SD2MDL), designated S621 (CPVAIHADQLTPTWRVYSTC). Binding affinity was computationally estimated using the Heuristic Affinity Prediction Tool for Immune Complexes (HAPTIC), while experimental validation was performed using enzyme-linked immunosorbent assay (ELISA) with rabbit-derived antipeptide antibodies. Clinical diagnostic accuracy testing was done using plasma samples from RT-PCR- confirmed COVID-19 patients and pre-COVID-19 controls.

ResultsS621 demonstrated nanomolar binding affinity [Formula] and high avidity (3.67 nM), closely matching HAPTIC predictions (3.54 nM). Diagnostic evaluation yielded a sensitivity of 89.92% and specificity of 27.79%, corresponding to an overall accuracy of 71.79%.

DiscussionThese findings demonstrate that a single synthetic peptide derived from a conserved spike subdomain can function as a high-affinity surrogate for full-length antigens, supporting its potential application in rapid peptide-based immunodiagnostics.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.06.05.26355009v1?rss=1">
<title>
<![CDATA[
Investigation of the continuous spread of SARS-CoV-2 in the post pandemic time - Insights into the reason for the sustained spread despite the establishment of population immunity 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.06.05.26355009v1?rss=1"
</link>
<dc:creator>Yi, B.</dc:creator>
<dc:date>2026-06-08</dc:date>
<dc:identifier>doi:10.64898/2026.06.05.26355009</dc:identifier>
<dc:title><![CDATA[Investigation of the continuous spread of SARS-CoV-2 in the post pandemic time - Insights into the reason for the sustained spread despite the establishment of population immunity]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-06-08</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
In spite of well-established global immune landscape, SARS-CoV-2 is still able to further spread and continue causing infection waves. The current understanding about the reason behind is limited, and it is still difficult to predict the evolution or spreading tread of SARS-CoV-2. Therefore, it is necessary to investigate whether the establishment of population immunity has changed the virus evolution or spreading pattern.

In this investigation, one overall analysis of the SARS-CoV-2 spreading in the past several years have been carried out through one thorough genomic epidemiology study, with Germany being chosen as one representative location in view of the systemic efforts for genomic surveillance. The growth advantage of a few predominant variants in its early spreading period has been evaluated through a logistic regression model. The results have revealed that the major circulating SARS-CoV-2 variants since 2023 are mainly derived from the Omicron BA.2 family. Since middle of 2024, most predominant variants were produced primarily through recombination, indicating that the evolution derived from recombination might be the major driving force for the continuous spread of SARS-CoV-2 despite the existence of population immunity. Furthermore, the lower growth advantage of recently emerged variants might possibly lead to a tread of reduction in the frequency of infection wave.

The information revealed from this investigation suggests that although short-term spreading tread can be affected by specific virus feature as well as local immunity landscape, the long-term spreading tread is mainly decided by the genomic diversity of the viruses, and can be predicted through phylogenetic and genomic epidemiology investigation. The results have emphasized the importance of maintaining the efforts for genomic surveillance of SARS-CoV-2, which is essential from both medical and research perspectives.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.06.04.26354892v1?rss=1">
<title>
<![CDATA[
Disentangling infectiousness and susceptibility by age group using transmission pair data: a study of SARS-CoV-2 household transmission 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.06.04.26354892v1?rss=1"
</link>
<dc:creator>Leung, K. Y.</dc:creator>
<dc:creator>Miura, F.</dc:creator>
<dc:creator>Backer, J. A.</dc:creator>
<dc:date>2026-06-05</dc:date>
<dc:identifier>doi:10.64898/2026.06.04.26354892</dc:identifier>
<dc:title><![CDATA[Disentangling infectiousness and susceptibility by age group using transmission pair data: a study of SARS-CoV-2 household transmission]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-06-05</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundDifferential contributions to transmission across age groups have been reported for many respiratory infections, including SARS-CoV-2. They are crucial for estimating the impact of age-specific interventions. Disentangling these age-dependent contributions remains challenging, as they may reflect differences in contact rates, biological susceptibility, or infectiousness.

AimWe aim to jointly estimate age-specific per-contact infectiousness and susceptibility and their effect on the impact of age-specific interventions.

MethodsThe age-specific infectiousness and susceptibility were jointly estimated in a Bayesian framework by combining contact data with transmission pair data (who-infected-whom). We applied this approach to 197,840 self-reported household transmission pairs collected in the Netherlands during the COVID-19 pandemic. Using these estimates, we projected the expected impact of school closure and work-from-home measures during the early stages of an epidemic in the absence of other interventions.

ResultsBoth infectiousness and susceptibility to SARS-CoV-2 infection were lowest in children aged 0-9 years and highest in adults over 30 years old, with 2-to 4.5-fold differences between these groups. Projected impacts of age-specific interventions indicated that school closures would reduce the reproduction number by 8% or 29% when age-specific susceptibility and infectiousness were or were not considered, respectively. Conversely, working-from-home policies would lead to reductions of 41% with and 20% without age-specific infectiousness and susceptibility.

ConclusionOur method enables robust estimation of age-specific infectiousness and susceptibility. Accounting for these age heterogeneities is essential for projecting the impact of age-targeted interventions. Our approach is adaptable to other respiratory infections and can guide more tailored public health responses.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.05.23.26353936v1?rss=1">
<title>
<![CDATA[
Cumulative In-Context Learning versus Simple Historical Weighting for Real-Time Geographic Origin Identification of Ongoing Epidemic Waves: A Comparative Evaluation Using Eight COVID-19 Waves in Japan 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.05.23.26353936v1?rss=1"
</link>
<dc:creator>Nakagawa, S.</dc:creator>
<dc:creator>Yamamoto, A.</dc:creator>
<dc:date>2026-05-25</dc:date>
<dc:identifier>doi:10.64898/2026.05.23.26353936</dc:identifier>
<dc:title><![CDATA[Cumulative In-Context Learning versus Simple Historical Weighting for Real-Time Geographic Origin Identification of Ongoing Epidemic Waves: A Comparative Evaluation Using Eight COVID-19 Waves in Japan]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-05-25</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundIdentifying the geographic origin of epidemic waves early is critical for targeted public health responses. Conventional statistical methods for wave origin estimation rely on fixed algorithms applied to case count time-series data and treat each wave independently. Large language models (LLMs) offer a novel alternative through cumulative learning--the ability to incorporate confirmed epidemiological findings from prior waves into predictions for subsequent waves. Whether this approach outperforms conventional statistical baselines in early detection, and whether the same cumulative learning principle can be implemented in transparent statistical methods, remains unknown.

MethodsWe compared three computational approaches across eight COVID-19 epidemic waves in Japan (Waves 2-8, 2020-2023): (1) non-cumulative statistical baselines (B0-B5) treating each wave independently; (2) a cumulative-learning LLM (Claude Haiku) receiving confirmed origins from all prior waves as in-context historical knowledge; and (3) cumulative calculation statistical baselines implementing the identical historical weighting mechanism as a transparent arithmetic score. We additionally evaluated a non-cumulative LLM condition--receiving only current-wave data--to isolate the contribution of intrinsic LLM geographic reasoning from accumulated historical knowledge. All approaches were evaluated at 7, 14, 21, and 28 days after wave onset and validated against genomically confirmed wave origins.

ResultsCumulative calculation statistical baselines (B1, B3) achieved mean F1 = 0.51 at 14 days after wave onset, performing comparably to the cumulative-learning LLM (F1 = 0.52) and outperforming all non-cumulative statistical baselines (F1 = 0.41-0.46). Wave 7 (Omicron BA.5) was correctly identified at 14 days by both methods (F1 = 1.00). Wave 6 (Omicron BA.1) was undetectable by all methods (F1 = 0.00), consistent with an origin outside the domestic surveillance system.

ConclusionsThe cumulative historical weighting mechanism--not LLM reasoning per se--drives performance improvement, as transparent arithmetic implementation matches LLM accuracy. However, the non-cumulative LLM achieves F1 = 0.46 without any historical context, suggesting substantial intrinsic geographic reasoning capacity. These findings advance understanding of when and why in-context learning confers advantage, and provide a deployable, spreadsheet-implementable method for real-time epidemic origin identification requiring no AI infrastructure.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.05.25.26353920v1?rss=1">
<title>
<![CDATA[
Predictors of maternal mental health and coping during the COVID-19 pandemic: A multi-country cross-sectional study 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.05.25.26353920v1?rss=1"
</link>
<dc:creator>Liu, C.</dc:creator>
<dc:creator>Liu, M.</dc:creator>
<dc:creator>Dib, S.</dc:creator>
<dc:creator>Ferrando, M.</dc:creator>
<dc:creator>Kagawa, M.</dc:creator>
<dc:creator>Ongprasert, K.</dc:creator>
<dc:creator>Rougeaux, E.</dc:creator>
<dc:creator>Shukri, N. H. M.</dc:creator>
<dc:creator>Vazquez, A.</dc:creator>
<dc:creator>Wells, J.</dc:creator>
<dc:creator>Fewtrell, M.</dc:creator>
<dc:creator>Yu, J.</dc:creator>
<dc:date>2026-05-25</dc:date>
<dc:identifier>doi:10.64898/2026.05.25.26353920</dc:identifier>
<dc:title><![CDATA[Predictors of maternal mental health and coping during the COVID-19 pandemic: A multi-country cross-sectional study]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-05-25</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Objectives and studyThis study aimed to examine predictors of post-partum maternal mental health (MMH) and coping during COVID-19 lockdown across seven countries (the UK, China, Japan, Malaysia, Mexico, Argentina, and Thailand).

MethodsAn anonymous questionnaire, developed in the UK in English and translated into local languages, was used in 2021-2022 to collect data on MMH and perceived coping ability from women aged [&ge;]18 years with an infant born before or during lockdowns. Five MMH components (worry, sadness, loneliness, difficulty relaxing, annoyance) and coping were assessed on a 4-point Likert scale, then dichotomised. MMH and coping were compared across countries using Chi-square tests with post-hoc pairwise comparisons conducted via Bonferroni-adjusted z-tests. Predictors of MMH and coping were examined using multivariable logistic regression.

ResultsA total of 7,650 women were analysed. Younger infant age, higher income, walking and exercise, and level of support were associated with better MMH and coping, whereas higher education was associated with better coping but poorer MMH. MMH and coping differed across countries (all p<0.001), which remained after adjusting for covariates: mothers in Asian countries reported better MMH, while those in the UK and Thailand reported better coping.

ConclusionsPostpartum MMH and coping during lockdown were shaped by both individual and contextual factors. Findings highlight cross-country differences and underscore the need to strengthen maternal support system during future disruptions to perinatal care.

Key messagesO_LIConsistent predictors of better mental health and coping included younger infant age, higher income, regular physical activity, and enough support-factors that are modifiable and relevant in future public health emergencies.
C_LIO_LICountry of residence remained an independent predictor even after adjusting for individual and social factors, suggesting cultural norms, health service models, and policy responses play important roles.
C_LIO_LIAlthough the COVID-19 pandemic is largely over, the findings offer important lessons for future crises. Strengthening support systems, promoting physical activity, and ensuring equitable caregiving within households can help protect postpartum mothers wellbeing during any major social disruption.
C_LI
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.05.21.26353796v1?rss=1">
<title>
<![CDATA[
TRENDS-Thai: decadal trends of dengue, chikungunya, and hand, foot, and mouth disease in Thailand (2016-2025): a multi-disease time-series analysis of COVID-19 disruption 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.05.21.26353796v1?rss=1"
</link>
<dc:creator>Pongpirul, W.</dc:creator>
<dc:creator>Ahmed, M. M.</dc:creator>
<dc:creator>Pongpirul, K.</dc:creator>
<dc:date>2026-05-24</dc:date>
<dc:identifier>doi:10.64898/2026.05.21.26353796</dc:identifier>
<dc:title><![CDATA[TRENDS-Thai: decadal trends of dengue, chikungunya, and hand, foot, and mouth disease in Thailand (2016-2025): a multi-disease time-series analysis of COVID-19 disruption]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-05-24</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
IntroductionDengue, chikungunya, and hand, foot, and mouth disease (HFMD) are priority notifiable infections in Thailand. Whether vector-borne and contact-mediated diseases responded differently to the coronavirus disease 2019 pandemic has not been quantified within a unified national surveillance framework over an extended period.

MethodsWe conducted an ecological interrupted time-series analysis using weekly province-level notifiable disease surveillance data from epidemiological week 1 of 2016 to week 53 of 2025 across all 77 Thai provinces. Incidence per 100,000 population was calculated using year-specific civil registration population denominators. Segmented quasi-Poisson regression with two Fourier harmonics for annual seasonality was fitted, with the primary pandemic onset defined as week 1 of 2020 and two alternative onset definitions prespecified for sensitivity analysis.

ResultsThe analysis included 40,579 province-week observations across 527 epidemiological weeks, comprising 790,263 dengue, 32,265 chikungunya, and 713,822 HFMD cases nationally. Immediate incidence rate ratios at pandemic onset were 0.39, 0.54, and 0.51 for dengue, chikungunya, and HFMD, respectively. Sustained post-onset trends diverged across diseases, with declining trajectories for the two vector-borne infections and a positive post-onset slope for hand, foot, and mouth disease. Dengue rebounded above pre-pandemic levels by 2023, chikungunya remained quiescent through 2025, and HFMD exceeded its pre-pandemic baseline by approximately 26%.

ConclusionVector-borne and contact-mediated diseases in Thailand followed sharply contrasting decadal trajectories that tracked the transmission ecologies of each pathogen. These findings support transmission-mode-specific pandemic-resilient surveillance, accelerated arboviral and enteroviral vaccine deployment, and integrated vector management.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.05.20.26353686v1?rss=1">
<title>
<![CDATA[
Effect of Antiseptic Mouthwash/Gargling Solutions on SARS-CoV-2 Viral Load: A Randomized Clinical Trial 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.05.20.26353686v1?rss=1"
</link>
<dc:creator>Banava, S.</dc:creator>
<dc:creator>Radaic, A.</dc:creator>
<dc:creator>Pachiyappan, K.</dc:creator>
<dc:creator>Cheng, N. F.</dc:creator>
<dc:creator>Hernandez-Kapila, Y. L.</dc:creator>
<dc:creator>Gansky, S. A.</dc:creator>
<dc:date>2026-05-22</dc:date>
<dc:identifier>doi:10.64898/2026.05.20.26353686</dc:identifier>
<dc:title><![CDATA[Effect of Antiseptic Mouthwash/Gargling Solutions on SARS-CoV-2 Viral Load: A Randomized Clinical Trial]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-05-22</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundThe COVID-19 pandemic has caused significant global mortality. Despite declining infection rates, new variants of SARS-CoV-2 continue to emerge, necessitating new prevention strategies.

ObjectiveThis study aimed to evaluate the effect of four over-the-counter (OTC) antiseptic mouthwash/gargling solutions in the U.S., compared with a distilled water control, on SARS-CoV-2 viral load across multiple oral and oropharyngeal sample types.

MethodsThis pilot single-center randomized controlled clinical trial enrolled adults in the San Francisco Bay Area, California, who tested positive for COVID-19. Participants were randomized to distilled water, chlorine dioxide, hydrogen peroxide, cetylpyridinium chloride, and essential oils. Participants were instructed to rinse and gargle four times daily for four weeks using standardized instructions to ensure protocol adherence. Samples were collected on Days 1, 7, and 28 and analyzed using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The primary outcome was the change in SARS-CoV-2 viral load from baseline to Day 28, assessed using cycle threshold (Ct) values. Secondary outcomes included self-reported clinical symptoms and hospitalization.

ResultsForty-nine participants completed the study. No mouthwash demonstrated a statistically significant reduction in SARS-CoV-2 viral load over time. Cetylpyridinium chloride showed a transient increase in Ct values on Day 7 that was not sustained on Day 28. At baseline, throat swab samples had the lowest Ct values across all sample types. Due to limited subgroup sample sizes for secondary outcome measures, no statistical or moderator analyses were conducted.

ConclusionFurther large-scale randomized trials are needed before recommending antiseptic mouthwashes for SARS-CoV-2 prevention or management.

Trial RegistrationClinicalTrials.gov NCT04409873
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.05.20.26353699v1?rss=1">
<title>
<![CDATA[
Caregiving Demands and Depression Symptoms among Caregivers of Individuals with Down Syndrome during the COVID-19 Pandemic 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.05.20.26353699v1?rss=1"
</link>
<dc:creator>Nguyen, J.</dc:creator>
<dc:creator>Wall, C.</dc:creator>
<dc:creator>Jo, E.</dc:creator>
<dc:creator>Allen, L. K.</dc:creator>
<dc:creator>Wheeler, N.</dc:creator>
<dc:creator>Baumer, N.</dc:creator>
<dc:creator>D'Aguilar, A.</dc:creator>
<dc:creator>York, T. P.</dc:creator>
<dc:creator>Capone, G.</dc:creator>
<dc:creator>Jackson-Cook, C.</dc:creator>
<dc:creator>Amstadter, A. B.</dc:creator>
<dc:creator>Brown, R. C.</dc:creator>
<dc:date>2026-05-22</dc:date>
<dc:identifier>doi:10.64898/2026.05.20.26353699</dc:identifier>
<dc:title><![CDATA[Caregiving Demands and Depression Symptoms among Caregivers of Individuals with Down Syndrome during the COVID-19 Pandemic]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-05-22</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundThis study examined the association between caregiving demands and depression symptoms among caregivers of individuals with Down syndrome during the COVID-19 pandemic.

MethodWe conducted an online survey of 200 caregivers of children and adults with Down syndrome, including demographic data, the Patient Health Questionnaire-8 (PHQ-8), and questions about lack of childcare and taking over instruction during the pandemic. A multiple linear regression analysis identified predictors of caregiver depression symptoms.

ResultsHousehold income (B = -3.45, p < .001) and having to take over instruction (B = 2.24, p < .001) were significant predictors of PHQ-8 scores. Child age, caregiver gender, difficulty paying for health insurance, and lack of childcare were not significant predictors.

ConclusionsLower income and instructional caregiving demands were associated with higher depression symptoms among caregivers of individuals with Down syndrome, suggesting potential targets for policy and intervention during future public health emergencies.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.05.20.26353581v1?rss=1">
<title>
<![CDATA[
A longitudinal cohort study comparing clinical trials registered on ClinicalTrials.gov that stopped during the first three years of the SARS-CoV-2 pandemic with trials that stopped in the three years prior 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.05.20.26353581v1?rss=1"
</link>
<dc:creator>Carlisle, B. G.</dc:creator>
<dc:creator>Hutchinson, N.</dc:creator>
<dc:creator>Moyer, H.</dc:creator>
<dc:date>2026-05-22</dc:date>
<dc:identifier>doi:10.64898/2026.05.20.26353581</dc:identifier>
<dc:title><![CDATA[A longitudinal cohort study comparing clinical trials registered on ClinicalTrials.gov that stopped during the first three years of the SARS-CoV-2 pandemic with trials that stopped in the three years prior]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-05-22</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundThe global SARS-CoV-2 pandemic disrupted healthcare systems worldwide, raising concerns about its impact on clinical research. Early reports suggested reductions in participant enrollment, interruptions to ongoing trials, and challenges to protocol adherence, yet the magnitude and duration of these operational disruptions remain unclear.

MethodsWe conducted a registry-based analysis comparing clinical trials during the COVID-19 pandemic (December 2019 to November 2022) with a matched pre-pandemic cohort (December 2016 to November 2019). Studies were included if they reported any modifications to trial status, enrollment, or protocols during the study periods. Key variables included trial stoppage, enrollment changes, and adoption of remote or hybrid procedures.

ResultsThe global SARS-CoV-2 pandemic resulted in widespread disruptions to trial operations with 13,323 clinical trials terminated, suspended or withdrawn over the course of the pandemic, a 38% increase compared to the 9,665 trials that stopped in the 3 years prior to the pandemic. Registries indicated a sharp decline in new participant enrollment across geographic regions and therapeutic areas, with partial recovery in later months. Review findings highlighted barriers including patient inaccessibility, staff redeployment, and supply chain interruptions.

ConclusionsThe pandemic caused system-wide operational shocks that compromised trial timelines and may have downstream methodological consequences. Recovery in enrollment does not imply restoration of pre-pandemic protocol fidelity or outcome ascertainment. Standardized reporting of disruptions, proactive contingency planning, and resilient trial designs are needed to maintain data integrity during large-scale disruptions and to support reliable evidence generation.

What is newO_LICOVID-19 caused widespread, measurable disruptions to ongoing clinical trials globally, including pauses in enrollment, randomization, and follow-up.
C_LIO_LIRecovery of trial activity was uneven across regions and therapeutic areas, with some trials still experiencing delayed recruitment and operational challenges months into the pandemic.
C_LIO_LIStandardized reporting of trial disruptions and flexible, resilient trial designs are needed to maintain reliable evidence generation during future large-scale health emergencies.
C_LI

Plain language summaryThe COVID-19 pandemic affected the way clinical trials were conducted around the world. Many studies had to stop enrolling new participants, delay treatments, or change how patients were monitored. These interruptions were caused by travel restrictions, social distancing, and limited access to hospitals and research staff. Some studies used phone calls or video visits to continue collecting information, but these changes may have affected the quality of the results. Even as enrollment recovered in some areas, many trials still faced delays and challenges. Understanding these disruptions can help researchers plan better for future emergencies, ensuring that clinical trials remain safe, reliable, and useful for developing new treatments.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.05.20.26353716v1?rss=1">
<title>
<![CDATA[
Ischemic stroke after bivalent mRNA COVID-19 vaccination and influenza vaccination during the 2022-2023 season: a multi-site self-controlled case series study 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.05.20.26353716v1?rss=1"
</link>
<dc:creator>Xu, S.</dc:creator>
<dc:creator>Sy, L. S.</dc:creator>
<dc:creator>Hong, V.</dc:creator>
<dc:creator>Farrington, P.</dc:creator>
<dc:creator>Glenn, S. C.</dc:creator>
<dc:creator>Kim, S.</dc:creator>
<dc:creator>Ryan, D. S.</dc:creator>
<dc:creator>Tubert, J. E.</dc:creator>
<dc:creator>Tong, P.</dc:creator>
<dc:creator>Lewin, B. J.</dc:creator>
<dc:creator>Tseng, H. F.</dc:creator>
<dc:creator>Carbayo, A.</dc:creator>
<dc:creator>Davis, C.</dc:creator>
<dc:creator>Sangha, N. S.</dc:creator>
<dc:creator>Belongia, E. A.</dc:creator>
<dc:creator>Sundaram, M. E.</dc:creator>
<dc:creator>Nelson, J. C.</dc:creator>
<dc:creator>Daley, M. F.</dc:creator>
<dc:creator>Klein, N. P.</dc:creator>
<dc:creator>Fireman, B.</dc:creator>
<dc:creator>Haapala, J.</dc:creator>
<dc:creator>Hurley, L. P.</dc:creator>
<dc:creator>Irving, S. A.</dc:creator>
<dc:creator>Cocoros, N. M.</dc:creator>
<dc:creator>Weintraub, E. S.</dc:creator>
<dc:creator>Duffy, J.</dc:creator>
<dc:creator>Qian, L.</dc:creator>
<dc:date>2026-05-22</dc:date>
<dc:identifier>doi:10.64898/2026.05.20.26353716</dc:identifier>
<dc:title><![CDATA[Ischemic stroke after bivalent mRNA COVID-19 vaccination and influenza vaccination during the 2022-2023 season: a multi-site self-controlled case series study]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-05-22</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundThe Vaccine Safety Datalink (VSD) detected a statistical signal for ischemic events (ischemic stroke or transient ischemic attack) following bivalent mRNA COVID-19 vaccination through prospective surveillance during 2022-2023. Although multiple studies from other surveillance systems and countries reported no increased risk, important methodological limitations remained. This U.S. study addressed those limitations by evaluating the ischemic stroke risk following bivalent mRNA COVID-19 vaccination, influenza vaccination, and their same-day coadministration using event-dependent self-controlled case series (SCCS) design.

MethodsStudy outcomes included first-ever ischemic stroke (primary outcome), first-in-1-year ischemic stroke (secondary outcome), and ischemic events (exploratory outcomes), identified using ICD-10-CM codes in inpatient and emergency department settings during September 1, 2022-March 31, 2023, among individuals aged [&ge;]12 years across eight VSD sites. Analyses were conducted separately for Pfizer-BioNTech and Moderna bivalent vaccines, with relative incidences (RI) and 95% confidence intervals (CI) estimated for 1-21-day and 1-42-day risk intervals, using person-time outside these intervals as the control period. Subgroup analyses were performed by age group (12-64, >65 years) and history of documented SARS-CoV-2 infection.

ResultsA total of 6,510 first-ever ischemic strokes were identified among more than 6.8 million participants. Among recipients of Pfizer-BioNTech bivalent COVID-19 and influenza vaccines, no statistically significant increased risk of first-ever ischemic stroke was observed following bivalent COVID-19 vaccination (RI = 0.94; 95% CI: 0.63-1.41), influenza vaccination (RI = 0.95; 95% CI: 0.82-1.10), or same-day coadministration (RI = 1.15; 95% CI: 0.88-1.49) within 1- 21-day risk intervals; findings were similar for 1-42-day intervals. Comparable null results were observed for Moderna vaccines and across all subgroups, secondary, and exploratory outcomes.

ConclusionNo increased risk of ischemic stroke was found following bivalent mRNA COVID-19 vaccination, influenza vaccination, or their coadministration in this multi-site SCCS study. These findings are consistent with previous studies and underscore the importance of continued vaccine safety monitoring.

HighlightsO_LIWe evaluated ischemic stroke risk after bivalent mRNA COVID-19 vaccination, influenza vaccination, and their coadministration.
C_LIO_LINo increased risk of ischemic stroke was observed within 1-21 or 1-42 days following these vaccination exposures.
C_LIO_LIFindings were consistent across vaccine type, age group, and prior SARS-CoV-2 infection status.
C_LIO_LIThese results support the safety of bivalent mRNA COVID-19 vaccines with respect to ischemic stroke.
C_LI
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.05.19.26353613v1?rss=1">
<title>
<![CDATA[
Fronto-limbic and Thalamocortical Network Alterations after COVID-19 Recovery: a Multimodal MRI Study 
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</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.05.19.26353613v1?rss=1"
</link>
<dc:creator>Mishra, S. S.</dc:creator>
<dc:creator>Misra, R.</dc:creator>
<dc:creator>Douaud, G.</dc:creator>
<dc:creator>Biswal, B.</dc:creator>
<dc:creator>Gandhi, T.</dc:creator>
<dc:date>2026-05-22</dc:date>
<dc:identifier>doi:10.64898/2026.05.19.26353613</dc:identifier>
<dc:title><![CDATA[Fronto-limbic and Thalamocortical Network Alterations after COVID-19 Recovery: a Multimodal MRI Study]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-05-22</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundPersistent neurological and cognitive symptoms following SARS-CoV-2 infection point to long-term alterations in brain structure and function. The thalamus, orbitofrontal cortex, and limbic networks are particularly susceptible to inflammatory and neurovascular stressors. However, the relationship between cortical, white-matter, and thalamocortical alterations in post-COVID syndrome remains unclear.

Methods76 COVID-19 recovered participants (CRPs) and 51 healthy controls (HCs) underwent multimodal MRI comprising T1-weighted structural, diffusion, and resting-state functional acquisitions. Grey-matter morphology was assessed using voxel-based morphometry (VBM), white-matter microstructure using tract-based spatial statistics (TBSS), and thalamocortical functional connectivity (TC-FC) using seed-based analyses from major thalamic nuclei. Results were evaluated both across the groups (HC vs. CRP) and after stratifying CRPs by hospitalisation status (HC vs. Non-hospitalized patients (NHPs) vs. Hospitalized patients (HPs)).

ResultsNo group-level grey-matter differences were observed between HCs and CRPs; however, HPs showed localized volume loss in the orbitofrontal and frontal-pole cortices (pFWE < 0.05). TBSS revealed widespread microstructural abnormalities, including reduced fractional anisotropy and mean diffusivity across association and commissural tracts (pcorr < 0.05), with regional increases in mode of anisotropy indicating selective loss of crossing fibres (pcorr < 0.05). Resting-state analyses revealed increased TC-FC from the mediodorsal thalamic nucleus to anterior cingulate, parietal, and occipital cortices (pcorr < 0.05), while differences in pulvinar and ventrolateral nuclei were not significant (pcorr > 0.05).

ConclusionsOur findings indicate that COVID-19 recovery is associated with enduring alterations in fronto-limbic and thalamo-cortical circuits, most prominently in individuals with severe infection. Convergent structural and functional changes involving the orbitofrontal cortex and mediodorsal thalamus suggest network-specific reorganisation that may underpin persistent cognitive and affective symptoms of post-COVID syndrome.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.05.21.26353568v1?rss=1">
<title>
<![CDATA[
COVID-19 vaccination and the risk of cardiovascular and thromboembolic events after SARS-CoV-2 infection: a systematic review and meta-analysis 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.05.21.26353568v1?rss=1"
</link>
<dc:creator>Heymans, S.</dc:creator>
<dc:creator>Heidecker, B.</dc:creator>
<dc:creator>Marjenberg, Z.</dc:creator>
<dc:creator>Green, R.</dc:creator>
<dc:creator>Pliakas, T.</dc:creator>
<dc:creator>Lip, G. Y. H.</dc:creator>
<dc:creator>Lüscher, T. F.</dc:creator>
<dc:creator>Abduljawad, S.</dc:creator>
<dc:date>2026-05-22</dc:date>
<dc:identifier>doi:10.64898/2026.05.21.26353568</dc:identifier>
<dc:title><![CDATA[COVID-19 vaccination and the risk of cardiovascular and thromboembolic events after SARS-CoV-2 infection: a systematic review and meta-analysis]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-05-22</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
Background and AimsSARS-CoV-2 infection is associated with an increased risk of cardiovascular, cerebrovascular and venous thromboembolism events. We aimed to assess the impact of COVID-19 vaccination prior to SARS-CoV-2 infection on the risk of these events post-infection.

MethodsEmbase and MEDLINE were searched from January 2021 to 11 September 2025, supplemented by citation searching. Observational studies were included if they reported risks of cardiovascular, cerebrovascular, or venous thromboembolic events after SARS-CoV-2 infection between different vaccination groups (e.g. unvaccinated, vaccinated, or booster vaccinated), or reported risk of events after SARS-CoV-2 infection compared with no infection, stratified by vaccination status. Random-effects meta-analyses were conducted to estimate pooled hazard ratios (HRs) comparing vaccinated and unvaccinated individuals across prespecified outcomes.

ResultsTwenty-three studies were included in the systematic review; most reported an association between vaccination and a reduced risk of post-infection vascular events. Ten studies were included across meta-analyses comparing vaccinated and unvaccinated individuals. Pre-infection vaccination was associated with significantly reduced risks of composite cardiovascular/cerebrovascular events (HR 0.60, 95% confidence intervals [CI] 0.51-0.69), stroke (HR 0.75, 95% CI 0.64-0.88), acute coronary syndrome (HR 0.70, 95% CI 0.52-0.95), arrhythmias (HR 0.82, 95% CI 0.69-0.98), and venous thromboembolism (HR 0.51, 95% CI 0.36-0.73). No statistically significant reduction was observed for heart failure (HR 0.72 [95% CI 0.47-1.10]).

ConclusionsPre-infection COVID-19 vaccination is associated with lower risks of cardiovascular, cerebrovascular and venous thromboembolism events following SARS-CoV-2 infection in the pre- and post-Omicron eras, supporting its role within broader prevention strategies.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.05.18.26353507v1?rss=1">
<title>
<![CDATA[
Sexually Transmitted and Bloodborne Infections, Methamphetamine Use, and COVID-19 Vaccination in Manitoba, Canada: A Retrospective Matched Cohort Analysis Using Population-Based Administrative Healthcare Data (2020-2022) 
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</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.05.18.26353507v1?rss=1"
</link>
<dc:creator>Shaw, S. Y. Y.</dc:creator>
<dc:creator>Mahar, A.</dc:creator>
<dc:creator>Bailey, K.</dc:creator>
<dc:creator>Payne, M.</dc:creator>
<dc:creator>Kindrachuk, J.</dc:creator>
<dc:creator>Kelly, C.</dc:creator>
<dc:creator>Friesen, K. J.</dc:creator>
<dc:creator>Bernstein, C. N.</dc:creator>
<dc:creator>Reimer, J.</dc:creator>
<dc:creator>Becker, M. L.</dc:creator>
<dc:creator>McClarty, L. M.</dc:creator>
<dc:creator>Stein, D.</dc:creator>
<dc:creator>Nickel, N. C.</dc:creator>
<dc:date>2026-05-21</dc:date>
<dc:identifier>doi:10.64898/2026.05.18.26353507</dc:identifier>
<dc:title><![CDATA[Sexually Transmitted and Bloodborne Infections, Methamphetamine Use, and COVID-19 Vaccination in Manitoba, Canada: A Retrospective Matched Cohort Analysis Using Population-Based Administrative Healthcare Data (2020-2022)]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-05-21</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
ObjectivesTo examine COVID-19 vaccine uptake among people diagnosed with sexually transmitted and bloodborne infections (STBBI), people with healthcare-documented methamphetamine use, and those experiencing both exposures in Manitoba, Canada.

MethodsWe conducted a retrospective matched-cohort study using linked population-based administrative healthcare, laboratory, and vaccination databases in Manitoba. Individuals aged [&ge;]16 years with laboratory-confirmed chlamydia/gonorrhea (CT/NG), syphilis, HIV, and/or documented methamphetamine use during the four years prior to March 1, 2020 were included in eight exposed cohorts. Each cohort was matched to unexposed comparators on age, sex, geographic region, and income quintile. The primary outcome was receipt of [&ge;]2 COVID-19 vaccine doses between December 1, 2020 and March 31, 2022. Poisson regression models estimated adjusted rate ratios (aRRs) and 95% confidence intervals (95% CIs) for vaccine uptake.

ResultsCompared with matched comparators, most exposed cohorts were less likely to complete the COVID-19 primary vaccine series. Individuals in the Syphilis Only (aRR: 0.83, 95% CI: 0.80-0.86), Syphilis Plus (aRR: 0.77, 95% CI: 0.74-0.79), CT/NG Only (aRR: 0.91, 95% CI: 0.90-0.92), CT/NG Plus (aRR: 0.74, 95% CI: 0.72-0.77), Methamphetamine Only (aRR: 0.71, 95% CI: 0.68-0.73), and Methamphetamine + STBBI cohorts (aRR: 0.64, 95% CI: 0.62-0.67) had significantly lower vaccine uptake. The HIV Only cohort did not differ significantly from matched comparators (aRR: 0.97, 95% CI: 0.93-1.004). Lower uptake was concentrated among individuals living in lower-income areas.

ConclusionsPopulations affected by STBBI, reported methamphetamine use, or both experienced significant inequities in COVID-19 vaccine uptake, particularly those with multiple STBBIs and concurrent substance use. Integrated vaccination approaches linked with HIV, harm reduction, and addiction services may improve vaccine equity during future public health emergencies.

STRENGTHS AND LIMITATIONS OF THIS STUDYO_LIPopulation-based study using objective measures of COVID-19 vaccination.
C_LIO_LIRegression models addressed confounding by age, geographic area, area-level income, healthcare utilization, and previous mental health and alcohol use disorder diagnoses.
C_LIO_LIDoes not capture individuals not interacting with healthcare system.
C_LIO_LIResidual confounding can still be present, with no information on behavioural risk factors for STBBI, race/ethnicity, and individual-level socioeconomic measures.
C_LI
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.05.16.26353381v1?rss=1">
<title>
<![CDATA[
The control gap in long COVID research: a meta-epidemiological analysis 
]]>
</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.05.16.26353381v1?rss=1"
</link>
<dc:creator>Panagiotopoulos, A.-P.</dc:creator>
<dc:creator>Laskaris, A.</dc:creator>
<dc:creator>Tsakri, D.</dc:creator>
<dc:creator>Manoussopoulos, Y.</dc:creator>
<dc:creator>Anastassopoulou, C.</dc:creator>
<dc:creator>Tsakris, A.</dc:creator>
<dc:creator>Ioannidis, J.</dc:creator>
<dc:date>2026-05-21</dc:date>
<dc:identifier>doi:10.64898/2026.05.16.26353381</dc:identifier>
<dc:title><![CDATA[The control gap in long COVID research: a meta-epidemiological analysis]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-05-21</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
ObjectivesTo quantify the frequency of baseline control-group use in published long COVID prevalence studies and assess their key methodological features.

MethodsWe performed a meta-epidemiological assessment of 440 post-acute COVID-19 prevalence publications from an existing systematic review. To evaluate study design and methodological transparency, we extracted data on the inclusion and classification of comparator groups, the exclusive use of self-reported outcome measures, and whether uncontrolled investigations explicitly recognized the omission of a control group as a limitation. In addition, we surveyed by email the corresponding authors of these articles to determine if any supplementary comparative data existed. The protocol was prospectively registered (DOI: 10.17605/OSF.IO/T2UP9).

ResultsAmong 440 studies, 372 (84.5%) reported no control group. Healthy or uninfected comparators were reported in 55 studies (12.5%) and other comparator types in 14 (3.2%); 1 study included both categories. Solely self-reported outcomes were used in 279 studies (63.4%). Among 372 uncontrolled studies, 244 (65.6%) did not explicitly acknowledge the absence of a baseline comparator as a limitation. Corresponding authors of 140 studies (31.8%) responded to the survey; 126 (90.0%) reported no additional comparative data, while 14 (10.0%) mentioned some available comparative datasets (19 additional datasets). Almost all that information (10/14, 17/19) had been already published in other articles not captured by the index systematic review. Studies with controls had modestly higher citation impact (median 7 versus 4 per year, p=0.002).

Conclusions

Most published long COVID prevalence studies lacked comparator groups and relied exclusively on self-reported outcomes without acknowledging this limitation. Direct author contact identified little additional comparator information. Much of the long COVID prevalence literature may therefore be poorly suited to estimating burden attributable specifically to SARS-CoV-2.

Key PointsO_ST_ABSQuestionC_ST_ABSWhat is the frequency of baseline control group inclusion and the reliance on subjective outcomes in published long COVID prevalence studies?

FindingsThis meta-epidemiological analysis demonstrates that over 80% of published long COVID prevalence studies lacked a baseline non-COVID control group. Most of these investigations also relied exclusively on subjective patient-reported outcomes without explicitly acknowledging the absence of a comparator as a limitation.

MeaningThese findings suggest that the majority of the long COVID prevalence literature is poorly suited to accurately estimate the symptom burden specifically attributable to SARS-CoV-2.
]]></description>
</item>
<item rdf:about="https://www.medrxiv.org/content/10.64898/2026.05.19.26353577v1?rss=1">
<title>
<![CDATA[
Predicting Functional Changes in Down Syndrome During the COVID-19 Pandemic: The Role of Biopsychosocial Determinants of Health 
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</title>
<link>
https://www.medrxiv.org/content/10.64898/2026.05.19.26353577v1?rss=1"
</link>
<dc:creator>Jo, E.</dc:creator>
<dc:creator>Wall, C.</dc:creator>
<dc:creator>Allen, L. K.</dc:creator>
<dc:creator>Wheeler, N.</dc:creator>
<dc:creator>Baumer, N.</dc:creator>
<dc:creator>D'Aguilar, A.</dc:creator>
<dc:creator>York, T. P.</dc:creator>
<dc:creator>Capone, G.</dc:creator>
<dc:creator>Jackson-Cook, C.</dc:creator>
<dc:creator>Amstadter, A. B.</dc:creator>
<dc:creator>Brown, R. C.</dc:creator>
<dc:date>2026-05-21</dc:date>
<dc:identifier>doi:10.64898/2026.05.19.26353577</dc:identifier>
<dc:title><![CDATA[Predicting Functional Changes in Down Syndrome During the COVID-19 Pandemic: The Role of Biopsychosocial Determinants of Health]]></dc:title>
<dc:publisher>Cold Spring Harbor Laboratory Press</dc:publisher>
<prism:publicationDate>2026-05-21</prism:publicationDate>
<prism:section></prism:section>
<description><![CDATA[
BackgroundBiopsychosocial factors associated with functional changes, including changes in personality, communication, movement, and weight, were evaluated in individuals with Down syndrome (DS) during the COVID-19 pandemic.

MethodCaregivers of individuals with DS (aged [&ge;]12, n = 118) completed an online survey. Elastic net regression with bootstrap resampling assessed 31 candidate predictors.

ResultsPandemic-related mental health was most strongly associated with functional changes ({beta} = 0.388). Healthcare access barriers were also reliably selected: inability to access mental health treatment, difficulty affording insurance, difficulty accessing specialists, and residing in a low-income health professional shortage area. The model explained 35.2% of variance.

ConclusionsMental health and healthcare access barriers were biopsychosocial correlates of functional changes for people with DS during COVID-19.
]]></description>
</item>
</rdf:RDF>
