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We require not only oxygen and water but also protection against cosmic rays.

Can I replace 'and' with 'comma' in this sentence?

We require not only oxygen, water but also protection against cosmic rays.

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I wouldn't suggest replacing the 'and' with the 'comma' because the sentence has the general format:

We require not only X but also Y.

Instead of 'X' we can use a single item or a list of items. In your case there are two items and therefore 'oxygen and water' was used. Had it been a longer list containing 3 items, the sentence would have read:

We require not only oxygen, water and food but also protection against cosmic rays.

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