1. Field of the Invention
The present invention relates to apparatus and methods for concentrating small numbers of target microorganisms found in a large volume of aqueous solution into a smaller volume of solution, followed by selective staining and detection of the target microorganisms.
2. Description of the Related Art
The present inventor has developed techniques and devices for sensitively detecting potentially pathogenic microorganisms (including bacteria, fungi, and protozoa) using Fountain Flow™ cytometry in transparent or translucent fluids.
For example, U.S. Pat. No. 6,765,656 to the present inventor teaches a Fountain Flow™ Cytometer, wherein a sample of fluorescently tagged cells flows up a tube (for example in a flow cell) toward a CCD camera and foreoptics.
There are many and various clinical and industrial applications requiring the detection and/or enumeration of microorganisms in various background matrices (e.g. food, beverages, and body fluids) for quality control and clinical diagnoses. It is common practice to use a dye specific to certain types of microorganism so that it is easy to contrast cells of interest against a background of other particles, including other kinds of cells/microorganisms. This is particularly important in techniques such as Fountain Flow™ cytometry or conventional flow cytometry whereby an automated method is used to detect and count cells of interest based on their fluorescent intensity. In these cases it is common to use one of a variety of stains that is specific to the microorganism of interest, for example an immunolabel, where fluorescent molecules are attached to an antibody specific to the microorganism of interest. However, there are applications where detections of smaller numbers of selected microorganisms in large volumes of water are cost-prohibitive owing to the large volume of expensive dye necessary (e.g. antibody dyes and fluorescent in situ hybridization dyes). With this in mind, it is desirable to produce a method that separates out a smaller volume of fluid containing most of the microorganisms of interest as well as other microorganisms, which may then be dyed with a more expensive dye which labels target microorganisms.
An object of the present invention is to provide apparatus and methods for identifying target microorganisms in a fluid sample. A system according to the present invention first separates out a fraction of the fluid sample containing most of the target microorganisms and then dyes that fraction with a dye specific to the target organisms.
The process is started with a fluid sample containing fluorescent particles (target and non-target). If the particles are not naturally fluorescent, a fluorescent dye may be used to fluoresce them. The separation step is accomplished by passing the sample through a fluorescent detection device. When the detection device detects a fluorescent particle, it temporarily diverts the sample flow exiting the detector into a specimen reservoir. The rest of the time, the sample flow exiting the detector flows into a waste receptacle, such as a reservoir or a drain. The particles that are detected and diverted will generally include most of the target particles, but will also generally include many other particles that also exhibit fluorescence. Whether the target particles are naturally fluorescent, or are dyed with a fluorescent dye, other similar particles will also be false positives during this phase of the process.
The sample portion in the specimen reservoir thus contains a higher concentration of target particles (and non-target particles). The next phase of the process comprises labeling the target particles with a dye specific to the target particles. This allows the target particles to be detected and counted.
The present invention allows fluorescence measurements of specific microorganisms in a fluid sample, in particular blood, blood products, freshwater, and saltwater. These are applications where detection of smaller numbers of target microorganisms in large volumes of water is cost-prohibitive, owing to the large volume of expensive dye necessary to specifically tag the target microorganisms (e.g. antibody dyes and fluorescent in situ hybridization dyes). The process utilizes a less expensive dye (or natural fluorescence) to separate out a smaller volume of specimen containing most of the microorganisms of interest (as well as other microorganisms present). The smaller volume is then dyed with a more expensive dye specific to the target microorganisms and then examined for target microorganisms. The relatively inexpensive dye separates cells from the aqueous sample that include, as a subset, target cells of interest. The invention may use a Fountain Flow™ cytometer (refer to
The embodiments below illustrate examples of apparatus and methods for enumerating target microorganisms found in small numbers in an aqueous solution. First, separation is performed in order to concentrate microorganisms, as well as some non-target microorganisms and detritus, into a much smaller specimen. Then, target microorganisms are specifically tagged and detected/enumerated.
Sample 404 from container 402 is generally an aqueous solution containing a low concentration of target microorganisms, as well as other, non-target microorganisms. These target microorganisms, as well as some non-target microorganisms and detritus (i.e. false positive detections), will be detected by their fluorescence. Some microorganisms are naturally fluorescent, while others require fluorescent tagging with a dye.
Sample 404 is flowed through fluorescent detection device 408 via tubing 406. Fluorescent detection device 408 detects the fluorescent particles and generates a fluorescence detection signal 440. Detection signal 440 is used by processor 442 to generate a flow control signal 444. Flow control signal 444 causes flow control element 414 to divert the sample issuing from detection device 408, via tubing 410 and spout 412, into specimen receptacle 430 for a period after a fluorescent particle is detected. Generally, a small volume of sample containing a fluorescent particle is diverted into specimen reservoir 430, before flow returns to waste receptacle 436. Thus, a fraction of the sample containing most of the target particles (as well as some non-target particles) becomes specimen 432.
The rest of the time, the sample issuing from detection device 408 flows into waste reservoir 436, becoming waste 438 which can generally be discarded.
An example of a flow control element 414 is shown in
Preferably, only a small portion of sample is diverted into specimen reservoir 430 (for example on the order of 1% of the entire sample) so that an expensive dye specific to the target microorganisms can be used sparingly.
In a preferred embodiment, an inexpensive dye, e.g. SYBR Green (Invitrogen, Eugene, Oreg.), is mixed with a relatively large volume of sample 404 (10 ml to 1 liter). After a sufficient period of time has elapsed (usually a few minutes or even less), the sample is run through fluorescence detector 408 (e.g. a Fountain Flow™ cytometer), the output of which flows to flow control element 414 which causes spout 412 to empty into either specimen reservoir 430 or waste receptacle 436. When no fluorescent particles are detected by the Fountain Flow™ cytometer, the flow empties into waste receptacle 436, and when a fluorescent particle is detected, solenoid 416 drives spout 412 over to specimen reservoir 430, which thus collects fluorescent organisms above some threshold brightness. The solenoid can be controlled through an interface by the same processor 442 that is used to detect microorganisms in the Fountain Flow™ cytometry system. For rare cell detection with minimal false positives, specimen reservoir 430 will contain a relatively small amount of liquid specimen 432, which can be stained with a more selective, more expensive secondary stain selected to tag the target particles. Then the particles in specimen reservoir 430 can be measured by epifluorescence microscopy, conventional flow cytometry, Fountain Flow™ cytometry, etc. Examples of this process are shown in
It is preferable that there is not a great deal of dead fluid volume between detection and nozzle 412. If the velocity of particles through the detection device 408 and flow control element 414 were absolutely constant, then it would be possible to position the spout over specimen reservoir 430 for precisely the amount of time necessary to place an extremely small liquid volume containing the detected particle. However, particles will vary in velocity according to their trajectory and orientation in the flow cell and sorter. The optimum means of collecting small volumes of water in specimen reservoir 430 while still collecting most of the detected particles, is to minimize the volume between the detection device 408 and sorter spout 412. These design constraints are discussed in more detail in conjunction with
As an alternative, fluorescence detection signal 440 could function as the flow control signal, removing the necessity of generating the flow control signal separately.
When the concentration of target microorganisms is small, it may not be necessary to be concerned about a second target microorganism passing through the system during T1 or T2. It may sometimes be desirable to continue diverting the sample if a second target microorganism is detected during T2, or to lengthen the upcoming T2 if a second target microorganism is detected during T1.
Specimen 432 is filtered through filter 770 in
Note that in some embodiments it is desirable to concentrate the target particles into a small area on the filter 770, say a few mm on a side, in order to have the particles concentrated into a single microscope field of view. In this case, the output of 764 would be a fine stream rather than a spray as shown.
In
In the embodiment of
Below, two examples of target microorganism enumeration according to the present invention are described.
One application the present invention is to provide an inexpensive, portable, and rapid means for the detection of toxic algae in seawater. Such use can lessen the public health and economic impact of toxic algal blooms, especially in coastal communities, which depend on harvesting fish and shellfish. Early detection will allow steps for mitigation to be put into place to prevent large economic losses, such as the early transfer of infected shellfish to decontamination tanks. Currently available techniques do not allow for the detection of toxic algae in a sufficiently timely way.
FFS (Fountain Flow™Sorting) performs detection and species identification of algae at very low concentrations (<50/liter), which allows sorting algal cells from a large (100-500-ml) sample, based on their autofluorescence (from chlorophyll and other natural fluorochromes found in algae), into a much smaller (˜100-200 μl) subsample that is then stained with a relatively expensive dye for species identification.
One dye of choice would be custom rRNA FISH (Fluorescent in Situ Hybridization) probes specific to the toxic algal species of interest (as described by Metfies et al. in 2006). Peptide nucleic acid (PNA) FISH uses a synthetic fluorescent molecule that binds only to a specific rRNA sequence, designed to identify a specific toxic species.
In one embodiment, specimen 432 is filtered onto a black polycarbonate filter 770, stained with an rRNA FISH dye, and enumerated with an epifluorescence microscope 700 using emission/illumination filters 776, 784, optimized for that dye. In another embodiment the subsample is filtered onto black polycarbonate filter and inserted into a handheld imaging/counting device that performs the counting automatically. As another alternative, The Countess™ from Invitrogen uses a chamber slide, so a portion of the specimen may be examined without filtering. Note that direct filtration/labeling of the primary sample 404 is not practical owing to clogging of filters when significant volumes of seawater are sampled. Filtration results in clogged filters when significant volumes of seawater are sampled.
In this embodiment samples 404 are examined for toxic algae in a multiple-step process: 1) The 100-ml to 1-liter seawater samples are sorted by autofluorescence intensity (at the optimal wavelength bandpasses for chlorophyll a and b). 2) seawater samples 404 are flowed through the Fountain Flow™ Sorter in order to separate (>75%) algal cells into a smaller (˜100 μml) volume (at flow rates of 5-100 ml per minute), which are be filtered onto a polycarbonate (for example) filter 770, 3) algae on the filter will be stained with one or both of the two rRNA FISH probes specific to the two species (for example) of toxic algae being tested, 4) the filter will be examined by direct epifluorescence microscopy 700 for species identification and enumeration.
In two alternate embodiments step 4 is replaced by enumeration using a portable optical (imaging) counter, such as the Countess™ from Invitrogen, or the sample is passed through a Fountain Flow™ cytometer a second time after step 3 above.
The invention described here can be used for the detection of microorganisms in blood and blood products. A family of embodiments can be used for the detection of the Candida fungus in human blood.
Timely and appropriate antibiotic treatment for sepsis has been shown to be critical, significantly decreasing mortality (MacArthur et al., 2004). It has been shown (Kumar et al., 2006) that there is a 7% rise per hour, after the onset of septic shock, in the mortality rate from untreated sepsis in general. Culture-based detection systems represent the current accepted practice in the detection of bacterial/fungal bloodstream infection, but take days to complete.
One particular problem with treatment of fungemia is the high incidence of Candidemia caused by Candida glabrata, which is resistant to fluconazole, the most common drug used to treat Candidemia (Kauffman, 2005). The “Guidelines for Treatment of Candidiasis” (Pappas et al., 2004) recommends that identification of the infecting fungus should be used to guide therapy. They specifically recommend fluconazole for C. albicans (without prior exposure to azole), while other antifungal drugs should be used for C. glabrata. The difference in efficacy, toxicity, and expense of differing drug therapies is important. Thus, any rapid technique or suite of techniques that can identify to the species level are key. The potential cost savings from using appropriate drug therapy in Candidemia patients has been estimated at $1,808 per patient (Forrest et al., 2006).
The embodiment of the invention describe here is to Candidemia diagnosis in septic patients. FFS detects, enumerates and identifies the species of Candida at very low concentrations (<5/ml), which (as above) allows us to sort fungal cells, stained with an inexpensive dye, from a large (10-ml) sample 404 into a much smaller (e.g. 100-μl) specimen 432 that is then stained with more-expensive dyes for species identification. As antibodies for strains of Candida other than Candida albicans are not commercially available, this embodiment would include the use Fluorescent In Situ Hybridization (FISH) dyes for direct microscopic identification once a positive detection is made of Candida in blood (Forrest et al., 2006; Trnovsky et al., 2008). FISH uses a synthetic fluorescent molecule that binds only to a specific rRNA sequence, designed to identify a specific species.
Samples are be examined for Candida in a multiple-step process: 1) The 5-10 ml samples 404 are incubated with a fluorescent fungal cell wall (chitin/cellulose) dye (such as Calcofluor White, Pontamine Fast Scarlet, or Solophenyl Flavine) with reagents to suppress fluorescence from background (especially leukocytes), 2) the stained sample is flowed through the Fountain Flow™ Sorter 408 to separate (>75%) yeast cells into a smaller (˜100 μl) volume specimen 432, which is then filtered onto a polycarbonate filter 770, 3) Candida on the filter is stained with a PNA (peptide nucleic acid) FISH dye specific to one (or more) species of Candida, and 4) the filter is examined by direct epifluorescence microscopy 700 for species identification and enumeration. The PNA FISH dyes are commercially available from AdvanDx (Woburn, Mass.).
The inventor has developed a dye combination to minimize false-positive detections for the primary (pre-sort) detection and has submitted a patent application for this technology (U.S. patent application Ser. No. 12/214,549, incorporated herein by reference).
In this embodiment one could use a PNA FISH assay sold by AdvanDx for the secondary, post-sort, species identification and enumeration. This FDA-approved assay, which differentiates Candida albicans and Candida glabrata, is commonly used to label one cultured colony or 20 μl of liquid culture, and it is cost-effective for identification at these small levels of sample, but it is not viable for detection of low concentrations of Candida in blood (<100 cells/ml), as required for early and rapid detection of Candidemia.
In the standard AdvanDx protocol, 20 μl of liquid culture is placed in a microcentrifuge tube with 0.2 ml of PNA combined fixing/hybridization reagent for Candida albicans and Candida glabrata. (The C. albicans FISH is used with a green FITC fluorochrome, and the C. glabrata FISH is used with a red fluorochrome). The contents are vortexed, incubated at 55 C for 30 min., centrifuged, and washed twice (incubated at 55 C in the wash buffer for 10 minutes each time), and then mounted on a glass slide, dried, and examined by epifluorescence microscope. In the present embodiment, cells are filtered onto a polycarbonate filter 770 for microscopic examination, either before or after FISH staining. This process is executed in samples for which yeast has already been detected using the primary stain.
An important consideration in optimal sorting of particles in a Fountain Flow™ device is timing. In a perfect Fountain Flow™ Sorter the sorting mechanism would be positioned immediately after the portion of the flow cell in which fluorescent detections are made. This would allow for the sorting mechanism to be actuated immediately after detection for a short period of time, and then allowed to return to its default position.
However, in a real system there is a time delay, Δt, between the detection of a fluorescent cell and its passage through the sorting spout. Δt varies from particle to particle because the velocity of the fluid isn't constant across any tubing cross-section, but has a parabolic profile, with a maximum velocity along the axis of the tubing, approaching zero at the tubing walls. It can be shown that 75% of the particles flowing past a point in a cylindrical pipe travel at a velocity between the maximum velocity and 0.25× the maximum velocity. In order to sort particles correctly 75% of the time, the sorter solenoid must be activated (held in the positive sort position) over an appropriate time interval to accommodate particles traveling within this velocity range. This is called the activation time, T1 in
We define the efficiency, Q, of our sorter as the total volume of sample divided by the volume of sample sorted for target cells, when 75% or greater of the cells are sorted correctly. If 1-ml of sample 404 is sorted so that 75% of the cells are in 10-μl of the positively sorted specimen 432 and 25% are in 990-μl of waste fluid, then Q=100. Using the Hagen-Poiseuille relationship one can show that to first order Q does not depend on the fluid flow velocity, but is inversely proportional to the (“dead”) volume between the location where a particle is optically detected and the sorting spout. In general, if one wants to sort rare particles (N per sample) into a subsample ˜1% of the sample volume, then the sorter tubing volume, between where the particle is optically detected and the spout 412, must be no larger than ˜1%/N of the total volume to be sampled. (In other words, a large dead volume leads to an inefficient sort.) For 1 particle/ml in 10-ml samples to be sorted into volumes of 10 μl, then the “dead” volume between detection and spout should also be no more than ˜10 μl.
Returning to
Flow cell 802 comprises a rectangular columnar body 810 with the illumination chamber 820, input channel 804, and output channel 806 on one end (the top in
Illumination chamber 820 is formed between window 818, and the top of body 810. Oval O-ring 814 forms the walls of illumination chamber 820. Hence, input channel 804 leads into chamber 820 at point 805, and output channel 806 leads out of chamber 820 at point 807.
Cell 802 is functionally similar the prior art cell in
Compared to the prior art flow cell of
Preliminary data using our provisional flow sorter prototype, is shown in Table 2 (Havens and Johnson, unpublished). This includes data taken sorting 90-micron Fluoresbrite fluorescent beads (PolySciences, Warrington PA) in distilled water. Because of the large “dead volume” between the flow cell and sorting spout each particle that is sorted is accompanied by ˜100 μl of fluid, several times larger than is possible with the miniaturized flow cell 802 of
It will be appreciated by one versed in the art that there are many possible variations on these designs within the scope of the present invention.
This application claims priority to provisional application for patent No. 61/065,340 filed Feb. 11, 2008.
Number | Date | Country | |
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61065340 | Feb 2008 | US |