The rationale and method for constructing internal control DNA used in pertussis polymerase chain reaction

Improving Quantitative Power in Digital PCR through Digital High-Resolution Melting

Applying digital PCR (dPCR) technology to challenging clinical and industrial detection tasks has become more prevalent because of its capability for absolute quantification and rare target detection. However, practices learned from quantitative PCR (qPCR) that promote assay robustness and wide-ranging utility are not readily applied in dPCR. These include internal amplification controls to account for false-negative reactions and amplicon high-resolution melt (HRM) analysis to distinguish true positives from false positives. Incorporation of internal amplification controls in dPCR is challenging because of the limited fluorescence channels available on most machines, and the application of HRM analysis is hindered by the separation of heating and imaging functions on most dPCR systems. We use a custom digital HRM platform to assess the utility of HRM-based approaches for mitigation of false positives and false negatives in dPCR. We show that detection of an exogenous internal control using dHRM analysis reduces the inclusion of false-negative partitions, changing the calculated DNA concentration up to 52%. The integration of dHRM analysis enables classification of partitions that would otherwise be considered ambiguous "rain," which accounts for up to ∼3% and ∼10% of partitions in intercalating dye and hydrolysis probe dPCR, respectively. We focused on developing an internal control method that would be compatible with broad-based microbial detection in dPCR-dHRM. Our approach can be applied to a number of DNA detection methods including microbial profiling and may advance the utility of dPCR in clinical applications where accurate quantification is imperative.

Laboratory Diagnosis of Pertussis

The introduction of vaccination in the 1950s significantly reduced the morbidity and mortality of pertussis. However, since the 1990s, a resurgence of pertussis has been observed in vaccinated populations, and a number of causes have been proposed for this phenomenon, including improved diagnostics, increased awareness, waning immunity, and pathogen adaptation. The resurgence of pertussis highlights the importance of standardized, sensitive, and specific laboratory diagnoses, the lack of which is responsible for the large differences in pertussis notifications between countries. Accurate laboratory diagnosis is also important for distinguishing between the several etiologic agents of pertussis-like diseases, which involve both viruses and bacteria. If pertussis is diagnosed in a timely manner, antibiotic treatment of the patient can mitigate the symptoms and prevent transmission. During an outbreak, timely diagnosis of pertussis allows prophylactic treatment of infants too young to be (fully) vaccinated, for whom pertussis is a severe, sometimes fatal disease. Finally, reliable diagnosis of pertussis is required to reveal trends in the (age-specific) disease incidence, which may point to changes in vaccine efficacy, waning immunity, and the emergence of vaccine-adapted strains. Here we review current approaches to the diagnosis of pertussis and discuss their limitations and strengths. In particular, we emphasize that the optimal diagnostic procedure depends on the stage of the disease, the age of the patient, and the vaccination status of the patient.

Development of a quantitative polymerase chain reaction method using a live bacterium as internal control for the detection of Listeria monocytogenes

A novel real-time quantitative polymerase chain reaction (Q-PCR) assay was developed for rapid and accurate detection of Listeria monocytogenes. In this Q-PCR assay, a computational DNA random shuffling method was used to design an internal amplification control (IAC) sequence, which was the same in length and G + C content to the hly amplicon. This IAC sequence was inserted into the genome of L. monocytogenes to create a mutant strain named L. monocytogenes-IAC. The LM-IAC was used as an internal control during the PCR assay and produced accurate quantification of L. monocytogenes due to similar DNA extraction and amplification efficiencies between LM-IAC strain and wild-type L. monocytogenes. Quantification by this method was over a 5-log linearity range of initial L. monocytogenes with an R(2) value of 0.9997. This PCR method will provide accurate quantification of L. monocytogenes and can be used in the clinic and food assays for diagnostic purposes.

Selective PCR: a novel internal amplification control strategy for enhanced sensitivity in Salmonella diagnosis

AIMS

The aim of this study was to develop a novel strategy that permits the independent amplification of internal amplification control (IAC) and target sequence using the same set of primers, to improve the sensitivity of diagnostic PCR assays.

METHODS AND RESULTS

The method described here is a Salmonella specific PCR test targeting the quorum sensing gene sdiA. It is based on a large size difference between the IAC and the target and consequently on their different extension time. The results indicate the enhanced sensitivity of this test when compared with the competitive IAC strategy. This is demonstrated through parallel testing of artificially contaminated human faecal samples.

CONCLUSIONS

Utilizing this method, the concentration of the IAC, which often leads to false negative results if the target is present in extremely low concentration owing to competition, does not constitute a critical parameter for the detection limit of a PCR assay.

SIGNIFICANCE AND IMPACT OF THE STUDY

To our knowledge, this is the first report of using extension time as a critical parameter for the sensitivity of a PCR test. A different approach for the construction of an IAC, based on inverse PCR, has also been introduced.

Development of a novel internal control for a real-time PCR for HSV DNA types 1 and 2

BACKGROUND

Detection of herpes simplex virus types 1 and 2 DNA by polymerase chain reaction (PCR) is the method of choice in many laboratories due to improved sensitivity, specificity and turnaround times compared with culture and antigen detection. However, internal controls need to be employed to ensure that inhibitors in samples do not produce false negative results.

OBJECTIVE

We have developed an internal control for our routine diagnostic HSV 1 and 2 LightCycler PCR assay that has identical primer binding sites to the HSV target DNA but an internal sequence derived from plasmid DNA and detected by a different probe and fluorophore combination.

METHODS

Production of the internal control was achieved using a straightforward two-step PCR technique in which plasmid DNA was amplified with HSV-plasmid chimeric primers, followed by amplification of the resulting amplicons with HSV primers and purification for subsequent use.

RESULTS

Both the internal control and viral DNA were amplified in initial tests with 11 tissue-culture HSV 1 and 2 positives (22 in total), with little or no inhibition of the target sequences. A high level (98%) of concordant results were obtained with 272 clinical samples assayed in parallel with and without the internal control.

CONCLUSION

These results are sufficient to justify the incorporation of the internal control into the routine LightCycler HSV DNA assay in our laboratory.

Strategies for the inclusion of an internal amplification control in conventional and real time PCR detection of Campylobacter spp. in chicken fecal samples

To illustrate important issues in optimization of a PCR assay with an internal control four different primer combinations for conventional PCR, two non-competitive and two competitive set-ups for real time PCR were used for detection of Campylobacter spp. in chicken faecal samples. In the conventional PCR assays the internal control was genomic DNA from Yersinia ruckeri, which is not found in chicken faeces. This internal control was also used in one of the set ups in real time PCR. In the three other set-ups different DNA fragments of 109 bp length prepared from two oligos of each 66 bp by a simple extension reaction was used. All assays were optimized to avoid loss of target sensitivity due to the presence of the internal control by adjusting the amount of internal control primers in the duplex assays and the amount of internal control in all assays. Furthermore, the assays were tested against faecal inhibitors to ensure that the internal control and the target PCR had the same sensitivity towards inhibitors.

Bordetella pertussis PCR: simultaneous targeting of signature sequences

The absence of analytical controls for polymerase chain reaction (PCR)-based diagnostic tests for Bordetella pertussis limits their clinical utility. In this study, multiplex PCR simultaneously targeted two specific Bordetella pertussis sequences, the chromosomal repeated insertion sequence IS481 (IS) and the pertussis toxin promoter region (PT). A multi-target hybridization-EIA (Hyb-EIA) method in a 96-well microtiter-plate format was used to detect amplicons. Forty-seven (15%) of the 318 nasopharygeal specimens tested positive for at least one DNA target of B. pertussis by PCR, including the 10 known positive samples by culture and/or direct fluorescent antibody (DFA). Forty-six of the 47 PCR positive samples were considered positive for B. pertussis using the consensus interpretation criteria. Simultaneous detection of multiple chromosomal regions may identify false-positive and -negative results due to analytical variations or potential sequence polymorphism, and uncover a wider range of pathogenic strains.