Patent Application
20230110491
The present invention relates to a method for assessing cell viability of bacterial and fungal cells and to a method for the detection of bacterial and fungal cells with specific enzyme activities. The methods of the present invention rely on the real-time measurement of the level of luminescence signal from a luciferase enzyme directly from a growing culture of bacterial or fungal cells. Furthermore, the present invention relates to a method for assessing susceptibility of bacterial cells to antibiotics by measuring ATP levels using a luciferase assay system.
Luciferases are a class of oxidative enzymes, which are able to generate bioluminescent light by means of a chemical reaction with oxygen and a substrate. The most commonly used luciferases are the firefly luciferases. Firefly luciferase catalyzes a two-step oxidation reaction of its specific substrate, D-luciferin, in the presence of Mg2+, O2 and ATP with characteristic light release kinetics. The first step is activation of luciferin by ATP to yield a reactive mixed anhydride (luciferyl-AMP). In the second step, the activated intermediate reacts with molecular oxygen to create a transient dioxetane (oxyluciferin) that breaks down to the oxidized products oxoluciferin and CO2 under emission of visible light (530-640 nm) with a maximal intensity at 560 nm.
Luciferin-luciferase bioluminescence is a highly sensitive detection method used for numerous clinical, diagnostic and research applications. In almost every modern technique, bioluminescence has proven to be superior to traditional chromogenic, fluorogenic and radiolabeling methods. For example, radiolabeling in immunoassays has been almost entirely replaced by bioluminescence for obvious safety and practical reasons, while maintaining comparable levels of sensitivity. Fluorescence detection is also generally surpassed by bioluminescence in terms of sensitivity, selectivity and lower background noise.
The luciferin-luciferase system can, for example, be used in ATP assays, detection of enzyme activities, in vitro reporter gene assays, whole animal imaging (in vivo reporter assay), immunoassays, and pyrosequencing. However, the application of wild-type (WT) beetle luciferases are often limited by insufficient stability of these enzymes at temperatures above 30° C. In addition, the specific conditions of a particular assay may have an inhibiting effect on the luciferase reaction, thereby affecting the assays sensitivity. Therefore, many novel beetle luciferases with promising properties including increased thermostability have been developed in recent years.
A key application of the luciferin-luciferase system is the measurement of ATP in living (viable) cells. Adenosine triphosphate (ATP) is present in all living cells and plays a central role in the energy balance. The intracellular concentration of ATP is tightly regulated and is maintained at a similar level in all cells. When a cell dies, the ATP is completely degraded; ATP levels therefore reflect the presence of living cells. The ATP bioluminescence can therefore be used as a measure of growth (proliferation) of viable cells in culture and/or the impact of substances (e.g., cytotoxic agents or growth regulatory substances) on the viability of cells in culture. Under optimum conditions, light intensity is linearly related to ATP concentration. Cellular ATP is typically measured by lysis of the cells with suitable detergents, which leads to the release of ATP that in turn reacts with the luciferin-luciferase and results in detectable light emission.
Another important application of the luciferin-luciferase system is the detection of a broad range of enzymatic activities by using D-luciferin coupled with enzyme-labile groups as substrates (referred to as “pro-luciferins”). Pro-luciferins can be used, for example, for the detection of specific groups of bacteria expressing a target enzyme that is capable of cleaving the enzyme-labile group to release the luciferase substrate D-luciferin. Then, typically after lysis of the cells, in the presence of ATP, Mg2+ and oxygen present in an assay reaction mixture, the reaction of D-luciferin with luciferase leads to detectable light emission.
The cellular ATP-based cell viability assay and the enzyme activity assay using pro-luciferin substrates generally involve the following steps: 1) incubating a sample containing cells (e.g. bacterial cells) in a liquid culture medium, 2) cell lysis, 3) addition of lysate to luciferase/luciferin assay solution (luciferase, D-luciferin, Mg2+) or luciferase/pro-luciferin assay solution (luciferase, pro-luciferin, Mg2+, ATP), and 4) measurement of luminescence to quantify the number of viable cells (for ATP assay) or to detect the specific enzymatic activity of the target microorganism (for, e.g., the detection of specific groups of bacteria). In order to increase the ease of use and convenience of these assays, it would be desirable to simplify the steps and/or reduce the number of steps.
The assessment of cell viability also plays a key role in antibiotic susceptibility testing (AST). Antibiotic susceptibility testing is used to determine which antibiotic agent will impair cell viability, in particular cell growth. The results from this test will help a healthcare practitioner to determine which antibiotics are likely to be most effective in treating a person's infection. In addition, the results allows the practitioner to choose a narrow-spectrum antibiotic, thereby slowing down the development of antibiotic resistance caused by the incorrect use of broad spectrum antibiotics. Thus, it is increasingly important to specifically test for resistance to shorten treatment times, ensure efficacy and reduce the risk of antibiotic resistance.
The most frequently used AST methods are based on growth inhibition, wherein bacterial growth is assessed, either in agar, by measuring zones of inhibition around a disk or strip impregnated with antibiotic (e.g., by the Etest gradient diffusion method or the disk diffusion test) or by assessing turbidity in liquid media containing a drug (e.g., using the broth microdilution test). These methods, however, are time-consuming because bacteria from a patient's sample must initially be grown to reach a suitable concentration for testing, which typically takes about 18-24 hours. Once the bacteria reach a suitable concentration, the bacteria are exposed to different antibiotics and bacterial growth is determined after several hours of culturing (e.g., 12 hours), typically after overnight culturing. At the earliest, results can be available three days after the sample is taken.
Thus, the biggest drawback of conventional growth dependent AST methods is that they are slow. In addition, the culturing can be difficult to ensure reproducibility. Furthermore, a given test can be limited in the number of antibiotics to be tested, in ease of use, costs and reliability. Therefore, there is a high need for methods suitable for fast and reliable detection of antibiotic susceptibility.
In view of the above, the object of the present invention is to provide improved methods for assessing cell viability, the detection of bacterial or fungal cells with specific enzyme activities, and assessing susceptibility of bacterial cells to antibiotics.
The above object is solved by the provision of luciferase-based methods based on the real-time measurement of the level of a luciferase-generated luminescence signal directly from a growing bacterial or fungal cell culture, which allows for the assessment of cell viability and detection of cells expressing specific enzyme activities in a simple and convenient way. Furthermore, the present invention provides a luciferase-based method for assessing susceptibility of bacterial cells to antibiotics that involves exposing the bacterial cells to an antibiotic and measuring ATP levels using a luciferase assay system.
In a first aspect, the present invention provides a method for assessing cell viability, comprising the following steps:
In a second aspect, the present invention provides a method for the detection of cells with specific enzyme activities, comprising the following steps:
In a third aspect, the present invention relates to a method for assessing susceptibility of bacterial cells to antibiotics, comprising the following steps:
Preferably, the growth medium used in the present invention is a solid growth medium comprising agar or a liquid growth medium comprising complex nutrients at low concentration. Furthermore, the cells are preferably bacterial cells, and the antibiotic is preferably a β-lactam antibiotic.
In a fourth aspect, the present invention provides a container, such as a culture dish, a culture chamber, a vial or tube, or a multi-well plate, comprising a solid or liquid growth medium, wherein the solid or liquid growth medium comprises (i) a luciferase enzyme and D-luciferin, or (ii) a luciferase enzyme, ATP and a pro-luciferin, or (iii) a luciferase enzyme, an antibiotic (e.g., a β-lactam antibiotic) and either D-luciferin or a pro-luciferin.
In a fifth aspect, the present invention relates to the use of a solid or liquid growth medium comprising a luciferase enzyme for the detection of bacterial or fungal cells, in particular for assessing cell viability of bacterial or fungal cells or detecting bacterial or fungal cells with specific enzyme activities, or for assessing susceptibility of bacterial cells to antibiotics.
The solid or liquid growth medium may further comprise D-luciferin as a luciferase substrate. In this case, the solid or liquid growth medium is used for the assessment of cell viability by means of an ATP assay, thereby allowing for the detection of bacterial or fungal cells.
Alternatively, the solid or liquid growth medium may further comprise ATP and a pro-luciferin. In this case, the solid or liquid growth medium is used for the detection of bacterial or fungal cells with (i.e. expressing) specific enzyme activities by means of a coupled enzyme assay. The assay involves the enzymatic conversion of the pro-luciferin into a luciferase substrate (e.g., D-luciferin or D-aminoluciferin) and the enzymatic conversion of the luciferase substrate by a luciferase enzyme to yield luminescence.
In another alternative, the solid or liquid growth medium may further comprise D-luciferin and an antibiotic or, alternatively, a pro-luciferin and an antibiotic. In this case, the solid or liquid growth medium is used for the assessment of susceptibility of bacterial cells to antibiotics by measuring ATP.
In a sixth aspect, the present invention relates to a composition for preparing a liquid or solid agar growth medium, wherein the composition is a solid (e.g., in the form of powders, beads, micronized particles, tablets, coatings, cuttable strips, pearls and the like).
If the composition is intended for preparing a liquid growth medium, the composition comprises luciferase, D-luciferin, nutrients (in particular one, two or all three of peptone, yeast extract and meat extract), and, optionally, a buffer substance, wherein the composition preferably comprises 0.02-0.20 wt. % luciferase, 0.05-0.80 wt. % D-luciferin, one, two or all three of peptone, yeast extract and meat extract, and, optionally, a buffer substance.
If the composition is intended for preparing a solid agar growth medium, the composition comprises luciferase, D-luciferin, nutrients (in particular one, two or all three of peptone, yeast extract and meat extract), agar and, optionally, a buffer substance, wherein the composition preferably comprises 0.01-0.10 wt. % luciferase, 0.02-0.40 wt. % D-luciferin, 30-70 wt. % agar, and one, two or all three of peptone, yeast extract and meat extract, and, optionally, a buffer substance.
Preferred embodiments of the present invention are set forth in the appended claims. Further embodiments and other objects, advantages and features of the present invention will become apparent from the following detailed description of the invention and the examples.
The present invention is further illustrated by reference to the following figures:
In light of the object of the present invention, the present disclosure provides methods for the detection of live bacterial and fungal cells, in particular for assessing cell viability of bacterial and fungal cells and detecting bacterial and fungal cells with specific enzyme activities, by use of a luciferase enzyme, which methods are improved compared to the currently available methods.
An important advantage of the methods according to the present invention is that the luciferase enzyme can be added directly to conventional growth media, thereby enabling online (real-time) assay formats. This means that the level of (bio)luminescence generated by the action of the luciferase enzyme, which correlates with cell growth, can be conveniently measured, either continuously or intermittently, in real-time during culturing and growth of the cells. Furthermore, no lysis of cells is required as compared to standard endpoint assays, which renders the methods of the present invention less burdensome, simpler and less expensive.
Moreover, the present invention provides a luciferase-based method for assessing susceptibility of bacterial cells to antibiotics. This method of antibiotic susceptibility testing (AST) is based on the surprising finding that bacteria (e.g., E. coli), despite a lack of cell growth, release ATP faster and in greater quantities when exposed to the antibiotic (e.g., ampicillin) than bacteria that are not exposed to the antibiotic. Bacterial strains that are resistant to the antibiotic show no such behavior.
The advantages of the AST method of the present invention lie in the simplicity and reduced test time. The short test time is a key advantage of the present invention because time is critically important in antibiotic susceptibility testing to ensure effective antibiotic treatment in a timely manner. In addition, rapid AST results allows for quicker administration of narrow-spectrum antibiotics, which are generally less expensive and have a lower risk of side effects and inducing antibiotic resistance.
In a first aspect, the present invention relates to a method for assessing cell viability, comprising the following steps:
The method according to the first aspect of the invention is based on the principle that the level of cellular ATP in the medium correlates with the detectable level of luminescence generated by the luciferin-luciferase system that requires ATP as a co-substrate (ATP-based cell viability method). The term “cellular ATP”, as used herein, refers to cell-derived ATP that is synthesized by the cells during growth (e.g., in step (b) of the method). External ATP, i.e. ATP added to the medium or ATP present in the sample (e.g. as a contaminant), is not covered by the term “cellular ATP”. It is believed that the cellular ATP in the medium is the result of leakage of intracellular ATP into the surrounding medium. Although the amount of leaked ATP is low, it is sufficient to result in a reliably detectable luminescent signal.
As used herein, the term “cell viability” or “viability” refers to the metabolic activity of living cells, which can be assessed, e.g., by measuring adenosine triphosphate (ATP). ATP is present in all living cells and its intracellular concentration is highly regulated and maintained at a similar level in all cells. When a cell dies, the ATP is completely degraded. Thus, the ATP levels not only reflect the presence of living cells, but also correlate with the number of living cells.
The term “living cells” is generally used interchangeably herein with “live cells” or “viable cells” and refers to cells that are metabolically active (e.g., produce ATP) and are generally able to grow. In connection with the present invention, the terms “cell growth” and “proliferation” may be used interchangeably used and refer to the increase in cell number.
The “cells” used herein are not particularly limited and generally include one or more of single cells, cells comprising cellular aggregates, or an organized structure or network of cells forming a tissue. In the context of the present invention, the cell(s) is/are bacterial cell(s) or fungal cell(s) including yeast and mold cells. Preferably, the cells are bacterial cells.
The bacterial cells may be selected from the group consisting of Salmonella spp. (e.g., S. enterica), Listeria spp. (e.g., L. monocytogenes), Staphylococcus spp. (e.g., S. aureus), Streptococcus spp. (e.g., S. pyogenes, S. agalactiae), Pseudomonas spp. (e.g., P. aeruginosa), Klebsiella spp. (e.g., K. pneumonia), Camplylobacter spp. (e.g., C. jejuni, C. coli, C. lari), Bacillus spp. (e.g., B. cereus), Clostridium spp. (e.g., C. perfringens, C. difficile), Mycobacterium spp. (e.g., M. tuberculosis), Enterococcus spp. (e.g. E. faecalis), Citrobacter spp. (e.g., C. diversus), Vibrio spp. (e.g., V. cholerae), Prevotella spp. (e.g., P. brevis), Shigella spp. (e.g., S. flexneri), Legionella spp. (e.g., L. pneumophilia), Escherichia spp. (e.g., E. coli). Preferably, the bacterial cells are Staphylococcus spp., Salmonella spp., or Escherichia coli.
The fungal cells may be selected from Aspergillus spp. (e.g., A. niger) and yeasts including Candida spp. (e.g., C. albicans), Saccharomyces spp. (e.g., S. cerevisiae) and Pichia spp. (e.g., P. kluyveri). Preferably, the fungal cells are selected from Candida spp., Saccharomyces spp., and Aspergillus spp.
In step (a) of the method of the present invention, a sample containing cells (i.e. bacterial cells or fungal cells) is applied on a solid growth medium, wherein said solid growth medium comprises a luciferase enzyme and D-luciferin as a luciferase substrate. Alternatively, a sample containing cells is contacted with a liquid growth medium, a luciferase enzyme and D-luciferin as a luciferase substrate. The fact that the luciferase enzyme and luciferase substrate are present in the solid or liquid growth medium is an important aspect of the present invention since this allows for the real-time determination of ATP during culturing/growth of the cells by means of measuring the luminescence signal.
Within the present invention, the term “growth medium” is used herein to mean a liquid solution which is used to provide sufficient nutrients (e.g., carbon- and energy sources, vitamins, amino acids, essential nutrients, salts, and the like) and properties (e.g., osmolarity, buffering) to maintain live cells, such as bacterial and fungal cells, and support their growth. The growth medium may herein also referred to as “nutrient growth medium”. The growth medium used in connection with the present invention can be a solid or liquid growth medium. The term “solid growth medium”, as used herein, is intended to include solid as well as semi-solid growth media like a gel-like growth medium (e.g., an agar-based medium). Preferably, the solid growth medium used herein comprises agar, i.e. the solid growth medium is preferably an agar growth medium. A solid growth medium may also include film formats where the culture medium is on a foil (like Petrifilm™ of 3M).
The term “agar”, as used herein, means a gelatinous substance, generally derived from algae. In particular, the term “agar” as used herein may refer to one or more members of a family of compounds derived from polysaccharide agarose, which forms the cell walls of algae called agarophytes. In most instances, agar includes a mixture of two polysaccharides, i.e. agarose and agaropectin, with agarose generally making up a higher proportion of the mixture. Agarose is a linear polymer, made up of repeating units of agarobiose, a disaccharide made up of D-galactose and 3,6-anhydro-L-galactopyranose. Agaropectin is a heterogeneous mixture of smaller molecules, and is made up of alternating units of D-galactose and L-galactose heavily modified with acidic side-groups, such as sulfate and pyruvate.
Both the solid growth medium and the liquid growth medium used in the present invention may comprise peptone, meat extract, yeast extract, or any mixture of two or more thereof. Suitable growth media for use herein include, without limitations, common commercially prepared media such as Nutrient Agar, Luria Bertani (LB) agar and broth, Mac Conkey agar, Lauryl Sulfate Broth, Sabouraud Dextrose (SD) agar and broth, and Yeast medium (YM) broth.
The D-luciferin may be used in any form, e.g. in its free acid form or in its salt from. Preferably, the D-luciferin is used in its free acid form.
Within the framework of the present invention, the luciferase enzyme is generally a thermostable luciferase. The term “thermostable” as used herein in connection with the luciferase enzyme means that the luciferase is resistant to irreversible inactivation (e.g. due to irreversible changes in its chemical structure such as denaturation) at elevated temperatures, particularly at a temperature of 30-45° C. or 35-40° C., and more particularly at about 37° C.
Further, the thermostable luciferase is preferably a modified firefly luciferase, in particular a modified luciferase derived from (wild-type) Photuris pennsylvanica or Photinus pyralis luciferase. In particular, the thermostable luciferase is preferably derived from the luciferase of P. pennsylvanica and, more preferably, has an amino acid identity of at least 80%, in particular at least 85%, at least 90% relative to the wild-type amino acid sequence of luciferase from P. pennsylvanica.
As used herein the term “amino acid identity” of two related amino acid sequences, expressed as a percentage, refers to the number of positions in the two optimally aligned sequences which have identical residues (×100) divided by the number of positions compared. A gap, i.e. a position in an alignment where a residue is present in one sequence but not in the other, is regarded as a position with non-identical residues. The “optimal alignment” of two sequences is found by aligning the two sequences over the entire length. Two identical sequences have a sequence identity of 100%. Aligned sequences of amino acid residues are typically represented as rows within a matrix. Gaps are inserted between the residues so that identical or similar characters are aligned in successive columns. In order to determine the sequence identity the Needleman and Wunsch global alignment algorithm (Needleman and Wunsch, 1970, J. Mol. Biol. 48(3):443-453) of the European Molecular Biology Open Software Suite (EMBOSS, Rice et al., 2000, Trends in Genetics 16(6): 276-277; see e.g. http://www.ebi.ac.uk/emboss/align/index.html) using default settings (gap opening penalty=10 (for proteins) and gap extension penalty=0.5 (for proteins)) can be employed. EBLOSUM62 can be used as the default scoring matrix.
Preferably, the thermostable luciferase used in the present invention is a luciferase enzyme that retains at least 20%, at least 40%, at least 70%, at least 80%, at least 90% or at least 95% activity after incubation for 1 hour at 60° C. in an aqueous buffer solution at pH 7.8. In particular, the thermostable luciferase used herein is a luciferase enzyme characterized in that it retains at least 20%, at least 40%, at least 70%, at least 80%, at least 90% or at least 95% activity after incubation for 1 hour at 60° C. in a buffer comprising 50 mM tris(hydroxymethyl)aminomethane, 10 mM MgSO4.7H2O, 2.0 g/I bovine serum albumin (BSA), 6 mM D/L-cystein, 1 mM ethylenediaminetetraacetic acid (EDTA), and 20 μm tetrasodium pyrophosphate, wherein the pH is adjusted to 7.8 with acetic acid.
A “cell sample” within the meaning of the present invention relates to any material, substance or composition comprising cells. The cells may be as defined above and can be derived from any source. The cell sample may be collected using a cell collection device such as a swab, broom, brush, spatula, or similar collection devices or by collecting a cell-containing material or composition (e.g. a liquid). Accordingly, basically any sample may be used in which cells may be present including, without limitations, cell suspensions, a cell containing specimen or culture (e.g., cellular and tissue cultures, pre-cultured cell cultures in growth medium), clinical and laboratory biological samples, food (e.g., liquid and solid food products, and food waste) and agricultural samples, drinking and recreational water samples.
In case of solid growth media (e.g., agar plates), the solid growth media can be inoculated directly from surfaces or even by particles from the air. Often samples are also resuspended in buffer and then plated out (e.g. food samples) or aqueous samples are plated out (drinking water) or filters are applied on which bacteria from larger liquid volumes have been concentrated. The cells may also be comprised in a liquid which can at least partially originate from the biological sample itself (e.g. in the case of a cell culture) or can be partially or fully provided by a collection medium that is used to receive the cells and/or that is used to receive the cell-containing biological sample. For example, a cell sample that was obtained by using a swab or other cell collection device (such as spatula or brush) can be contacted with a collection medium. Cells comprised in or cell samples contacted with a respective collection and/or storage medium are also encompassed by the term “cell sample” as used herein.
In accordance with the method of the present invention, the “contacting” of step (a) can be carried out in any manner as long as the cells contained in the sample are brought into contact with, mixed in or added to the growth media. In particular, if a liquid medium is used, no specific order is intended, or suggested, by the term “contacting” as used herein. In other words, the cell sample may by contacted with (e.g. added to) the liquid medium after or before one or both of a luciferase and a luciferase substrate is contacted with (e.g. added to) the liquid medium. In a preferred embodiment, the cells-containing sample is contacted with a liquid growth medium comprising a luciferase enzyme and D-luciferin. As a result of the contacting, the liquid growth medium, like the solid growth medium, comprises the growth medium as such, the cell sample, the luciferase enzyme and the luciferase substrate.
In step (b), the cells on the solid growth medium or in the liquid growth medium are incubated to grow the cells, resulting in a culture reaction mixture. Suitable incubating conditions for growing different types of cells are well-known in the art. The incubation time depends on various factors, including the number of initial cells, the type of cells (e.g., the bacterial or fungal species), the type of growth medium and culture conditions. However, the incubation time must at least be sufficiently long so as to result in a luminescence signal that is significantly increased compared to a control sample.
Advantageously, non-microbial ATP (e.g. from food) that might be present at the beginning of step (b) is used by the luciferase enzyme before growth-related microbial ATP starts to accumulate. This means that only cellular ATP is detected, which correlates with the number of viable cells. Further, no ATP digesting enzyme needs to be added to remove unwanted external ATP, making the assay format as simple as possible.
In step (c), luminescence during growth of the cells is directly measured from the culture reaction mixture obtained in step (b). Advantageously, no lysis of cells is required prior to measuring the luminescence. This reduces the number of steps and allows for the real-time monitoring of the luminescence. The measured luminescence is an indicator of ATP released by the cells that is utilized by the luciferase enzyme as a co-substrate. Since the ATP level reflects the presence of live cells, an increase of luminescence over time indicates growth of cells, i.e. increase in the number of live cells, and thus cell activity (metabolic activity).
The luminescence can be measured using a standard luminometer (e.g. a luminescence microplate reader, a tube luminometer or an imaging device with a cooled CCD camera) as known in the art. The luminescence readings are expressed as RLU (relative luminescence units). The luminescence can be continuously measured or, alternatively, be measured from time to time, i.e. intermittently, as desired.
In a second aspect, the present invention relates to a method for the detection of cells with specific enzyme activities, comprising the following steps:
This method shares features with the method according to the first aspect of the present invention. Therefore, all explanations, definitions, and comments regarding advantages of the invention set out herein above also apply to the second aspect of the present invention unless otherwise specified. In the following, therefore, only those aspects or features are discussed in which the method according to the second aspect differs from the method according to the first aspect of the present invention.
In the method according to the second aspect of the present invention, pro-luciferins (sometimes also referred to as “caged luciferins”) are used instead of the luciferase substrate D-luciferin as in the method according to the first aspect of the present invention. A “pro-luciferin”, as used herein, is a molecule that does not result in luminescence in the presence of luciferase, but has first to be enzymatically converted to luciferin (e.g., D-luciferin or D-aminoluciferin). Thus, in the presence of target cells pro-luciferins are cleaved through target cell-specific enzyme activity, resulting in the release of D-luciferin or D-aminoluciferin. The released D-luciferin or D-aminoluciferin reacts with the luciferase enzyme and the bioluminescent signal is recorded using a luminometer. In other words, the use of a pro-luciferin couples luciferin concentrations (more specifically D-luciferin or D-aminoluciferin concentrations) to a specific enzyme activity of the target cells to be detected.
In such enzyme-coupled assays using pro-luciferins, the intensity of the recorded signal shows a good linear correlation with the cell concentration (cell number) in a given sample. Also, the use of pro-luciferins results in a high signal-to-noise ratio. Thus, the method according to the second aspect of the present invention is useful as a sensitive assay for the detection of diverse bacteria-specific enzyme activities and, thus, for the detection of specific bacteria strains, species or groups.
The enzyme-labile group (ELG) of the pro-luciferin is a chemical group that is connected to the luciferase substrate (LUC) or the self-immolative linker (SIL) by an enzyme cleavable bond. Preferably, the ELG is responsive to a specific enzyme expressed by the target bacteria or fungi, thereby enabling the specific detection of, for example, Salmonella spp. (e.g. S. typhimurium and S. enteritidis) in the presence of other bacteria such as Citrobacter freundii and Escherichia coli. Exemplary enzyme-labile groups (ELG) suitable for use herein are shown in Table 1. This table also indicates the target enzyme that is capable of cleaving off the ELG as well as the target microorganism to be detected.
Campylobacter jejuni and C.
coli (differentiation from C.
lari)
Moraxella catarrhalis; most
Salmonella spp.
Salmonella spp.
Listeria monocytogenes;
Bacillus spp.;
Staphylococcus spp.;
Clostridium spp.;
Mycobacterium tuberculosis
Staphylococcus aureus;
Clostridium perfringens;
Streptococcus agalactiae;
Candida spp.; MRSA
Pseudomonas aeruginosa
Enterococci spp.;
Streptococcus pyogenes;
Citrobacter spp.
Salmonella spp.
Cronobacter sakazakii;
Staphylococcus aureus;
Listeria spp.; ESBL
Vibrio spp.; Enterococci
Clostridium difficile
E. coli; Streptococcus
agalactiae
E. coli; Streptococcus
agalactiae
Candida albicans
Prevotella spp.
Cronobacter sakazakii
Shigella spp.
Bacillus spp.
Shigella spp.
Legionella pneumophila
Preferred pro-luciferins having the structure ELG-LUC or ELG-SIL-LUC for use in accordance with the present invention are shown in Table 2. The X group of the SIL (self-immolative linker) shown in Table 2 bonds to the ELG (enzyme-labile group). It should be understood that the ELG shown in Table 2 may also be used with other SILs described herein.
with X =
The term “amino acidyl”, as used herein, refers to an amino acid moiety that is bound to the remainder part of the pro-luciferin by means of its carboxylic acid group. When an amino acid comprises more than one carboxylic acid group, each of said carboxylic acid groups may bind the amino acid to the remainder part of the pro-luciferin. Preferably, when an amino acid comprises more than one carboxylic acid group, it is bound to the remainder part of the pro-luciferin by means of its alpha-carboxylic acid group. Accordingly, when R1 is an amino acidyl group or a di- or tri-peptidyl group and X is —NH—, the carboxylic acid group of the amino acidyl group or the di- or tri-peptidyl group and the —NH— group forms an amide group (—CONH—).
If amino acids or oligopeptides are used as enzyme-labile groups (ELG) and the pro-luciferin does include a SIL moiety, the LUC group is generally D-luciferin. If, however, amino acids or oligopeptides are used as enzyme-labile groups (ELG) and the pro-luciferin does not include a SIL moiety, the LUC group is generally D-aminoluciferin.
Preferred amino acidyl groups include, but are not limited to, alanyl (A-), preferably L-alanyl, pyroglutamic acidyl, preferably L-pyroglutamic acidyl, argininyl (R-), asparaginyl (N-), aspartic acidyl (D-), cysteinyl (C-), glutaminyl (Q-), glutamic acidyl (E-), glycinyl (G-), histidinyl (H-), isoleucinyl (I-), leucinyl (L-), lysinyl (K-), methioninyl (M-), phenylalanyl (F-), prolinyl (P-), serinyl (S-), threoninyl (T-), tryptophanyl (W-), tyrosinyl (Y-), and valinyl (V-). Particularly preferred amino acidyl groups are L-alanyl, L-pyroglutamic acidyl, L-leucinyl, or β-alanyl. Preferred tri-peptidyl groups include, for example, Boc-Val-Pro-Argininyl, Boc-Asp(OBzI)-Pro-Argininyl, and SucOMe-Arg-Pro-Tyrosinyl (SucOMe-RPY-). Although not specifically shown in Table 2, oligopeptidyl groups are generally suitable for use herein (e.g. peptidyl groups with up to 8 amino acids), including—besides di-peptidyl and tri-peptidyl-tetra-peptidyl and penta-peptidyl.
If R1 is myo-inositol phosphoryl, the pro-luciferin (either with or without SIL) is particularly suitable for detecting a microorganism expressing Phosphatidylinositol-specific phospholipase C (PI-PLC), e.g. Listeria, in particular Listeria monocytogenes. If R1 is octanoyl, the pro-luciferin (either with or without SIL) is particularly suitable for detecting a microorganism expressing C8 esterase, e.g. Salmonella, in particular Salmonella enterica. If R1 is phosphoryl, the pro-luciferin (either with or without SIL) is particularly suitable for detecting a microorganism expressing a phosphatase, e.g. S. aureus, which is a major carrier of antibiotic resistance.
Specific examples of particularly suitable pro-luciferins include D-luciferin-6-O-beta-D-glucuronide, D-luciferin-6-O-beta-D-galactopyranoside, D-luciferin-caprylate, D-luciferin-6-O-choline phosphate, 6-O-(alpha-D-galactopyranosyl)-D-luciferin, D-luciferin-6-O-phosphat, D-luciferin-6-O-myoinositol-1-phosphate, and salts thereof.
In accordance with the present invention, a self-immolative linker (SIL) is a self-eliminating chemical moiety that splits off (i.e. is released) as soon as the enzyme-labile group (ELG) is cleaved off by an enzyme of the target bacterium or target fungus, resulting in the release of the luciferase substrate (i.e. D-luciferin or D-aminoluciferin) which in turn is converted by the luciferase enzyme to generate bioluminescence. In the case of pro-luciferins, the spacer generally leads to a stabilization of the molecule and thus to a reduction of the unspecific background by abiotic hydrolysis.
Particularly suitable self-immolative linkers (SIL) for use herein include:
wherein X is connected to ELG, and wherein each of these linkers may or may not be functionalized with a peptide, preferably a cell penetrating peptide, an endolysine or a protein, and wherein X is —O— or —NH—, preferably —O—, and X′ is selected from S, O, and NH. A particularly suitable SIL for use herein is
wherein X is —O— or —NH—, preferably —O—.
In a third aspect, the present invention relates to a method for assessing susceptibility of bacterial cells to antibiotics, comprising the following steps:
This method may also be referred to as “antibiotic susceptibility testing” or “AST method” and is based on online (or “real-time”) measurement of ATP release. It can be used for the rapid assessment of susceptibility of live bacterial cells to antibiotics. The term “susceptibility”, as used herein, is intended to mean a physiological response of a microorganism (e.g., bacterial or fungal cells) to an antimicrobial agent (i.e. an antibiotic). The desired physiological response to an antibiotic is one which adversely affects the viability of the microorganism, which results in partial or complete inhibition of growth and/or partial or complete elimination (i.e. death), depending on the concentration of the antibiotic.
Advantageously, the test time required for exposing the bacteria to antibiotics and measuring ATP release in accordance with the method of the present invention is very short (e.g., about 0.5 to 1 hour). It does not rely on determination of time-consuming growth inhibition but measures the amounts of released ATP. In addition, the method is sufficient sensitive so that, for certain medical samples, depending on the cell concentration, enrichment of cells by incubation with medium may not be necessary. Generally, 4 to 8 hours, and up to a maximum of 12 hours in certain cases, is enough time for growing the cells to obtain a sufficiently high cell count of living cells for the AST method according to the present invention. The reduced test time of the method of the present invention allows for quicker administration of narrow-spectrum antibiotics, which leads to improved patient outcomes, lower costs and reduced risk of antibiotic resistant.
Steps (a), (b) and (c) of the AST method according to the present invention are essentially identical to steps (a) and (b) of the method according to the first aspect of the invention, except for the presence of an antibiotic, and the comments, explanations and definitions provided above in connection with the method according to the first aspect of the invention equally apply here.
The antibiotic used in the AST method of the present invention is selected from β-lactam antibiotics including, but not restricted to, penicillins such as methicillin, cephalosporines such as cefotaxime, and carbapenems such as imipenem, glycopeptide antibiotics such as vancomycin, aminoglycoside antibiotics such as neomycin, protein translation inhibitors such as chloramphenicol, and polypeptide antibiotics such as colistin.
Generally, the AST method of the present invention is based on ATP detection with luciferase and D-luciferin as substrate. If a pro-luciferin is used, the pro-luciferin is converted to D-luciferin or D-aminoluciferin by a specific enzyme activity of the target bacteria (target bacterial cells). Hence, the method using a pro-luciferin allows one to assess the susceptibility to antibiotics and, at the same time, to specifically detect certain bacterial species. More specifically, if there is a rapid increase in luminescence, this means that there is both enzyme activity (it is a specific type of bacterium) and release of ATP (this strain reacts to the antibiotic at the concentration used).
The AST method of the present invention may further comprise step (d) of carrying out steps (a), (b) and (c) without an antibiotic (i.e. in the absence of an antibiotic) as a control. Moreover, the method may comprise steps (a) to (d) and further step (e) of comparing the luminescence measured in step (c) with the luminescence measured in step (d) without an antibiotic. Furthermore, the method may comprise a step of determining the MIC (minimal inhibitory concentration) of the antibiotic from the luminescence measured over time in step (c).
In a fourth aspect, the present invention relates to a container comprising a solid or liquid growth medium, wherein the solid or liquid growth medium comprises (i) a luciferase enzyme and D-luciferin, or (ii) a luciferase enzyme, ATP and a pro-luciferin, or (iii) a luciferase enzyme, an antibiotic and either D-luciferin or a pro-luciferin.
The container is not particularly limited but is preferably a culture dish, a culture chamber, a vial or tube or a multi-well plate, in particular a transparent vial, tube or multi-well plate.
The solid or liquid growth medium is as described above. In particular, the medium is generally a nutrient medium (nutrient growth medium), and the solid medium preferably comprises agar, i.e. is an agar medium (nutrient agar medium). Likewise, the terms “luciferase” or “luciferase enzyme”, “pro-luciferin” and “antibiotic” have the meaning as defined herein.
In a fifth aspect, the present invention relates to the use of a solid or liquid growth medium comprising a luciferase enzyme for the detection of bacterial or fungal cells, in particular for assessing cell viability of bacterial or fungal cells or detecting bacterial or fungal cells with specific enzyme activities, or for assessing susceptibility of bacterial cells to antibiotics.
In one embodiment, the solid or liquid growth medium further comprises D-luciferin, and the medium is used for the assessment of cell viability by means of an ATP assay to thereby detect bacterial or fungal cells. This embodiment is related to the method according to the first aspect of the present invention and, thus, the explanations and definitions set out in connection with said method equally apply here.
In another embodiment, the solid or liquid growth medium further comprises ATP and a pro-luciferin, and the medium is used for the detection of bacterial or fungal cells expressing specific enzyme activities by means of a coupled enzyme assay. The meaning of the term “coupled enzyme assay” within the context of the present invention is well known to those skilled in the art and, as explained above, refers to a method or assay involving the enzymatic conversion of the pro-luciferin into a luciferase substrate, followed by the enzymatic conversion of the luciferase substrate by a luciferase enzyme to yield luminescence. This embodiment is related to the method according to the second aspect of the present invention and, thus, the explanations and definitions set out in connection with said method equally apply here.
In yet another embodiment, the solid or liquid growth medium further comprises an antibiotic and either D-luciferin or D-aminoluciferin, and the assessment of susceptibility of bacterial cells to antibiotics is carried out by measuring ATP. This embodiment is related to the method according to the third aspect of the present invention and, thus, the explanations and definitions set out in connection with said method equally apply here.
The solid or liquid growth medium is typically present in a container as described herein, in particular in a culture dish, a culture chamber, a test tube or vial, or a multi-well plate. The cells are grown in the container and the luminescence generated during growth of the cells is measured from the container (i.e. directly from the container), either continuously or intermittently. In other words, the luminescence measurement is carried out in real-time (online).
In a sixth aspect, the present invention relates to a composition for preparing a liquid or solid agar growth medium, wherein the composition is a solid and comprises, among other substances, luciferase and D-luciferin.
If the composition according to the sixth aspect of the present invention is for preparing a liquid growth medium, the composition comprises, or essentially consists of, luciferase, D-luciferin, nutrients, and optionally, a buffer substance, wherein the composition preferably comprises, or essentially consists of, 0.02-0.20 wt. %, preferably 0.05-0.10 wt. %, luciferase, 0.05-0.80 wt. %, preferably 0.15-0.40 wt. %, D-luciferin, nutrients, preferably one, two or all three of peptone, yeast extract and meat extract, and, optionally, a buffer substance. All wt. % relate to the total weight of the solid composition. The buffer substance is not limited in any way and may include phosphate buffer, MOPS 3-(N-morpholino)propanesulfonic acid) buffer and the like. As recognized by those skilled in the art and mentioned for reasons of clarity only, the composition for preparing a liquid growth medium does not comprise agar.
If the composition is for preparing a solid agar growth medium, the composition comprises, or essentially consists of, luciferase, D-luciferin, nutrients, agar and, optionally, a buffer substance, wherein the composition preferably comprises, or essentially consists of, 0.01-0.10 wt. %, preferably 0.02-0.06 wt. %, luciferase, 0.02-0.40 wt. %, preferably 0.04-0.20 wt. %, D-luciferin, 30-70 wt. %, preferably 40-60 wt. %, more preferably 45-55 wt. %, agar, nutrients, preferably one, two or all three of peptone, yeast extract and meat extract, and, optionally, a buffer substance. All wt. % relate to the total weight of the solid composition. The buffer substance is not limited in any way and may include phosphate buffer, MOPS 3-(N-morpholino)propanesulfonic acid) buffer and the like.
Within the present invention, the luciferase is generally used in the form of a lyophilized material, e.g. as lyophilized luciferase. The lyophilized luciferase material may consist of luciferase and, optionally, other substances such as stabilizing agents (e.g., human serum albumin, sucrose and the like).
As used herein, the term “nutrients” generally refers to substances or materials that are necessary for, or promote, the growth of cells, in particular of bacterial and/or fungal cells. In other words, the composition comprises nutrients which, when the composition is mixed with an aqueous solution such as water, provides a growth medium.
Furthermore, the term “nutrients” is intended to include “complex nutrients” and “minimal nutrients”, i.e. the term “nutrients” may refer to “complex nutrients” or “minimal nutrients” or both. The term “complex nutrients” refers to raw materials containing two or more substances that are necessary for or that promote the growth of microorganisms. Examples of complex nutrients include natural raw materials such as peptone, yeast extract, meat extract and the like. Preferably, the composition according to the sixth aspect of the present invention contains one or two or all three of peptone, yeast extract and meat extract. A special advantage of these complex nutrients is the wide range of individual substances, such as amino acids, proteins, vitamins, mineral salts or trace elements, which can be made available to cultured cells, e.g. bacterial and/or fungal cells.
The term “minimum nutrients”, as used herein, refers to chemically defined substances that include the minimum nutrients enabling the growth of the cultured cells, e.g. bacterial and/or fungal cells. Minimum nutrients typically contain a carbon source (e.g., glucose, pyruvate, succinate etc.), salts (e.g., MgSO4, NH4Cl, Na2HPO4 etc.) to provide essential elements such as magnesium, nitrogen, phosphorus and sulfur, and, optionally, amino acids.
The term “essentially consists of”, as used herein, is intended to mean that substances other than those indicated are only contained in relatively low amounts of, e.g., less than 20 wt. %, 15 wt. %, 10 wt. %, 5 wt. % or less than 1 wt. %. For example, the luciferase may be used in lyophilized form comprising other ingredients added for, e.g., stabilization such as BSA (bovine serum albumin) and a saccharide such as sucrose. Thus, if, for example, 10 wt. % of lyophilized luciferase material is included in the composition and said lyophilized material contains 1 wt. % luciferase enzyme and 99 wt. % of other substances, the composition of the present invention contain 9.9 wt. % of substances other than those explicitly indicated.
An exemplary composition for preparing a liquid growth medium comprises 7.57 wt. % lyophilizate of luciferase (X-Shining™ Luciferase), 37 wt. % peptone, 15 wt. % yeast extract, 7.5 wt. % meat extract, 15.6 wt. % 3-(N-morpholino)propanesulfonic acid, 17.3 wt. % 3-(N-morpholino)propanesulfonic acid, sodium salt, and 0.23 wt. % D-luciferin. An exemplary composition for preparing a solid agar growth medium comprises 3.65 wt. % lyophilizate of luciferase (X-Shining luciferase), 18.2 wt. % peptone, 7.3 wt. % yeast extract, 3.65 wt. % meat extract, 7.6 wt. % 3-(N-morpholino)propanesulfonic acid, 8.5 wt. % 3-(N-morpholino) propanesulfonic acid, sodium salt, 51 wt. % agar, and 0.1 wt. % D-luciferin.
The composition according to the sixth aspect of the present invention is a pre-formulated medium that, when mixed with an aqueous solution such as water, provides a medium for, e.g., the detection of ATP from cultures and, particularly, for assessing cell viability as explained in connection with the first aspect of the present invention.
The composition may be provided in various solid forms and is not limited to a particular solid form. However, exemplary suitable solid forms include, but are not limited to, powders, beads, micronized particles, tablets, coatings, cuttable strips, pearls and the like. Particularly suitable for use herein are powders and tablets.
The composition according to the sixth aspect of the present invention as described hereinabove may further contain an antibiotic. In this case, the composition can be used for assessing the susceptibility of bacterial cells to the antibiotic, as explained hereinabove.
Since the pre-formulated composition of the present invention generally contains all ingredients required for medium preparation and for luciferase-based ATP detection it can be conveniently mixed with water for immediate use as a medium. Importantly, the luciferase-containing composition can be added to, or mixed with, water only once at the beginning of the experiment, measurement or monitoring. This is, no fresh luciferase enzyme needs to be added throughout the experiment, measurement or monitoring, and the luminescence can be measured continuously (real-time) directly from the growing cell culture.
Also, the pre-formulated composition of the present invention can be easily stored for extended periods of time prior to use without allowing for significant deterioration of its ingredients. Thus, the composition according to the sixth aspect of the present invention has an advantageous combination of stability during storage and ease of use.
The present invention will now be further illustrated by the following, non-limiting examples.
The examples provided below show that a thermostable luciferase can be added directly to conventional growth media and used (a) in a real-time ATP assay for the detection of live bacterial cells, (b) in a coupled enzyme assay using pro-luciferins for the detection of specific species or groups of bacteria, and (c) in an ATP assay for antibiotic susceptibility testing (AST).
Nutrient agar pH 7.4 (5 g/I peptone, 5 g/I NaCl, 2 g/I yeast extract, 1 g/I meat extract, 15 g/I agar) was autoclaved and cooled to 50° C. 1:1000 v/v of a thermostable luciferase (X-Shining™ Luciferase; aqueous solution with glycerol, 10 mg/ml; available from Biosynth AG, Switzerland) was added to a final concentration of 10 μg/ml. Next, 40 μM D-luciferin (Biosynth AG) was added from a concentrated stock solution. The prepared agar with luciferase enzyme and its substrate D-luciferin was then added to a white microplate (0.2 ml per well) and the plate was left for solidification for several hours.
Actively growing cultures (Nutrient Broth, 37° C., OD600 0.08 to 0.33) of Staphylococcus aureus ATCC 29213 and Salmonella enteritidis RKI 05/07992 were then diluted to 104 CFU in sterile PBS and inoculated to microplate wells with agar (1 μl per well=approx. 10 CFU/well). 1 μl sterile phosphate buffered saline (PBS) was added to sterile control wells. The surrounding wells were filled with sterile water and the plate was incubated at 37° C. in a luminescence microplate reader. The luminescence was measured every 10 min (kinetic mode).
The results are shown in
Furthermore, for hygiene tests, the presence of luciferase in the growth medium from the beginning of incubation has the advantage that non-microbial ATP (e.g. from food) is consumed by the luciferase enzyme before growth-related microbial ATP starts to accumulate. Thus, only cellular ATP is detected, which render the method more reliable. Further, no ATP digesting enzyme needs to be added to remove unwanted external ATP, making the method as simple as possible.
Nutrient broth pH 7.4 (5 g/I peptone, 5 g/I NaCl, 2 g/I yeast extract, 1 g/I meat extract) was autoclaved and cooled to room temperature. 1:1000 v/v of the same thermostable luciferase as in Example 1 was added to a final concentration of 10 μg/ml. Next, 0.4 mM D-luciferin (Biosynth AG) and 1 mM MgCl2 was added from concentrated stock solutions. The prepared broth was sterilized by filtration (0.2 μm), incubated for 2.5 h at 30° C. in order to burn-off background and then added to a white microplate (0.198 ml per well).
Agar plate pre-cultures of Pseudomonas fluorescens ATCC 49838 (
In a second, similar experiment, equal volumes of cell suspensions (OD 0.1) of all five stains were mixed, serially diluted in sterile PBS and then inoculated to a similar microplate (2 μl per well, 3 replicate mixtures and dilution series). Cell concentration of mixtures were determined by plating on tryptic soy agar (
The results of
The luminescence onset times were deduced from the time courses of the luminescence presented in
The onset time was plotted against initial cell concentration (viable cells) in log scale, and the regression coefficient and formula of a fitted exponential function were calculated in Excel (
The results shown in
This example was carried out in the same manner as Example 1, except that instead of D-luciferin the following substrates were added from concentrated stock solutions: (i) 0.1 mM D-luciferin-spacer-caprylate (Biosynth AG) and 1 mM ATP, and (ii) 1 mM D-luciferin-spacer-phosphate trisodium salt (Biosynth AG) and 1 mM ATP.
As can be seen from
If, however, D-luciferin-spacer-phosphate is used as a pro-luciferin, a strong increase in luminescence is observed for Staphylococcus aureus (open triangles) after about 8 hours of incubation, which is well above the control (open squares) after about 10 hours of incubation (
These results show that the “onset time” (i.e. when curve with bacteria starts to be significantly above sterile control) is only after about 8 to 12 hours of incubation. Thus, the coupled enzyme assay using pro-luciferins enables the fast detection of bacteria in a simple and convenient way.
The relative activity of thermostable luciferase in different growth media and buffers commonly used in biological assays was analyzed at room temperature (20-23° C.). Luminescence (relative light units, RLU) was measured with a tube luminometer, thermostable luciferase (same as used in Example 1) was added at 10 μg/ml final concentration, total assay volume was 0.2 ml, enzymatic reaction was started by adding 0.15 mM D-luciferin and 0.4 μM ATP from 20× concentrated stock solution.
All buffers and media except reference and except when noted otherwise were supplemented with 1 mM MgCl2 (some Mg2+ is introduced with the enzyme solution into both the supplemented and non-supplemented buffers and media). The measurement temperature was room temperature. The results are shown in Table 3 (D-Luc=D-luciferin).
The results demonstrate that luciferase retains significant activity in numerous commonly used assay buffers and growth media for at least one day at 37° C. In case of defined buffer solutions, it is advantageous to add magnesium salts. In most cases the enzyme retains >50% activity within 24 h at room temperature. Thus, as shown in Examples 1 and 2, thermostable luciferase is suitable for measuring luminescence directly from cell-containing growth media in real-time without the need for cell lysis and without using a particular ATP-assay buffer.
Nutrient broth with luciferase, D-luciferin and MgCl2 was prepared in a similar way as in Example 2 and filled in wells of a white microplate (0.19 ml per well). Ampicillin was added from a dilution series of a filter-sterilized, concentrated stock solution prepared in sterile ultrapure water (5 μl per well). Sterile water was added to control wells without antibiotic. Wells were inoculated with 5 μl of cell suspensions (OD 0.1, prepared in sterile PBS from agar plate pre-cultures) of either Ampicillin resistant (AMPR) E. coli RKI 66/09 (AmpC) or Ampicillin sensitive (AMPS) E. coli ATCC 25922. Initial cell concentration in wells was approximately 2.5×106 CFU/ml. The microplate was incubated at 37° C. in a luminescence microplate reader and relative luminescence units (RLU) were measured every 2 min for 8 h. For comparison, optical density (600 nm) was measured for all wells after 15 h incubation at 37° C.
The results of
Having regard to the above, the results show that despite the lack of cell growth in the sensitive strain (shown in
The above results further show that the AST test time of the method of the present invention is reduced since low initial concentrations of bacteria can be used, thereby reducing the time needed for growing the isolated bacteria to a suitable concentration for testing. In addition, the test time required for exposing the bacteria to antibiotics and measuring ATP release is very short (e.g., 0.5 to 1 hour) and does not rely on bacterial growth. Reduced time is critically important since it allows for quicker administration of narrow-spectrum antibiotics, which leads to improved patient outcomes, lower costs and reduced antibiotic resistant bacteria strains. Thus, the presented AST method based on the measurement of ATP is suitable for rapid testing of efficacy of antibiotics.
| Number | Date | Country | Kind |
|---|---|---|---|
| 20161528.3 | Mar 2020 | EP | regional |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/EP2021/055793 | 3/8/2021 | WO |
