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The important role of FCS in SARS-CoV-2 evolution. (A), The number of FCS was varied in different coronavirus. SARS-CoV-2 had F1-3 sites, RaTG13 had F1-2 sites with 96% similarity to SARS-CoV-2, SARS had F2 site, HKU1 and OC43 had F1 site while HKU9-1 had no FCS. (B), the location and number of FCS may play an important role in coronavirus evolution. (C), The sequence of F1 shared high similarity among HKU1, OC43 and SARS-CoV-2, which may be caused by the Furin cleavage site translocation during the evolution of SARS-CoV-2 ancestor and finally resulted its human transmission. (D), F1-3 showed high conservation in different coronavirus, hinting the potential role in virus invasion and replication.

The important role of FCS in SARS-CoV-2 evolution. (A), The number of FCS was varied in different coronavirus. SARS-CoV-2 had F1-3 sites, RaTG13 had F1-2 sites with 96% similarity to SARS-CoV-2, SARS had F2 site, HKU1 and OC43 had F1 site while HKU9-1 had no FCS. (B), the location and number of FCS may play an important role in coronavirus evolution. (C), The sequence of F1 shared high similarity among HKU1, OC43 and SARS-CoV-2, which may be caused by the Furin cleavage site translocation during the evolution of SARS-CoV-2 ancestor and finally resulted its human transmission. (D), F1-3 showed high conservation in different coronavirus, hinting the potential role in virus invasion and replication.

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We found, in our 788 confirmed COVID-19 patients, the decreased rate of severe/critical type, increased liver/kidney damage and prolonged period of nuclear acid positivity during virus dissemination, when compared with Wuhan. To investigate the underlining mechanism, we isolated one strain of SARS- CoV-2 (ZJ01) in mild COVID-19 patient and found th...

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... were three potential FCSs on the S protein. F1, F2 and F3 were separately located in S1/S2, S2 and the N-terminal domain (NTD) of S1 (Figure 4(A)). Further comparative alignment analysis of GZ02 (SARS viral strain), Wuhan-Hu-1 (the earliest sequenced SARS-CoV-2), RaTG13, HKU9-1 (the potential ancestor of SARS and SARS-CoV-2), HKU-1 and OC43 showed that the variation of FCS sequence had certain regularity in coronavirus evolution ( Figure 4(B)). ...
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... F2 and F3 were separately located in S1/S2, S2 and the N-terminal domain (NTD) of S1 (Figure 4(A)). Further comparative alignment analysis of GZ02 (SARS viral strain), Wuhan-Hu-1 (the earliest sequenced SARS-CoV-2), RaTG13, HKU9-1 (the potential ancestor of SARS and SARS-CoV-2), HKU-1 and OC43 showed that the variation of FCS sequence had certain regularity in coronavirus evolution ( Figure 4(B)). In detail, there was no FCS in HKU9-1, but one potential FCS in the F2 locus of GZ02 (Furin score 0.366) showed effective Furin binding capacity [28]. ...
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... OC43 and HKU-1 are much likely to genetically interact with original SARS-CoV-2. This genetic recombination may have caused the original SARS-CoV-2 to acquire an FCS at the F1 site and eventually become highly infectious and pathogenic (Figure 4(C)). We also found a similar FCS on the S protein of MERSCoV. ...
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... mutations may influence the tertiary and quaternary structures of the S protein and finally change the Furin binding capacity. The F1-3 sites were conserved in SARS-CoV-2 and SARS (Figure 4(D)), indicating the importance of mutations in these sites. ...
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... insertion may become a critical point for the animal-to-human change of the host of RaTG13. Sequence alignment revealed that this inserted sequence may arise from the translocation between human coronavirus HKU1 and OC43 (Figure 4). SARS-CoV-2 harbours three FCS (F1-3). ...
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... were 3 potential furin cleavage site (FCS) on S protein, where F1, F2 and F3 separately located in S1/S2, S2 and the N-terminal domain (NTD) of S1 ( Fig 4A). Further comparative alignment analysis on GZ02 (SARS viral strain), Wuhan-Hu-1 (the earliest sequenced SARS-CoV-2), RaTG13, HKU9-1 (the potential ancestor of SARS and SARS-CoV-2) and SARS-CoV-2 (HKU-1 and OC43) showed that FCS exhibited a clear sequence and rule in coronavirus evolution ( Fig 4B). ...
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... were 3 potential furin cleavage site (FCS) on S protein, where F1, F2 and F3 separately located in S1/S2, S2 and the N-terminal domain (NTD) of S1 ( Fig 4A). Further comparative alignment analysis on GZ02 (SARS viral strain), Wuhan-Hu-1 (the earliest sequenced SARS-CoV-2), RaTG13, HKU9-1 (the potential ancestor of SARS and SARS-CoV-2) and SARS-CoV-2 (HKU-1 and OC43) showed that FCS exhibited a clear sequence and rule in coronavirus evolution ( Fig 4B). In detail, there was no FCS in HKU9-1, but one potential FCS in F2 locus of GZ02 (Furin score 0.366) showed effective furin binding capacity 28 . ...
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... and CO43 could cause human upper respiratory tract infection but the symptom was milder than SARS and SARS-CoV-2. Therefore, we reckoned that the ancestor of SARS-CoV-2 may exchange gene with HKU1 or OC43 to obtain FCS in F1 site during evolution to human transmission (Fig 4C). ZJ01 had Glu702 to Lys702 substitution at the site 18 th amino acid behind F1 site, and deletion (Ala771 to -) at the site 37 th amino acid ahead of F2 site. ...
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... mutations may influence the tertiary and quaternary structure of S protein and finally change the Furin binding capacity. F1-3 sites were conservative in SARS-CoV-2 and SARS (Fig 4D), indicating the importance of mutation in these sites. ...
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... 1101 this inserted sequence may arise from the translocation between human coronavirus HKU1 and OC43 (Figure 4). SARS-CoV-2 had three FCS (F1-3), where F1 hydrolyzes S protein to S1 and S2 and promotes virus-cell fusion, F2 hydrolyzes S2 and participates in virus pathogenicity after cell entry, while F3 functions through NTD and promotes adhesion between virus and cell surface. ...

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... SARS-CoV-2 spike (S) glycoprotein plays an integral role in the viral transmission and virulence [3]. The S protein contains two functional subunits, S1 and S2, cleaved by furin protease at the host cell [4]. The S1 subunit contains the receptor binding domain and facilitates the interactions with the host cell surface receptor, Angiotensin-converting enzyme 2 (ACE2) [5,6]. ...
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... FURIN takes on this role in coronaviruses including COVID-19 (70)(71)(72). Since Notch1 has been shown to transcriptionally induce FURIN, Notch signaling may indirectly lead to enhanced viral entry via enhanced FURIN expression (73,74). ...
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... Minimal expression of key receptors required for SARS-CoV-2 entry, including ACE2 and TMPRSS2 in innate immune cells such as monocytes and macrophages, has been recently reported in nonhuman primates [112] and humans [30]. In addition, monocytes can express high levels of CD147 [113], a potential receptor for SARS-CoV-2 entry [114]. ...
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... FURIN takes on this role in coronaviruses including COVID-19 (70)(71)(72). Since Notch1 has been shown to transcriptionally induce FURIN, Notch signaling may indirectly lead to enhanced viral entry via enhanced FURIN expression (73,74). ...
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... Furin is found highly expressed in various tissues like lungs by which SARS-CoV-2 can successfully infect the respiratory system via this convertase and initiate activation of its surface glycoprotein [94]. Similarly, in some sample studies obtained from SARS-CoV-2 infected persons in China, various mutations in the furin cleavage site were observed which ultimately affect the binding ability of S-protein to surface [95]. Thus, this site is an important feature in the pathogenicity of SARS-CoV-2. ...
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... Indeed, this has reflected in the COVID-19 trajectory. 19 For instance, COVID-19 was more severe in Wuhan in the early stage of the pandemic with 32% severe cases and 11% case fatality. 20,21 However, later data from Wuhan showed more mild form of SARS-CoV-2 infection compared to Zhejiang 22 and the entire China. ...
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... Genomic studies of SARS-CoV-2 suggest a phylogenetic relation with RaTG13, an endogenous variant reported in bats, based on the 96.2% identity between the two genomes [4]. Three different variants of SARS-CoV-2 have been reported, which are distributed on Asia, Europe, and America [5], to date accounting for 54 strains [6]. Additionally, among 103 strains of SARS-CoV-2 analyzed by Tang et al. [7], 101 exhibited a complete link between two specific Single Nucleotide Polymorphisms (SNPs): 72 strains exhibited a "CT" haplotype (defined as lineage L, because it is at the Leucine codon) and 29 strains exhibited a "TC" haplotype (defined as lineage S, because it is at the Serine codon) at these two SNPs. ...
... By using Equation (6) in Equation (5), we obtain Equation (7): ...
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