Impact of G29179T mutation on two commercial PCR assays for SARS-CoV-2 detection

Detection of community-acquired respiratory viruses during COVID-19 pandemic in subtropical region in Japan

PURPOSE

Coronavirus disease 2019 (COVID-19) pandemic changed the dynamics of other community-acquired respiratory viruses (CARVs), however, information regarding the frequency of CARV detection during COVID-19 pandemic in subtropical regions is limited. Additionally, studies comparing the diagnostic accuracy between multiplex and monoplex PCR for the diagnosis of COVID-19 are scarce.

METHODS

We evaluated samples collected from patients suspected of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Okinawa, a subtropical climate in Japan, from March 2020 to March 2021. For SARS-CoV-2, results obtained from monoplex (NIID method) and multiplex (Allplex™ SARS-CoV-2 Assay) PCR were compared.

RESULTS

In total, 744 samples were collected and 238 viruses were detected in 205 specimens, of which 22 showed viral co-infection. Viral co-infection was more common in patients aged 10 and under than in older patients (p = 0.0054). For CARV, 142 viruses were detected in 127 specimens (17.1%), and human rhinovirus (HRV) was most common. Overall concordance rate for two SARS-CoV-2 assays was 94.1%; 7 and 37 specimens were detected only by NIID and Allplex™ SARS-CoV-2 Assay, respectively. The median cycling threshold values of the 44 samples that were only positive for either the NIID or Allplex™ SARS-CoV-2 Assay were 37.91 for E gene, 38.13 for RdRp/S gene, 38.21 for N gene and 39.16 for N2 gene.

CONCLUSION

HRV was continuously detected during COVID-19 pandemic in the subtropical region and viral co-infection was more common in younger patients. For the diagnosis of COVID-19, multiplex PCR was more reliable, especially in samples with low viral load.

SARS-CoV-2 Nucleocapsid Protein Mutations Found in Switzerland Disrupt N-Gene Amplification in Commonly Used Multiplex RT-PCR Assay

At the end of 2021, we observed an increase in N-gene target failures (NGTF) with the TaqPathTM COVID-19 CE-IVD RT-PCR Kit from Thermo Fisher Scientific (TaqPath). We subsequently used whole-genome sequencing (Oxford Nanopore Technology) to identify potential issues with N-gene PCR efficacy. Among 168,101 positive samples with a cycle threshold (CT) value <30 from August 2021 to May 2022, 194 specimens without N-gene amplification by PCR were identified (0.12%). Most NGTF samples originated from a wave of infection attributable to the Delta variant (B.1.617.2) and its sublineages. Sequencing revealed the nucleotide substitution G28922T (A217S) in 151 samples (88.8%). The substitution G215C, a hallmark mutation for Delta lineages, was concurrently present in all of these samples. Ten samples (5.9%) carried the deletion 28,913-28,918 (del214/215), eight samples (4.7%) the deletion 28,913-28,915 (del214) and one sample (0.6%) the deletion 28,892-28,930 (del207-219). Samples showing intact N-gene amplification by PCR lacked these specific mutations, but delayed-type amplification (i.e., partial or pNGTF) was attributable to the exclusive presence of A217S. As the N gene is a common target in many RT-PCR methods for SARS-CoV-2, an in-depth analysis of single-target failures using a combination with viral whole genome sequencing may allow for the identification of diagnostic flaws and eventual new variants.

A mutation responsible for impaired detection by the Xpert SARS-CoV-2 assay independently emerged in different lineages during the SARS-CoV-2 pandemic

BACKGROUND

COVID-19 diagnosis lies on the detection of SARS-CoV-2 on nasopharyngeal specimens by RT-PCR. The Xpert-Xpress SARS-CoV-2 assay provides results in less than one hour from specimen reception, which makes it suitable for clinical/epidemiological circumstances that require faster responses. The analysis of a COVID-19 outbreak suspected in the neonatology ward from our institution showed that the Ct values obtained for the targeted genes in the Xpert assay were markedly different within each specimen (N Ct value > 20 cycles above the E Ct value).

RESULTS

We identified the mutation C29200T in the N gene as responsible for an impairment in the N gene amplification by performing whole genome sequencing of the specimens involved in the outbreak (Omicron variant). Subsequently, a retrospective analysis of all specimens sequenced in our institution allowed us to identify the same SNP as responsible for similar impairments in another 12 cases (42% of the total cases reported in the literature). Finally, we found that the same SNP emerged in five different lineages independently, throughout almost all the COVID-19 pandemic.

CONCLUSIONS

We demonstrated for the first time the impact of this SNP on the Xpert assay, when harbored by new Omicron variants. We extend our observation period throughout almost all the COVID-19 pandemic, offering the most updated observations of this phenomenon, including sequences from the seventh pandemic wave, until now absent in the reports related to this issue. Continuous monitoring of emerging SNPs that could affect the performance of the most commonly used diagnostic tests, is required to redesign the tests to restore their correct performance.

The Mutational Landscape of SARS-CoV-2

Mutation research is crucial for detecting and treating SARS-CoV-2 and developing vaccines. Using over 5,300,000 sequences from SARS-CoV-2 genomes and custom Python programs, we analyzed the mutational landscape of SARS-CoV-2. Although almost every nucleotide in the SARS-CoV-2 genome has mutated at some time, the substantial differences in the frequency and regularity of mutations warrant further examination. C>U mutations are the most common. They are found in the largest number of variants, pangolin lineages, and countries, which indicates that they are a driving force behind the evolution of SARS-CoV-2. Not all SARS-CoV-2 genes have mutated in the same way. Fewer non-synonymous single nucleotide variations are found in genes that encode proteins with a critical role in virus replication than in genes with ancillary roles. Some genes, such as spike (S) and nucleocapsid (N), show more non-synonymous mutations than others. Although the prevalence of mutations in the target regions of COVID-19 diagnostic RT-qPCR tests is generally low, in some cases, such as for some primers that bind to the N gene, it is significant. Therefore, ongoing monitoring of SARS-CoV-2 mutations is crucial. The SARS-CoV-2 Mutation Portal provides access to a database of SARS-CoV-2 mutations.