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PREreview of An assessment of Nano-RECall: Interpretation of Oxford Nanopore sequence data for HIV-1 drug resistance testing

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This review is the result of a Live Review organized and hosted by PREreview and JMIR Publications on September 16, 2022. The call was joined by 10 people, including reviewers, preprint authors, and facilitators.


The authors of this study present a novel integrated bioinformatic pipeline called Nano-RECall custom fit for Oxford Nanopore Technologies (ONT) sequencing—which offers sequencing options that are more affordable with respect to standard Sanger Sequencing/RECall, that can be used to efficiently and more affordably identify drug-resistant cases of HIV. This pipeline for ONT is presented as an alternative to other existing pipelines which do not meet all the specifications compared to Sager’s RECall. Some of the clear advantages of the Nano-RECall pipeline include the fact that the software is openly available, it can run on different operating systems (i.e., Windows, Linux, and Mac), and it has Nanopore specific error correction. To test their new method, the authors used the same HIV 1 subtype C PCR amplicons to compare the outputs of Sanger sequencing using the standard RECall software to the outputs of ONT sequencing using their Nano-RECall bioinformatic pipeline. The comparison revealed that 97.8% of the mutations were detected by both methods, with only a few detected by one but not the other method (true in both directions). Even with some limitations which were discussed by the authors (e.g., the small number of samples tested with only one subtype), this approach is a promising solution, particularly as it is presented as an easier & more cost-effective solution. Below are some comments and feedback collected during the call which we hope will be useful to the authors to improve their manuscript and the delivery of their findings. 

Evidence and Examples: Concerns and Constructive feedback

  • For someone who is not familiar with the standard RECall pipeline it would be beneficial to provide more information about it in the methods section so to help the reader make an informed comparison and interpretation of the results.

  • It may be helpful, if they are available, to include data from users who have used the pipeline, and perhaps include an additional comparison with the currently available pipeline used for ONT sequencing.

  • It would be helpful to provide information about the file type and format needed to be fed into the pipeline would be helpful to a reader and potential user of the methodology.

  • In the introduction the Sanger RECall pipeline is described as one that is complicated as it requires many steps, it requires experts to be used, and is expensive. It would be helpful to present a clear comparison throughout the paper, but especially in the discussion between RECall and Nano-RECall across these characteristics.  

Below are other general suggestions and recommendations to improve on the clarity of the work presented.

Other points and final remarks

The reviewers appreciated the fact that the authors took time to discuss the comparison of their new methodology with current state of the art approaches, as well as the fact that the software is available on GitHub and open for feedback from the community.

Several authors of the preprint were present in the call and contributed to the discussion. The organizing team is grateful to all the participants of the PREreview + JMIR Publications’s Live Review and in particular to the subject matter expert, Dr. George Kolostoumpis and Dr. Susan Egbert for their contribution to the discussion, and to the preprint authors who engaged in this type of collaborative review.

Competing interests

The author of this review is a member of the PREreview team and facilitated the Live Review. They synthesized the notes from the Live Review discussion into this review and also contributed with a few suggestions for the preprint authors.