Patent Grant
9707555
This disclosure relates to methods of detecting the presence and the identity of microorganisms in a sample.
Emergence of drug resistant pathogens is a global healthcare crisis that is forcing physicians to treat common infectious diseases with ever more potent antibiotics. This is largely caused by the complexity and time required in identifying the offending bacteria, forcing physicians to prescribe empirically even with the knowledge of the high negativity rate amongst cultured specimens. The net result has been a significant increase in emergence of resistant strains, higher treatment costs, and longer recovery cycle due to an increase in side effect risks associated with taking broad spectrum and unnecessary antibiotics.
Broad spectrum antibiotics are commonly prescribed when treating patients that are exhibiting symptoms of sepsis or septic shock. Given the seriousness of these conditions, doctors will often prescribe one or more broad-spectrum antibiotics right away and are not likely to change the treatment regimen until the full effect of the drugs can be assessed or results from microbiology become available. For instance, the document “Surviving Sepsis Campaign Guideline” (SSCG) recommends a treatment protocol in which intravenous antibiotics, consisting of one or more broad-spectrum agents against likely bacterial/fungal pathogens, should be started within the first hour of recognizing severe sepsis and septic shock [R. P. Dellinger et al., Crit. Care Med 2008]. The treatment protocol states that the antimicrobial regimen is to be reassessed daily, and once the pathogen is known, as a matter of good practice, a more appropriate narrow-spectrum antimicrobial drug is to be administered.
Unfortunately, current clinical bacteriology methods typically provide pathogen identification information when it may be too late to impact patient outcomes. This is due to the time lag of 2-3 days from specimen collection to reporting results of pathogen identification and susceptibility testing. Causes for the time lag include the need to transport specimens to clinical laboratories staffed by expert clinical bacteriologists and the time required for blood culture and subsequent colony formation after plating the specimen on solid culture medium. Specimens that arrive at the clinical microbiology laboratory after normal business hours are typically held overnight until staff arrives the next day. Once specimens are plated on solid agar on day 2 (after a positive blood culture has been obtained), an additional 8-12 hours are needed for colonies to form. Plates are examined, colonies are enumerated, and appropriate colonies are selected for identification and susceptibility testing. The process further requires analysis and interpretation before reports are released, typically on day 3, which may be too slow to meaningfully impact antibiotic selection and patient outcomes.
While many aspects of clinical microbiology laboratory workflow have been automated, clinical bacteriology remains highly labour-intensive. Many laboratories currently automate identification and susceptibility testing using either the Vitek (Biomerieux) or Phoenix (Becton-Dickenson) instruments. However, these systems, and newer systems based on mass spectroscopy, depend on selection of appropriate colonies from overnight growth on agar plates by expert personnel.
Several nucleic acid amplification approaches for clinical bacteriology have recently been commercialized. However, most of these still require a sample preparation process which includes a nucleic acid extraction and purification step that can take more than 3 hours, as part of the pre-analytical process for species identification. These processes are required for providing an inhibitor and contaminant free sample for nucleic acid assays. Consequently, despite their specificity and sensitivity, molecular methods such as PCR have not replaced the much slower standard microbial culture-based techniques as the front line test in the clinical microbiology laboratory, and the results from clinical microbiology testing continue to be provided too late to substantially impact patient outcomes.
Methods and devices are provided for pretreatment of a sample containing microbial cells. In some embodiments, the pretreatment of the sample is performed via the initial selective lysis, within a sample pretreatment vessel, of non-microbial cells (such as blood cells) and the subsequent centrifugal separation of the sample to remove the resulting debris and concentrate the microbial cells. An immiscible and dense cushioning liquid may be included for collecting the microbial cells adjacent to the liquid interface formed by the cushioning liquid upon centrifugation of the pretreatment vessel. After removal of a substantial quantity of the supernatant, resuspension of the collected microbial cells, and re-establishment of the cushioning liquid interface, at least a portion of the remaining suspension may be removed without substantially removing the cushioning liquid. One or more intermediate wash cycles may be performed prior to extraction of the remaining suspension, which provides a “pretreated” sample.
The methods described herein may be useful in decreasing the time to result of nucleic assays for the identification of microbial cells by taking a different approach to the preparation of target nucleic acid suspension. In some embodiments disclosed herein that involve a whole blood sample, blood cells in the whole blood sample are selectively lysed and their resulting debris are washed away while the microbial cells are kept intact and collected. The cell suspension is thereby rendered substantially free of molecular assay interferents and inhibitors. Subsequently, the microbial cells may be lysed with a method that does not require lytic reagents, and the lysate, which has been rendered substantially free of molecular assay interferents and inhibitors, may be directly assayed, without nucleic acid extraction and purification.
Accordingly, in one aspect, there is provided a method of extracting microbial cells from a whole blood sample, the method comprising:
adding a whole blood sample to a pretreatment vessel, the pretreatment vessel comprising a pretreatment mixture, the pretreatment mixture comprising a blood cell lysis reagent and a hydrophobic cushioning liquid having a density greater than that of the whole blood sample and the blood cell lysis reagent;
agitating the contents of the pretreatment vessel;
centrifuging the pretreatment vessel such that the cushioning liquid forms a liquid interface below a supernatant, wherein microbial cells from the whole blood sample are removed from suspension and collected adjacent to the liquid interface;
withdrawing a substantial quantity of the supernatant without removing the collected microbial cells;
agitating the contents of the pretreatment vessel and allowing the cushioning liquid to re-establish the liquid interface below a suspension containing the microbial cells; and
extracting a least a portion of the suspension without extracting a substantial portion of the cushioning liquid, thereby obtaining an extracted suspension comprising microbial cells.
In another aspect, there is provided a pretreatment vessel for extracting microbial cells from a whole blood sample, comprising:
a vessel body defining an internal volume and an enclosure mechanism for sealing the vessel body, wherein the vessel body is configured for use in a centrifugation device;
the vessel body containing:
wherein the distal portion of said vessel body is conical in shape.
In another aspect, there is provided a method of extracting microbial cells from a liquid sample, the method comprising:
adding the liquid sample to a pretreatment vessel, the pretreatment vessel comprising a pretreatment mixture, the pretreatment mixture comprising a hydrophobic cushioning liquid having a density greater than that of the liquid sample;
agitating the contents of the pretreatment vessel;
centrifuging the pretreatment vessel such that the cushioning liquid forms a liquid interface below a supernatant, wherein microbial cells from the liquid sample are removed from suspension and collected adjacent to the liquid interface;
withdrawing a substantial quantity of the supernatant without removing the collected microbial cells;
agitating the contents of the pretreatment vessel and allowing the cushioning liquid to re-establish the liquid interface below a suspension containing the microbial cells; and
extracting a least a portion of the suspension without extracting a substantial portion of the cushioning liquid, thereby obtaining an extracted suspension comprising microbial cells.
In another aspect, there is provided a method of extracting microbial cells from a whole blood sample, the method comprising:
adding a whole blood sample to a pretreatment vessel, the pretreatment vessel comprising a pretreatment mixture, the pretreatment mixture comprising a blood cell lysis reagent;
agitating the contents of the pretreatment vessel;
centrifuging the pretreatment vessel such that the microbial cells from the whole blood sample are removed from suspension and collected adjacent to the distal surface of the pretreatment vessel;
withdrawing a substantial quantity of the supernatant without removing the collected microbial cells;
performing at least one series of wash steps, each series of wash steps comprising:
agitating the contents of the pretreatment vessel to obtain a suspension containing the microbial cells; and
extracting a least a portion of the suspension, thereby obtaining an extracted suspension comprising microbial cells.
In another aspect, there is provided a method of, the method comprising:
pretreating a sample containing microbial cells to obtain a suspension containing the microbial cells;
lysing the microbial cells within the suspension to obtain a lysate; and
performing a multiplexed set of molecular assays on the lysate, the multiplexed set of molecular assays comprising:
wherein the at least one tertiary rRNA-based molecular assay for each of each of fungi, Gram-positive bacteria, and Gram negative bacteria are suitable for the de-escalation of antimicrobial therapy based on their outcome.
In another aspect, there is provided an apparatus for extracting microbial cells from a sample, the apparatus comprising:
a motor;
a rotor driven by the motor, the rotor being configured to support a pretreatment vessel such that a centrifugal force is applied to the contents of the pretreatment vessel during rotation of said rotor, wherein the motor is configured to rotate the rotor at a speed sufficient for removing the microbial cells from suspension and collecting the microbial cells near a distal surface of the pretreatment vessel;
a rotating union comprising a rotating portion and a non-rotating portion, wherein said rotating portion rotates in unison with said rotor;
an aspirant tube extending from said rotating portion of said rotating union into the pretreatment vessel through a cap provided on the pretreatment vessel, said aspirant tube having a distal aspirant orifice positioned near the distal surface of the pretreatment vessel;
a dispensing tube extending from said rotating portion of said rotating union into the pretreatment vessel through said cap, said dispensing tube having a distal dispensing orifice positioned near the distal surface of the pretreatment vessel;
a stationary entrance tube connected to said non-rotating portion of said rotating union, such that said stationary entrance tube is in fluid communication with said dispensing tube during rotation of said rotor;
a stationary exit tube connected to said non-rotating portion of said rotating union, such that said stationary exit tube is in fluid communication with said aspirant tube during rotation of said rotor; and
a pump mechanism in fluid communication with said stationary entrance tube and said stationary exit tube for dispensing and aspirating fluids.
A further understanding of the functional and advantageous aspects of the disclosure can be realized by reference to the following detailed description and drawings.
Embodiments will now be described, by way of example only, with reference to the drawings, in which:
Various embodiments and aspects of the disclosure will be described with reference to details discussed below. The following description and drawings are illustrative of the disclosure and are not to be construed as limiting the disclosure. Numerous specific details are described to provide a thorough understanding of various embodiments of the present disclosure. However, in certain instances, well-known or conventional details are not described in order to provide a concise discussion of embodiments of the present disclosure. It should be understood that the order of the steps of the methods disclosed herein is immaterial so long as the methods remain operable.
As used herein, the terms, “comprises” and “comprising” are to be construed as being inclusive and open ended, and not exclusive. Specifically, when used in the specification and claims, the terms, “comprises” and “comprising” and variations thereof mean the specified features, steps or components are included. These terms are not to be interpreted to exclude the presence of other features, steps or components.
As used herein, the term “exemplary” means “serving as an example, instance, or illustration,” and should not be construed as preferred or advantageous over other configurations disclosed herein.
As used herein, the terms “about” and “approximately”, when used in conjunction with ranges of dimensions of particles, compositions of mixtures or other physical properties or characteristics, are meant to cover slight variations that may exist in the upper and lower limits of the ranges of dimensions so as to not exclude embodiments where on average most of the dimensions are satisfied but where statistically dimensions may exist outside this region. It is not the intention to exclude embodiments such as these from the present disclosure. In some embodiments, the phrases “about” and “approximately” refer to ranges of plus or minus 25% of the stated value.
In embodiments disclosed below, methods and devices are provided for sensitive detection and identification of microbial cells in a sample. In some embodiments, the pretreatment of the sample is performed via the initial selective lysis of non-microbial cells (such as blood cells) and subsequent centrifugation and optional wash cycles to remove the resulting debris and concentrate the microbial cells, where the microbial cells are subsequently resuspended. The resulting microbial cell suspension is herein termed the “pretreated cell suspension”.
Sample Pretreatment Using a Cushioning Liquid
A method was disclosed by Dorn, for example, in U.S. Pat. Nos. 5,070,014, 4,131,512, 4,212,948, 4,693,972, and 5,108,927, for lysing a blood sample and concentrating microbial pathogens for the purpose of culturing and detection. Dorn teaches the use of a sample collection tube that includes a blood lysis agent, containing saponin and sodium polyanetholesulfonate (SPS), and a cushioning liquid such as a high density liquid fluorinated hydrocarbon. A volume of whole blood is added to the sample collection tube, and the saponin lyses blood cells in the sample. The cushioning liquid forms a distinct liquid layer at the bottom of the sample collection tube, and is provided to collect microbial cells at its liquid interface when the tube is centrifuged and retain the viability of the microbial cells which may otherwise be damaged by impact or compaction forces in the resulting pellet. After removal of the majority of the supernatant, Dorn teaches the removal of all of the remaining liquid in the tube, including any residual supernatant and all of the cushioning liquid.
The method of Dorn enjoyed commercial success prior to the advent of automated blood culture systems, as it was suitable for preparing microbial cells in a form that could be readily cultured. Unfortunately, the present inventors have found that the Dorn sample preparation method is not suitable for many other applications, such as molecular assays, as the concentrated cell suspension obtained contains contaminants and inhibitory substances.
Many other known methods which employ blood lysing agents for the preparation of cell suspensions followed by a microbial lysing step, or which use non-selective lysing methods to lyse both blood cells and microbial cells to prepare the sample, are also incompatible with downstream molecular assays as they do not provide adequate removal of contaminants or inhibitory substances and therefore require the use of nucleic acid extraction and purification methods prior to the molecular assay (Nierhaus, A., et al. “Comparison of three different commercial PCR assays for the detection of pathogens in critically ill sepsis patients.” Medizinische Klinik-Intensivmedizin and Notfallmedizin (2013): 1-8.).
Accordingly, in some embodiments of the present disclosure, devices and methods are provided for the separation and concentration of microbial cells from a liquid sample, in which a cushioning liquid is optionally employed to collect microbial cells during a centrifugation step, but without substantially transferring the cushioning liquid when extracting the pretreated sample. Furthermore, in some embodiments, one or more wash procedures are performed prior to extraction of the pretreated sample in order to reduce the concentration of lysed blood cell debris and other undesirable components and substances that may be present in the pretreated sample. The reduction in concentration of these substances in the pretreated sample may be beneficial in avoiding enzyme inhibition for molecular assays, reducing the presence of non-target macromolecules and preventing degradation of target macromolecules.
The retained microbial cells present in the pretreated sample may be lysed and optionally subjected to treatment processes (example treatment processes are described further below) for rendering the intracellular nucleic acid macromolecules (such as ribosomal RNA (rRNA) and DNA) available for subsequent molecular analysis. In some embodiments, subsequent amplification and detection steps may be employed for the identification of the microbial cells. For example, the amplification and detection steps may be performed directly on the pretreated and lysed sample without employing common nucleic acid extraction and purification techniques. In particular, lysing techniques which do not employ reagents that would otherwise interfere with amplification and detection (for example, lysing techniques such as electrical, thermal and mechanical lysis) may be employed in this context.
In some embodiments, in which the sample is a blood sample containing blood cells (such as red blood cells and white blood cells) in addition to potentially containing microbial cells, the sample may be pretreated in order to lyse the blood cells.
In embodiments of the present disclosure that involve performing molecular assays after performing sample pretreatment, the composition of the cell lysis reagent may be selected to be different from that disclosed by Dorn, because unlike the methods disclosed by Dorn that required cell viability for subsequent analysis, cell viability may not be required for molecular methods, and the threshold for acceptable cell injury in the context of such molecular methods may be higher than that of the Dorn protocol.
In some embodiments that involve the pretreatment of blood samples, the formulation of the blood lysis reagent is modified relative to that disclosed by Dorn in order to improve the efficiency of washing cycles without substantial loss of target nucleic acids. For example, an improved blood cell lysis reagent may be provided by selecting appropriate concentrations of saponin and SPS. Moreover, as described below, other blood lysis reagents, such as, for example, Triton X-100 (polyethylene glycol tert-octylphenyl ether), which in the context of culture methods may inhibit cell growth, can be used in some of the methods disclosed herein. Examples of such blood lysis reagents are described in detail below.
In some embodiments, aspects of the sample pretreatment method are controlled or prescribed such that: a high recovery of microbial cells is obtained, such that a substantial percentage (e.g. greater than 10%, 25%, 50%, 75%, or 95%) of the microbial cells present in the original sample are transferred to the pretreated cell suspension; appreciable injury is not inflicted on the microbial cells, such that the recovered microbial cells preserve a substantial percentage (e.g. greater than 10%, 25%, 50%, 75%, or 95%) of the target rRNA or mRNA or 100% of the target DNA; and the pretreated cell suspension liquid should be substantially free of contaminants and substances that are detrimental to or inhibit subsequent nucleic acid assays (e.g. in some applications, it has been found that such contaminants and/or interferents should have a concentration below approximately 0.1%). As described further below, various aspects of the methods described herein are suitable to be performed as automated methods and devices.
Pretreatment vessel 20 is a vessel suitable for centrifugation, such as a microcentrifuge tube. In some embodiments, the centrifuge tube has a conical bottom shape and a smooth inner surface, which minimises adsorption or trapping of microbial cells during centrifugation. In some embodiments, pretreatment vessel 20 includes an injectable closure member, such as pierceable stopper 25 (such as a rubber stopper), or another suitable sealing mechanism that may be evacuated such that an appropriate volume of sample is drawn when the pierceable stopper is pierced by the needle of syringe 27.
In some embodiments, pretreatment vessel 20 is employed to obtain a selected volume of blood from a previously filled blood tube, such as another blood collection tube. In some embodiments, pretreatment vessel 20 may be employed as a sample collection device. For example, pretreatment vessel 20 may include a pierceable stopper that is configured for use with a Vacutainer®-type needle and holder device.
Cushioning liquid 21 is a high density and water immiscible liquid that serves to form liquid surface 32 onto which the microorganisms settle during centrifugation. As shown in
Blood cell lysis reagent 22 is an aqueous liquid that includes one or more substances selected to lyse blood cells. In some embodiments, the composition of the blood cell lysis reagent is selected such that blood cells are lysed without substantially affecting the integrity of microbial cells. Examples of suitable compositions of blood cell lysis reagent 22 are provided below.
As stated above, the presence of blood cell lysis reagent 22 in mixture 30 causes the selective lysis of blood cells. In one example implementation, blood cell lysis reagent 22 may be an aqueous liquid including at least the following components: saponin, sodium polyanetholesulfonate (a sodium salt of polyanetholesulfonic acid, known as SPS), and an antifoaming agent, such as poly (propylene glycol) (PPG, e.g. with a molecular weight of approximately 2000). In some embodiments, the saponin is purified saponin. Example methods for purifying saponin are disclosed in U.S. Pat. No. 3,883,425, titled “Detoxification of Saponins”, which is incorporated herein in its entirety. It has been found that without saponin purification blood cell lysis is less efficient and a gel-like substance is formed upon centrifugation.
In one example implementation, a composition of the blood cell lysis reagent, per approximately 1 mL of whole blood, may be provided as follows: an aqueous solution having a volume of approximately 500 μL with a concentration of approximately 75 mg/mL saponin (84510, Sigma), approximately 15 mg/mL sodium polyanetholesulfonate (SPS) (P2008, Sigma) and approximately 1% by volume of poly(propylene glycol) (PPG) MW 2000 (202339, Sigma). Upon mixing the blood lysis reagent with the whole blood sample the final concentrations of Saponin, SPS and PPG are approximately 25 mg/ml, 5 mg/ml, and 0.3% respectively.
In one example implementation, the concentrations of saponin and SPS, upon mixing whole blood and the blood lysis reagent may be in the range of approximately 1.5 to 80 mg/mL and 0.5 to 20 mg/mL, respectively. In another example implementation, the concentrations of the saponin and SPS may be in the range of from approximately 10 to 30 mg/mL and 2.5 to 10 mg/mL, respectively.
SPS is an anti-coagulant and anti-phagocytosis agent and is known to inhibit antimicrobial agents (Sullivan, N. M., Sutter, V. L., & Finegold, S. M. (1975). Practical aerobic membrane filtration blood culture technique: development of procedure. Journal of clinical microbiology, 1(1), 30-36.). The mechanism by which SPS assists in blood cell lysis is not well understood. Without intended to be limited by theory, it is believed that SPS may offer some level of protection to the microorganisms during blood cell lysis, reduce the incidence of entrapment of bacteria in cell debris, and/or reduce the amount of coagulated components which may otherwise be present in the sediment.
It is noted that SPS a known PCR inhibitor. At higher concentrations of SPS, more washing cycles may be employed to remove excess SPS, for applications in which a low concentration of SPS in the final extracted sample is desirable. It is also noted that U.S. Pat. No. 8,481,265 describes the use of saponin with concentrations (the final concentration) in the range of 40-100 mg/ml as a lysis reagent, without the use of SPS or a cushioning fluid. However, such an approach results in the pelleting of the microbial cells during centrifugation, and difficulty in resuspending the pelleted microbial cells. In fact, in the examples provided in U.S. Pat. No. 8,481,265, mechanical means were required for harvesting of the microorganism from the tube wall, which is less amenable to automation.
The addition of PPG, an antifoaming agent, assists in maintaining a suitable viscosity of the mixture. It has been found that without the inclusion of PPG, the mixture may be thick and/or sticky.
In another example implementation, a composition of the blood cell lysis reagent, for lysing approximately 1 mL of whole blood, may be provided as follows: an aqueous solution having a volume of approximately 500 μL, with a concentration of approximately 1.5% by volume Triton X-100 (X-100, Sigma), approximately 18 mg/mL sodium polyanetholesulfonate (SPS) (P2008, Sigma) and approximately 1% by volume poly(propylene glycol) (PPG) MW 2000 (202339, Sigma) in a buffer pH ranging from 5 to 11. Upon mixing the blood lysis reagent with the whole blood sample the final concentrations of Triton X-100, SPS and PPG are approximately 0.5%, 6 mg/ml, and 0.3% respectively. In one example implementation, the concentrations of Triton X-100 and SPS upon mixing the lysing reagent and whole blood sample may be in the range of approximately 0.5 to 1.5% and 5 to 10 mg/mL, respectively. In another example implementation, a composition of the blood cell lysis reagent, for lysing approximately 1 mL of whole blood, may be provided as follows: an aqueous solution having a volume of approximately 1 mL, and with a concentration of approximately 1% Triton X-100 (X-100, Sigma) in a buffer pH ranging from 9 to 11. In one example implementation, upon mixing the lysing reagent and whole blood sample the concentrations of Triton X-100 may be in the range of approximately 0.05 to 2.5%.
After forming mixture 30 and agitating pretreatment vessel 20, pretreatment vessel 20 is centrifuged, as illustrated in
It will be understood that the centrifugation time and speed required to effect sedimentation of the microbial cells depends on the centrifuge radius, sample viscosity and density, and sedimentation path length, and may be determined readily by those skilled in the art. For example, in one example embodiment, in which a blood volume of approximately 1 ml is injected into a 2 ml pretreatment vessel (with a suitable quantity of blood lysis reagents 22 and cushioning liquid 21 disclosed above) and placed in a fixed angle centrifuge, a centrifugal force of approximately 10000 g and a centrifugation time of approximately 1 minute is sufficient to sediment microbial cells of interest. It will be understood that other combinations of time, speed, and sample volume may be selected to achieve complete collection of the microbial cells at the cushioning surface 32.
As noted above, cushioning liquid 21 has a density greater than that of mixture 30 and is immiscible with mixture 30 such that interface 32 is formed. This ensures that under centrifugal forces cushioning liquid 21 rapidly moves to the sedimentation region 34 and displaces supernatant 33, thereby forming a distinct fluid phase in the sedimentation region 34 of pretreatment vessel 20. Cushioning liquid 21 prevents the loss of microbial cells during the pretreatment process. Such a loss could otherwise occur due to adsorption and trapping of microbial cells on the surface of pretreatment vessel 20 within or near sedimentation region 34, but is substantially prevented in the present embodiment due to the presence of the liquid interface 32, where the microbial cells collect. Since the density of the cushioning liquid is greater than that of the cells the cushioning liquid prevents the cells from coming into close contact with the vessel walls or entering cavities in the wall which may otherwise trap said cells.
Fluorinated hydrocarbons, having molecular weight ranging from about 300 to 850, are suitable as cushioning liquids. Examples are FC-40, FC-43, FC-70, and FC-77. For the examples provided in this disclosure, Fluorinert™ FC-40 (F9755, Sigma) was used. The cushioning liquid volume should be sufficiently large to provide an adequately large sedimentation surface so that all target precipitate is collected on its surface. The cushioning liquid volume suitable for effective microbial cell recovery is dependent on a number of factors, including the pretreatment vessel geometry, pretreatment vessel surface condition, centrifuge angle, centrifugal force and target cell sedimentation coefficient which are collectively termed centrifugal conditions.
One guiding principle for determining the volume of the cushioning liquid volume is that the surface of the pretreatment vessel wetted by the cushioning liquid should at least envelop the region of the pretreatment vessel surface where the microbial cells would sediment in the absence of the cushioning liquid. During centrifugation suspended cells move radially and when they encounter the pretreatment vessel wall they continue to move along the wall toward the extreme radial position until the component of the centrifugal force in the direction of the preferred movement is insufficient to overcome buoyancy and frictional forces which oppose cell motion. In the absence of the cushioning liquid the cells come to rest in a sedimentation region whose geometry reflects the centrifugal conditions. By providing cushioning liquid which envelops this region the cells will come into contact with the cushioning liquid either directly on its surface or on its periphery.
By way of illustration
When a cushioning liquid is initially present in the pretreatment vessel and centrifugation is performed in its presence, its surface 123 will approximately form a vertical plane and the cushioning liquid will wet the pretreatment vessel surface within the region 127 shown approximately in
Likewise, in a pretreatment vessel with a bottom cone angle of 45 degrees which matches the centrifuge angle in this example, shown in
When the pretreatment vessel bottom cone angle is greater than the centrifuge angle as shown in
It is evident from these examples that the minimum volume of cushioning liquid is dependent on the prevailing geometrical and sedimentation conditions. Swinging bucket or horizontally oriented centrifuges can likewise be considered and will generally have a sedimentation region at the apex of the pretreatment vessel, which should be enveloped by the cushioning liquid.
Other sedimentation vessels and centrifugal conditions can be similarly considered to determine the minimum cushioning liquid volume.
It is noted that variability in the centrifugal conditions may necessitate a cushioning liquid volume somewhat larger than the minimum determined as described above to ensure maximum recovery.
The sedimentation region on the surface of the pretreatment vessel which prevails in the absence of the cushioning liquid, and which is wetted by the cushioning liquid in accordance with the selected embodiments disclosed above, can be determined empirically. An example of an empirical method is the observation of the pellet of the sedimented cells on the surface of the selected pretreatment vessel under centrifugal conditions which are the same as those expected in the pretreatment process in the absence of the cushioning fluid. This may be assisted by fluorescent or other dyes applied to the cells to enhance the optical detection of the sedimented cells. The volume of cushioning fluid suitable for enveloping this measured region could be determined by observing the extent of the wetted region of the cushioning fluid on the surface of the pretreatment vessel under the same centrifugal conditions and ensuring that this wetted region extends at least beyond the previously observed sedimentation region (for example, by performing several experiments of cushioning liquid, and selecting the volume that sufficiently wets the measured region). Alternatively, the recovery of cells in the final suspension obtained by the methods described herein can be measured by various means such as, for example, culturing and colony enumeration, and a suitable volume of cushioning liquid determined empirically by selecting a volume that provides a suitable (e.g. maximum) cell recovery.
The volume of cushioning liquid can also or alternatively be estimated by considering the interaction between the sedimenting particle and the inner surface of the pretreatment vessel during centrifugation. During centrifugation, the particle whose density is greater than that of the suspension fluid will move radially outward under the influence of the centrifugal force vector {right arrow over (F)}c of magnitude |{right arrow over (F)}c|=Vp (ρp−ρm)ω2r until it reaches the surface of the pretreatment vessel. Here Vp, ρp, ρm, ω, r represent the volume of the particle, the density of the particle, the density of the particle suspension medium, the angular velocity and the radial distance from the particle to the axis of rotation respectively.
Upon the particle 151 reaching this surface 150 where the unit outward normal vector to the surface is n as depicted in
Directly opposing this force will be fluid resistance whose magnitude is commonly represented in the state of the art by the Stokes equation Fs=6πηrν, where η and ν are the fluid viscosity of the suspension medium and the velocity of the particle respectively, and a wall frictional force Fw, which, if of sufficient magnitude relative to the other prevailing forces, should be included and determined for the particular conditions of the pretreatment vessel surface, particle and suspension fluid under consideration.
Thus the particle will reach a limiting or terminal velocity when force equilibrium is achieved as represented by |{right arrow over (F)}ct|=Fs+Fw. A condition defining formation of a stable sediment may be defined by ν=0 or ν a sufficiently small value and thereby the above equations can be used to define a locus of points on the pretreatment vessel surface at which the particles will effectively come to rest. This locus of points defines a sedimentation region on the pretreatment vessel inner surface which should be wetted by the cushioning fluid in accordance with the principles discussed above. As a number of parameters in the above are subject to some amount of variation or uncertainty it is generally recommended to confirm the results empirically.
It is also to be understood that the cushioning liquid surface should not be so large as to cause loss of sedimented cells during aspiration of the supernatant during the centrifugal separation step.
In this respect, a consideration is the location of the sedimentation zone during centrifugation. Generally, some of the collected cells will settle on the periphery of the cushioning liquid (referred to below as a “periphery collection region”) and some of such cells may remain on the pretreatment vessel wall even if the pretreatment vessel is reoriented for aspiration. Since these cells are easily resuspended to the presence of the cushioning liquid, and care should be taken not to disturb this region with convective disturbances in order to prevent loss of cells. Such convective disturbance may occur due to aspiration of the supernatant.
In some embodiments the pretreatment vessel geometry and/or the volume of cushioning fluid should be selected so that this periphery collection region remains distant from the aspiration device. Moreover, in some embodiments, the pretreatment vessel geometry and/or the volume of cushioning fluid may be selected such that the periphery collection region remains submerged in the residual liquid during aspiration of supernatant.
For example, a pretreatment vessel (e.g. centrifuge tube) with a conical or round (e.g. hemispherical) bottom (or a combination thereof, such as conical tapering side walls terminating in a hemispherical or otherwise round bottom), may be employed to allow the sediment to remain in the bottom of the pretreatment vessel at a location that is distant from the aspiration device, and hence undisturbed while removing the supernatant. This becomes more important as the desired residual fluid volume is decreased.
A suitable maximum volume of cushioning liquid is thereby related to a number of factors, such as the desired residual fluid volume, the pretreatment vessel geometry, centrifuge angle and aspiration method. The distance between the aspiration tip and the cushioning fluid during the aspiration of the supernatant should be at least 1 mm and preferably 3 mm to 5 mm or greater. An example volume of cushioning liquid 21 is approximately 10 μL for a 2 mL pretreatment vessel in an angle centrifuge operating at 6000 g. In another example embodiment, the volume of cushioning liquid may range between approximately 5 μl and 15 μl. In another example embodiment, the volume of cushioning liquid may range between approximately 2.5 μl and 100 μl.
After centrifugation, pretreatment vessel 20 may be re-oriented in a position suitable for subsequent aspiration and dispensing operations, such as, for example, a vertical orientation as shown in
The prevention of resuspension of cells enables the removal of most of the supernatant, as shown in
In one embodiment, the amount of the supernatant that is removed is between 80% and 95% of the total amount of supernatant. In an example implementation employing the quantities according to those described in the above example, a suitable aspirant volume is approximately 1.35 mL.
As shown in
In one example implementation, washing liquid 35 may be any low ionic strength aqueous medium such as salt solutions or buffers. The choice of lower ionic strength enables using the microbial cell lysate, following electrical or mechanical cell lysis, for molecular assays without requiring an ion balance step.
As noted below, the microbial cells are suspended in residual washing liquid 37 when the pretreated sample is extracted from pretreatment vessel 20. Accordingly it may be beneficial for the washing liquid 35 to have a composition suitable for downstream processing of the sample. In one example implementation, washing liquid 35 may include one or more reagents or media for preserving the viability of the retained microbial cells. For example, washing liquid 35 may include monovalent salt solution such as potassium chloride or sodium chloride. In another example, the washing liquid is a buffer such as phosphate buffer pH 7.4, Tris buffer pH 8.0. In another example, the washing liquid is a buffer that is compatible with downstream nucleic acid amplification reactions. In embodiments in which electrical lysis is performed subsequent to extraction of the pretreated sample (as described below), the ionic strength of the washing liquid should be selected such that it is compatible with working parameters of the electrical lysis method. For example, for the case of lysing microbial cells via electrical method, the ionic strength of washing liquid 35 may be between approximately 0.1 and 1 mM.
The number of wash cycles employed during sample pretreatment may depend on various factors, such as the desired level of dilution of the residual supernatant 36. For example, in an embodiment in which the sample is a blood sample and the blood lysis reagent includes SPS, it may be useful to dilute the supernatant 36 such that the residual concentration of SPS is less than approximately 0.01 μg/mL.
In one example implementation, the wash procedure is not performed prior to extraction of the processed sample. This embodiment is particularly suited when the intended nucleic acid assay uses inhibitor-resistant PCR reagents, examples of which have been described by A. T. Hall et al (“Evaluation of Inhibitor-Resistant Real-Time PCR Methods for Diagnostics in Clinical and Environmental Samples.” PloS one 8.9 (2013): e73845.). It is known that high level of haemoglobin left in the suspension quenches the fluorescence signal that typically is employed for monitoring real-time PCR assays. It is understood that the inhibitor-resistant PCR reagents often do not offer the rapid cycling time, therefore wash cycles may be desirable when fast detection time is required.
In another embodiment, one wash cycle may be employed. In other embodiments, two or more wash cycles may be employed. In one example, based on the example parameters disclosed above, four wash cycles were found to provide effective removal of contaminants and inhibitory substances from the sample for downstream processing.
After performing the (optional) washing cycles, pretreatment vessel 20 may be agitated as is shown in
After agitation, cushioning liquid 21 is allowed to settle at the bottom of pretreatment vessel 20, as shown in
In one embodiment, a substantial volume of the residual suspension is removed, such that little or none of cushioning liquid 21 is removed. Such an embodiment is beneficial in removing most of the retained microbial cells, while avoiding contamination by cushioning liquid 21. For example, the controlled removal of a selected volume of the residual suspension may be achieved via the insertion of a syringe with calibrated length, which may be inserted through pierceable rubber stopper 25, leaving cushioning liquid 21 behind.
In some embodiments, the portion of the suspension that is removed does not include cushioning liquid. In another embodiment, the portion of the suspension that is removed is substantially free of the cushioning liquid, such that the presence of any cushioning liquid would not have an impact on the performance of a subsequent assay. In another embodiment, all of the residual suspension is removed, which may further include a small fraction of cushioning liquid 21, such as, for example, <1%, <2%, <5%, or <10%. In some embodiments, an acceptable amount of cushioning liquid that can be withdrawn may be determined based on knowledge of an acceptable concentration of the cushioning liquid in a subsequent assay (i.e. such that assay performance is not degraded). In some embodiments, a portion of the cushioning liquid may be removed, where the volume of cushioning liquid that is removed is less than amount that would reduce the performance of a subsequent assay below a preselected level. For example, in the case of a downstream assay involving real-time PCR, experiments may be performed to determine the volume of cushioning liquid that can be removed without reducing the cycle number below a pre-selected threshold for a given standard analyte concentration (e.g. a performance deficit of less than one cycle). In other assay formats, other suitable measures can be employed, such as threshold values associated with the limit of detection and the signal intensity.
In yet another embodiment, in which one or more optional wash cycles are performed, both the residual suspension and a substantial portion of cushioning liquid may be removed, and the cushioning liquid may be externally separated from the residual suspension. For example, in one embodiment, both the residual suspension and a substantial portion of the cushioning liquid may be removed by an aspiration vessel such as a pipette tip. In this case the cushioning liquid may be separated from the residual suspension by allowing it to settle adjacent to a lower orifice of the aspiration vessel (e.g. the pipette tip) and subsequently be dispensed from the orifice of the aspiration vessel or allowed to drip from the orifice of the aspiration vessel without loss of the residual suspension. In another example embodiment, external filtration may be employed to separate the suspension from the cushioning liquid.
Although the preceding example embodiments relate to the processing of whole blood as a sample matrix, it is to be understood that the methods disclosed herein may be adapted to the pretreatment of a wide variety of specimens. Suitable specimens include, but are not limited to, urine, sputum, cerebral spinal fluid, swabbed tissue samples, vaginal samples, and other sample types of biological origin, and non-biological samples that may contain microbial cells. A sample may be provided by processing a solid or partially solid sample in order to produce a liquid sample (e.g. using a process such as homogenization). Examples of other sample types include other liquid samples that may contain microbial cells, such as environmental water samples, liquid food samples, and homogenized food samples. The initial sample may be combined with a reagent, buffer, or other medium prior to introduction into the pretreatment vessel.
In
Similarly,
Sample Pre-Treatment without Cushion Liquid
The preceding methods and devices employ the use of a pre-treatment vessel with a cushioning liquid. The cushioning liquid prevents a loss in cell recovery (or assay signal in the case of downstream molecular assays) that would otherwise occur (in the absence of the cushioning liquid) due to the adhesion of microbial cells to the walls of the pretreatment vessel.
For example, as illustrated in
In other implementations, however, the pretreatment vessel may be formed from a material having a smoother surface than the plastic microcentrifuge tubes described above, and the smoother surface may allow for suitable or acceptable recoveries in the absence of the cushioning liquid. For example, it has been shown by Dorn, in U.S. Pat. No. 4,164,449, that a glass centrifuge tube, having a siliconized surface, may be suitable for pretreatment in the absence of a cushioning liquid, while enabling high recovery values. It is noted, however, that the recovery values reported by Dorn were based on inoculation of a 1000 microbial cells, and that the recovery may be considerably lower for lower inoculation numbers. It is also noted that the Dorn method involved the withdrawal of the major portion of the supernatant after a single centrifugation step, followed by the resuspension of the retained microbial cells in the residual supernatant. Such a method would be incompatible with downstream molecular assays due to the interferents present within the residual supernatant that is used to form the suspension.
Accordingly, in one embodiment, a pretreatment method may be performed according to the embodiments described above, but without employing the cushioning liquid, provided that the pretreatment vessel has a smooth inner surface having a hydrophobic surface treatment (such as a glass centrifuge tube having a siliconized surface). Unlike the method disclosed by Dorn, which was suitable for subsequently growth analysis, the method according to the present embodiment employs one or more intermediate wash steps prior to the withdrawal of the final suspension of microbial cells. The one or more intermediate was steps may be performed according to any of the washing methods described in the present disclosure. The one or more intermediate wash steps result in a higher purity microbial suspension, with a substantially reduced concentration of interferents that would otherwise inhibit or prohibit subsequent (downstream) molecular assays. Such purity was not important to the method of Dorn, in which the suspension was employed for growth purposes, as opposed to for molecular assays that are susceptible to interferents present in the supernatant of a lysed blood sample following an initial centrifugation step. Accordingly, the present embodiment, in which one or more intermediate wash steps are employed in a pretreatment method absent of a cushioning liquid, can be employed to provide a suspension having a high recovery of microbial cells while also having a dramatically lowered concentration of interferents, such that the suspension is suitable for subsequent molecular assays.
In some embodiments, a pretreatment method may be performed without using a cushioning liquid, where a pretreatment vessel having a smooth hydrophobically-treated inner surface is employed (such as a glass centrifuge tube having a siliconized surface), and where the distal portion of the pretreatment vessel has a conical or rounded (e.g. hemispherical) shape that is suitable for extraction of the supernatant (after centrifugation) while leaving a residual volume of less than approximately 100 ul, or less than approximately 50 ul. Such an embodiment results in a concentrated microbial cell suspension (purified by optional wash steps), that is suitable for performing molecular methods. This is in stark contrast to the method of Dorn, in which the final suspension was employed for subsequent growth analysis, without requiring or employing a low-volume concentrated suspension.
Automated Methods of Sample Pre-Treatment
In some embodiments, the sample pretreatment processes disclosed above (with or without a cushioning liquid), or variations thereof, may be automated to reduce the operator involvement and to improve cell collection and washing effectiveness. For example, a centrifuge that is configured with the ability to perform automated wash steps may be employed for this purpose.
Rotor 40 contains receptacles for a plurality of pretreatment tubes 41. A dispensing tube 42 and an aspirant tube 43 are inserted into the pretreatment tube 41 by piercing the pierceable top cap of the pretreatment tube. Dispensing tube 42 and aspirant tube 43 may be provided according to a number of different configurations, such as concentrically, or in a parallel/adjacent configuration as shown in
Entrance tube 46 and exit tube 47 may be connected to a dispensing fluid source and waste reservoir respectively, each of which are provided with a dispensing mechanism (such as a peristaltic pump or a syringe pump) for independently dispensing and aspirating fluids. The vortexing, dispensing, and aspiration actions may be controlled independently by the device in accordance with a pre-programmed treatment protocol, following one or more of the steps outlined in
The pretreatment protocol may be performed with the automated centrifuge washer in the following manner. With reference to
As shown in
Although only one of each component is illustrated in
In one embodiment, control and processing unit 225 may be, or include, a general purpose computer or any other hardware equivalents. Control and processing unit 225 may also be implemented as one or more physical devices that are coupled to processor 230 through one of more communications channels or interfaces. For example, control and processing unit 225 can be implemented using application specific integrated circuits (ASICs). Alternatively, control and processing unit 225 can be implemented as a combination of hardware and software, where the software is loaded into the processor from the memory or over a network connection.
Control and processing unit 225 may be programmed with a set of instructions which when executed in the processor causes the system to perform one or more methods described in the disclosure. Control and processing unit 225 may include many more or less components than those shown.
In the context of the current disclosure the initial pretreatment steps of
Since it is also generally necessary to concentrate the cells in a smaller fluid volume than the original sample, the elutriation chamber should be of an appropriate size to allow extraction of the suspended cells into the desired pretreated sample volume. Thus an elutriation chamber volume may be similar in size to the final sample. For example, the pretreatment fluid/sample volume used in examples herein is approximately 1.5 ml and a preferred final clean cell suspension volume is approximately 50 μl for some applications. For a typical elutriation chamber geometry with a volume of approximately 50 μl and typical benchtop centrifuge parameters the elutriation flow rate is limited to approximately 1 μl/second for which the total elutriation time amounts to processing times of approximately 30 minutes. This processing time can be substantially reduced by initially performing steps (a) to (f) followed by steps (l) and (m) of
An alternative pretreatment device 310 is shown in
A further embodiment is shown in
The pretreatment fluid/sample mixture 342 containing the cushioning fluid is initially dispensed into the first part 330 and subjected to centrifugation such that the microbial cells sediment on the surface and periphery of the cushioning fluid 346 at the bottom apex of the tube. Optionally the first part 330 contains a volume of blood lysis reagent and cushioning liquid as described previously and the sample is inserted, followed by mixing so as to produce a mixture and effect lysis of the blood cells, and is subsequently subjected to centrifugation.
Following sedimentation of the microbial cells the second part 331 is inserted into and pushed to the bottom of the first part 330 sufficiently slowly to allow the supernatant so displaced to flow through the outlet tube and into the waste chamber resulting in the engaged position of the parts as shown in
In order to improve the washing efficiency the fluid in the chamber may be mixed by vibration or vortexing intermittently in order to resuspend particulate that may attach to the chamber wall and to dilute fluid zones of relative stagnation. Furthermore the density of the wash fluid may be increased to a level exceeding that of the pretreatment fluid/sample mixture by, for example, the addition of trehalose to provide a more effective displacement of pretreatment fluid/sample mixture from the chamber.
Integration of Sample Pre-Treatment with Downstream Molecular Processing
In some embodiments, the preceding embodiments may be employed for the initial extraction and concentration of microbial cells, followed by downstream methods for identifying microbial cells using reverse transcription-PCR (RT-PCR); the reverse transcription of rRNA into complementary DNA (cDNA), with subsequent amplification and detection of the cDNA by PCR. The amplification of cDNA may optionally be performed simultaneously, or serially, with the amplification of genomic DNA, where the cDNA and the gDNA are employed for identifying different genotypic taxa of the microbial cells. The gDNA may be obtained from the same lysate as the rRNA.
Microbial cells that may be identified according to embodiments of the disclosure include bacteria and fungi. In some embodiments, rRNA from the microbial cells is released, and a reverse transcription step is employed to obtain cDNA, where the cDNA is representative of a first genotypic taxa level, and where the cDNA, if present, is subsequently amplified and detected in order to identify the first genotypic taxa level of the microbial cells. Simultaneously or sequentially, amplification and detection of gDNA released from the microbial cells is employed to identify a second genotypic taxa of the microbial cells of a second level, where the second level is of a lower level than the first level. In another embodiment, mRNA may be used as a target for the microbial identification, and a reverse transcription step is employed to obtain cDNA and where the cDNA, if present, is subsequently amplified and detected in order to identify the second genotypic taxa level of the microbial cells. This embodiment may be preferred when the information on the viability of the microorganism is desired. As it is known in the art, mRNA content of microorganisms drop following the cell death.
An example module for performing electrical treatment, reverse transcription of rRNA, PCR, and amplicon detection is schematically presented in
The device may include additional fluid features, such as valves for opening and closing ports 51 and 53. For example, valves 57 and 58 may optionally be provided at the inlet 51 and outlet ports 53 of electrical channel 52, and valve 59 is optionally provided at the outlet of thermal chamber 54. Valves 57, 58 and 59 may employ any suitable valving mechanism compatible with a microfluidic channel, including, but not limited to, pinch valves, ball valves, disc valves, plug valves. Valves 57 and 58 may be provided to assist in controlling evaporation of the liquid during electrical lysing and treatment and to control the exposure of the fluid to electrical field and thermal effects. For example, valves 57 and 58 may be useful in ensuring that a sufficiently high temperature is achieved for sufficient and/or efficient electrical lysis (for example, some organisms, such as fungi, may require higher temperatures and/or temperature rates of change for efficient lysis).
Referring now to
The lower electrode 64 and upper electrode 63 are electrically isolated from the base and top plates (substrates) by lower and upper electrically insulating layers. In accordance with thermal requirements, thermal insulating layers may also be provided which may be separate from or be suitable selections of the electrical insulating material. The channel has dimensions H×W×L which, in one example implementation, used for the tests in the following examples, was 0.2×6.4×15 mm3. The two electrodes 63 and 64 are intended for inducing an electric field across the channel resulting in the establishment of an ionic current.
As per the methods disclosed in PCT Application Number PCT/CA2012/000698, the application of suitable amplitude modulated electric pulse train by the external voltage source 68 on the two electrodes, establishes an electric field in the electric chamber. The electric field results in ionic current and Joule heating of the liquid. As the duration of the electric pulse train and, consequently, the accompanying Joule heating is brief, this mechanism of heating is known as flash heating. The coupled effect of the electric field acting on the cells and the flash heating of the liquid causes the microbial cells to lyse and intracellular molecules, such as proteins and nucleic acids, to be released from the cell. The lysis process, irreversibly permeabilizes the microbial cell membrane and readily supports molecular exchange in and out of the cell.
The thermal properties of the channel are dependent on many different channel parameters. For example, the channel conductivity and heat capacity can be controlled according to the geometry and/or thickness of the metal electrode. Most electrodes will have a high thermal conductivity, but the thermal properties of the channel can be tailored by selecting an appropriate electrode thickness to provide a suitable heat capacity and an appropriate (e.g. thermally insulating) substrate upon which the electrodes are supported.
Accordingly, one or more of the channel electrodes may be provided as a metal foil or coating having a high thermal conductivity and/or a high heat capacity relative to the total volume of fluid in the channel to promote rapid cooling after electrical treatment, while at the same time providing a sufficiently small heat capacity such that the flash heating can produce a rapid temperature rise within the channel during the application of the voltage pulses (for example, a temperature rise greater than approximately 250 degrees Celsius per second).
Generally speaking, the following ranges may be employed for electrical processing of microbial cells. The electric field strength within the channel that is produced by the application of the voltage pulses may range between approximately 200 V/cm<E<50 kV/cm, depending on the type of cell that is to be processed and the degree of electrical processing that is desired. A range of approximately 2 kV/cm<E<30 kV/cm may be preferable for lysis of microorganisms and using the lysate for performing diagnostic tests on the released nucleic acids.
According to different example implementations, the pulse width of individual voltage pulses may range between approximately 1 μs<tp<10 ms, depending on the type of cell that is to be processed and the degree of electrical processing that is desired. A range of approximately tp<1 ms may be preferable for avoiding the electrical breakdown of the dielectric coating in the case of blocking electrodes, minimizing the accumulation of the electrochemical products in the case of non-blocking electrodes. A range of approximately tp>10 μs is preferred for lowering the high frequency demands of driving electronics.
According to other example implementations, the time duration over which the voltage pulses are applied may be less than about 5 s, depending on the type of cell that is to be processed and the degree of electrical processing that is desired. In some cases, such as to minimize the heat induced degradation of target macromolecules and decrease the power demands of the driving electronics, an effective time duration for electrical processing may be less than about 100 ms.
According to other example implementations, the ionic strength of the cell containing liquid may range from approximately 0.1 mM<I<100 mM, depending on the ionic composition of the initial sample that is to be processed and the degree of electrical processing that is desired. In some cases, when filtering is used and fluid exchange is allowed, a more suitable range for the ionic strength may be from approximately 0.1 mM<I<10 mM, or 0.2 mM<I<1 mM.
According to other example implementations, the peak temperature of the liquid within the channel during the application of voltage pulses may range from approximately 30° C.<Tp<250° C., depending on the type of cell that is to be processed and the degree of electrical processing that is desired. In some applications, such as lysis of microorganisms and using the lysate for performing diagnostic tests on the released nucleic acids, it may be preferable for the temperature range to lie within approximately 80° C.<Tp<200° C.
The heating rate of the liquid for the electrical processing may be greater than approximately 250° C./s, depending on the type of cell that is to be processed and the degree of electrical processing that is desired. In some cases, such as lysis of Gram positive bacteria, fungi, and spores, a suitable range may include rates greater than about 2000° C./s.
The cooldown time of the liquid following electrical treatment may be less than approximately 1 s, depending on the thermal sensitivity of the target macromolecule. In some cases, such as when the target macromolecule is particularly sensitive, a preferred range may include times below about 100 ms.
The macromolecular content of the cell may undergo a transformation in the period between turning on of the electric field and cooling down of the liquid. This process, referred to herein as “E-treatment”, may render nucleic acids, such as rRNA and gDNA, more accessible to enzymes, thus improving the efficiencies of the ensuing nucleic acid reverse transcription and amplification processes. Moreover, E-treatment may be effective in inactivating most of enzymes that are released from microbial cells or have been left in the channel from residual blood cell debris. Thus, the deleterious inhibitory effects of such enzymes in the subsequent processes may be minimized. Other inhibitors that hinders transcriptase and/or polymerase activity may be also rendered less effective or benign through E-treatment.
Referring again to
According to this example implementation, the nucleic acid sequences of the rRNA are reverse-transcribed to complementary DNA (cDNA). The reagent for reverse transcription typically contains reverse transcription enzyme, deoxy nucleotide triphosphate mixture (dNTPs), an appropriate buffer with magnesium or manganese cofactor, and optionally RNase inhibitor. The reverse transcription can be any RNA-dependent DNA polymerase enzyme known in the prior art such as Moloney Murine Leukemia Virus (M-MuLV) reverse transcription, Avian Myeloblastosis Virus (AMV) reverse transcription and Thermus thermophilus (Tth) DNA polymerases.
The primers can be non-specific random primers or gene-specific primers. In some embodiments, nucleic acid sequences of no more than 500 bases will be reverse transcribed to cDNA using gene-specific primers. The specific primers can be primer sets or degenerate primers. One or more target nucleic acid sequences of one or more microorganisms will be reverse transcribed at the same time.
In one embodiment, three sets of primers, respectively targeting Gram-positive, Gram-negative, and fungal rRNA, are simultaneously used (multiplexed). Reverse transcription takes place at an appropriate temperature depending on the enzyme and on the primer annealing temperature (for example, for no more than 10 minutes). In addition, the reaction mixture may contain ingredients for performing PCR, including Taq DNA polymerase, deoxy nucleotide triphosphate mixture (dNTPs). Optionally, RNase inhibitors, Taq DNA polymerase antibody for hot-start, adjuvants to inhibit PCR inhibitors (example; bovine serum albumin) or to enhance PCR performance (example; betaine) may be included.
The PCR cycles may involve an initial incubation at 94-98° C. for 2-5 minutes, to inactivate the reverse transcription enzyme from the first stage, and to activate DNA polymerase for PCR, followed by a 2-step or 3-step thermal cycling. The thermal chamber may contain one or more specific primer sets or degenerate primers. In addition to the primers, one or more components of PCR reagent may also be provided in the chamber in a dry format, such as freeze-dried reagent, or ambient temperature dried reagent employing appropriate stabilizers.
In the example implementation illustrated in
In one embodiment, the detection is performed using molecular beacons. Molecular beacons have a stem-and-loop structure, with the loop portion being complementary to a single-stranded DNA target while the stem is formed by 6 to 8 nucleotides from two complementary arm sequences. A fluorophore (such as, but not limited to, fluorescein (6-FAM) is attached to the end of one arm, while a quencher (such as but not limited to dabcyl succinimidul ester) is attached to the other arm. In the absence of the specific target, the molecular beacon remains in a “dark” state. In the presence of the specific target, the fluorophore and quencher are separated and the fluorescence emission, resulting from excitation by light with appropriate spectrum, can be detected by an optical system. In the preferred embodiment, the excitation and detection are performed using epi-fluorescence microscopic objective that may utilize an LED light source. In some embodiments, the molecular beacon may be stored in wells 56 in a solution or in dry format.
According to one example implementation, a primer pair to detect all bacterial 16S rRNA genes may be CGGCTAACTCCGTGCCAGCAG (SEQ. ID. 1) and ATCTCTACGCATTTCACCGCTACAC (SEQ. ID. 2), which targets a hypervariable region of target bacterial species (nucleotides 504 to 697 using Escherichia coli O104:H4 str. 2011C-3493 as a reference). A primer pair to detect target fungal species could be AGGGGGAGGTAGTGACAATAAAT (SEQ. ID. 3) and CAAAGTTCAACTACGAGCTT (SEQ. ID. 4), which targets a variable region of eukaryotic 18S rRNA (nucleotides 436 to 622 using Candida albicans AB013586 as a reference). The molecular beacons can subsequently be used to identify specific nucleotide patterns within this amplified region to distinguish between the pathogens of interest. For example, a molecular beacon designed to detect target Gram-negative species could be 6-FAM-5′-CCGAGCGGTGCAAGCGTTAATC GGAATTACTGGGCGCTCGG-3′-DABCYL (SEQ. ID. 5), which targets a region of the 16S rRNA gene (nucleotides 541-569 using Escherichia coli O104:H4 str. 2011C-3493 as a reference) conserved in all Gram-negative bacteria. Alternatively, a molecular beacon designed to detect target fungal pathogens could be 6-FAM-5′-CCGAGCTCTGGTGCCAGCAGCCGCGGTAATTCGCTCGG-3′-DABCYL (SEQ. ID. 6), which targets a region of the 18S rRNA gene (nucleotides 539 to 564 using Candida albicans AB013586 as a reference) conserved in all fungi. Using this strategy, target bacterial and fungal blood pathogens can be identified using a small number of primer pairs and several molecular beacons. The molecular beacons could ultimately be multiplexed, allowing one to identify multiple bacterial and/or fungal pathogens in a single chamber.
In another example embodiment, microbial cells may be identified by two-step RT-PCR. Thermal chamber 54 in
In another example embodiment, thermal chamber 54 in
Electrical processing, by which the microbial cells are lysed and the intracellular rRNA and genomic DNA are rendered accessible for external enzyme action, is performed in step 11, as described above. Electrical treatment in this step may also inactivate or reduce the effect of enzymes or factors inhibitory to subsequent amplification and detection. In step 12, the pretreated and lysed sample is mixed with an appropriate master mix in the thermal chamber and targeted regions of the rRNA are reverse transcribed into corresponding cDNA. The master mix contains components for performing cycles of PCR amplification on the cDNA or specific regions of gDNA, as shown in step 13.
In the method and embodiments disclosed, the three preceding steps, namely 11, 12 and 13, may be performed in fluidic sequence in a single device in order to prevent or reduce losses in the number of target molecules. Such losses are associated with liquid exchanges and movements in commonly used methods for sample extraction and/or preparation. Accordingly, this aspect of the present method, along with the efficient sample pretreatment step 10, potentially enables achieving a detection limit down to a few microbial cells in the sample.
Performing an assay based on rRNA, as opposed to gDNA, as the primary mode of detection, may provide enhanced sensitivity for two reasons. Firstly, rRNA is not as stable as gDNA and thus foreign rRNA has a much smaller chance of being introduced into the thermal chamber as a major contamination component. Secondly, the number of rRNA molecules becoming available after electrical treatment of step 11, for even a single cell, is in the range of 104, which, according to the methods disclosed herein, will generally exceed the quantity of contaminant background molecules.
Following the completion of step 13, the liquid contains sufficient cDNA and/or amplicons to be split into multiple aliquots and delivered into a plurality of wells, in a manner such that each well receives a statistically significant number of target molecules.
Test Panels for Rapid De-Escalation of Antimicrobial Therapy Based on Processing of Direct Samples
In some embodiments, the panel of rRNA tests may be selected to enable rapid de-escalation of antibiotic therapy from one or more broad-spectrum antibiotics to one or more narrow-spectrum antibiotics. Using narrow-spectrum antimicrobial drugs not only provides a benefit in terms of cost reduction, but it also limits the potential for adverse effects such as superinfection and the development of drug-resistant microbes. As noted above, the present embodiments enable the rapid detection and/or identification of infectious agents, which could improve the decision-making process of health care professionals, and help them to administer narrow spectrum antimicrobial drugs at an earlier time. This may prevent the development of resistance, reduce toxicity, and substantially reduce healthcare costs.
Unlike known molecular methods that are focused on the targeted identification of an organism at the species level based on a comprehensive, species-level test panel, such as the Septifast system, selected embodiments described herein provide sufficient information for rapid de-escalation of antimicrobial therapy, without needing to provide full species and/or genus level identification for every expected pathogen. The reduced panels described herein are suitable for effective rapid re-vectoring of antimicrobial treatment because many organisms will respond to a common narrow-spectrum antibiotic, and as such, the test panel need not identify each and every genus and/or species of the expected pathogens, an instead need only identify those organisms or groups of organisms whose presence or absence will impact antimicrobial therapy and guide the selection of appropriate narrow-spectrum antibiotics. In many of the embodiments provided herein, a test panel is selected to provide information that is not exclusive to the genus or species level, but is instead includes a combination of rRNA test results at the kingdom, Gram-status, genus, and species levels.
Accordingly, in some embodiments, a test panel for rapid de-escalation of antimicrobial therapy includes, at a minimum, the following:
(a) one or more primary rRNA tests at the kingdom level to determine whether the organism is a bacterial or a fungal organism;
(b) one or more secondary tests to identify the Gram status of the organism, if bacterial; and
(c) one or more tertiary rRNA tests, for each of fungi, Gram-positive bacteria, and Gram-negative bacteria, to identify at least one genus or species of the organism, where the result of the tertiary test is suitable for selecting an appropriate narrow-spectrum antibiotic.
In some embodiments, one or more of the rRNA tertiary tests may be replaced and/or augmented by a strain level test, where the strain level test may be a gDNA test suitable for identification of a selected strain.
It has been found that such test panels are sufficient for rapid de-escalation of antimicrobial therapy from broad spectrum antibiotics to narrow spectrum antibiotics, especially when the test is performed on a direct, non-enriched sample, prior to enrichment or culturing.
The selection of one or more tertiary tests at the species or genus level will depend on a number of factors, such as the nature of the antibiogram, and the availability of suitable antibiotics. Non-limiting examples of test panels are described below. For example, over time, a suitable genus or species level tertiary test for Gram-negative bacteria may change due to changes in pathogen prevalence, changes in antibiotic resistance, and/or the availability of new antibiotics.
In some embodiments, the reduced test panel is selected by mapping the available antibiotics to information associated with the highest levels of pathogenic taxa, and the test panel is selected to include the tests for these highest levels. For example, the test panel may include, at a high level, three multiplex tests for isolating a true positive sample to one of Gram-positive, Gram negative, or fungi. This may be achieved, as noted above, by isolating specific regions of the ribosome belonging to all Gram-positive bacteria, to the exclusion of all others, for example, it becomes possible to identify a true Gram-positive sample. If this same procedure is repeated for all Gram-negative bacteria to the exclusion of all others, it becomes possible to identify a true Gram-negative sample. A third test would isolate and identify a true fungal sample.
This reduction principle may be repeated in a hierarchical format (for example, a decision tree or a flow chart) to determine the set of tests needed to de-escalate antimicrobial therapy. This effectively reduces the very large number of tests for all possible organisms to a subset of tests relevant to antimicrobial re-vectoring.
For example, a suitable test panel may involve a kingdom-based primary test for bacterial vs. fungal organisms, a Gram-status secondary test, and a tertiary test for the genus of Streptococci, and an additional species-level tertiary test, provided that the species-level test would enable further antimicrobial de-escalation. For example, a species-level tertiary test for Streptococcus pneumoniae would enable further de-escalation, based on presently available antibiotics.
In another example, a suitable tertiary test may be for the genus of Staphylococcus, and the test panel may include an additional species-level tertiary test for the species of Staphylococcus aureus. A sample testing positive to both of these tertiary tests would be thought to include Staphylococcus aureus, and a medical practitioner could subsequently decide to de-escalate antibiotic therapy to Vancomyacin and Oxacillin due to the awareness of potential methicillin resistance. On the other hand, if the sample found to be positive to Gram-positive and Staphylococcus, but negative to S. aureus, then the medical practitioner may determine that the offending organism is probably Staphylococci other than S. aureus and most probably a contaminant, which could lead the medical practitioner to determine that treatment is not warranted.
This principle is illustrated in
Three additional example panels are presented in
In the panel shown in
In the example panel shown in
The aforementioned rapid sample pretreatment and rRNA-based testing protocols, when combined with a rapid de-escalation test panel as described above, enables the rapid and effective selection of appropriate narrow-spectrum antibiotics, or the appropriate initial selection of a suitable antibiotic, thereby dramatically reducing the number of tests, and the complexity of medical inquiry, required to enable a therapeutic decision. In particular, when aforementioned methods of sample pretreatment and rapid rRNA reverse transcription PCR are employed to perform tests according to such a rapid de-escalation panel, results are provided on a suitable timescale to affect patient outcomes, and with sufficient information to guide the de-escalation of antimicrobial therapy.
As noted above, the present embodiments do not require an enrichment step, and are capable of rapidly providing results that influence antimicrobial treatment. For example, in some embodiments, the time delay between initiating the pretreatment phase and the availability of the test results may be less than approximately 30 minutes. The rapid availability of the test results is important for enabling de-escalation of antimicrobial treatment, or prescribing an initial narrow-spectrum antibiotic, on a clinically relevant and effective timescale.
This is to be contrasted with existing molecular methods, which fail to find widespread clinical utility due to (1) the requirement for complex and time consuming manual sample preparation steps, (2) insufficient recovery of microbial cells when performing sample preparation based on direct, non-enriched samples, and (3) overly complex test results that fail to clearly inform appropriate decision making in antimicrobial stewardship.
The following examples are presented to enable those skilled in the art to understand and to practice embodiments of the present disclosure. They should not be considered as a limitation on the scope of the present embodiments, but merely as being illustrative and representative thereof.
In the following examples, Gram-negative bacteria cells were grown on LB agar plates and a single colony of cells was cultured in LB broth overnight at 37° C. Gram-positive bacterial and fungal cells were grown on tryptic soy agar with 5% sheep blood and a single colony of cells was cultured in tryptic soy broth overnight at 37° C. The cells were centrifuged at 7000 rpm for 5 min. The cell pellet was washed twice and re-suspended in 0.8 mM phosphate buffer pH 7.4, pre-filtered through a 0.2 μm filter.
The blood cell lysis reagent was used whenever blood sample pretreatment was required. The blood cell lysis reagent consisted of a mixture of saponin (84510, Sigma), sodium polyanethol sulfanate (SPS) (P2008, Sigma) and poly(propylene glycol) (PPG) MW 2000 (202339, Sigma). Saponin was dissolved in reagent grade water, filtered through 0.2 μm PES syringe filter and purified using Amicon Ultra-15 10K MW cut-off (Z706345, Sigma). SPS was dissolved in reagent water and filtered through 0.2 μm PES syringe filter. PPG MW 2000 (202339, Sigma) was used directly from the original bottle. In addition, Fluorinert™ FC-40 (F9755, Sigma) was added to serve as cushioning liquid.
Unless any variation is specified, the following example pretreatment procedure which includes blood cell lysis step followed by 4 wash cycles was performed in experiments which required pretreatment of blood samples. 10 μL of Fluorinert™ was added to 2 mL siliconized microcentrifuge tubes (T3531, Sigma), followed by the addition of 500 μL of the blood cell lysis reagent. The blood cell lysis reagent consisted of 75 mg/mL saponin, 15 mg/mL SPS and 1% PPG. Sodium citrate-treated human whole blood (Bioreclemation Inc.) of 1 mL spiked with microbial cells was added to the tube containing the blood cell lysis reagent and the Fluorinert™, and mixed by inverting ten times and vortexing at low speeds for 10 sec. The final concentrations of the components in the mixture were 25 mg/mL saponin, 5 mg/mL SPS and 0.33% PPG. The tubes were centrifuged at 12,000 rpm for 1 min and 1.35 mL of the supernatant was removed, leaving 150 μL of the liquid supernatant, Fluorinert™ and the sedimented microbial I cells. The first wash cycles was performed by adding 1.35 mL of 0.8 mM phosphate buffer to the remaining liquid supernatant of 150 μL as described above, mixing by vortexing at low speed for 10 sec, centrifugation at 12,000 rpm for 1 min and removal of 1.35 mL of the supernatant, leaving 150 μL of the liquid supernatant, the Fluorinert™ and the sedimented microbial. The remaining wash cycles were performed by adding 0.75 mL of 0.8 mM phosphate buffer to the remaining liquid supernatant of 150 μL, mixing by vortexing at low speed for 10 sec, centrifugation at 12,000 rpm for 1 min and removal of 0.75 mL of the supernatant, leaving 150 μL of the liquid supernatant, the Fluorinert™ and the sedimented microbial. After the last wash, the sedimented microbial cells were re-suspended in the residual liquid, whose volume was in the range of 100 to 300 ul. Positive control samples are prepared by spiking 0.8 mM phosphate buffer pH 7.4 with the same concentration of respective microbial cells as the nominal concentration of the pretreated sample in respective experiments.
In examples that employed electrical cell lysis, the pretreated samples and the positive control samples were passed through an electrical chamber with steps of 10 μL/10 s and applying n=250 bipolar square pulses having duration of 50 μs and amplitude of 190 V. The electrical chamber had a dimension of 6.4×15×0.2 mm3 and the outlet and outlet ports were of restricted type.
In the following examples, real-time reverse transcription PCR (real-time RT-PCR) assay was performed to detect a specific target region in 16S or 18S rRNA of respective microbial cell types. The primers were designed by sequence alignment software (Bioedit, Ibis Biosciences, USA) and primer design software (Primer3, National Institutes of Health). The cell lysate of the pretreated sample and the spiking control following the electrical lysis was subjected to real-time RT-PCR. In addition to the samples, the following negative controls were subjected to real-time RT-PCR: pre-filtered phosphate buffer used for cell suspension (negative control; buffer), and unspiked blood subjected to the same pretreatment and electrical lysis protocol as the spiked blood samples (negative control; blood).
Unless any variation was specified, RT-PCR reaction of 20 μL volume was prepared by mixing 5 μL of sample, 10 μL of Kapa 2G Robust Hotstart 2×PCR reaction mix (kk5515, KAPA Biosystems), 1.2 μL of reverse transcriptase (GoScript, A5004 Promega), 1 μL of forward primer (10 μM), 1 μL of reverse primer (10 μM), 1 μl of SYTO-9 (100 nM, S34854, Invitrogen) and 0.8 μL of RNAase free water. One-step real time RT-PCR was performed by reverse transcription at 55° C. for 5 min, inactivation of reverse transcription at 95° C. for 2 min, followed by 35 cycles of cDNA amplification (denaturation at 95° C. for 3 sec, annealing at respective temperature for 3 sec, and extension at 72° C. for 3 sec) in Eco Real Time PCR system (illumina) using a double stranded DNA binding fluorescent dye, SYTO-9.
The experiments presented in this example were performed to determine the effect of washing cycles of reducing the quenching effect of lysed blood debris on the fluorescent signal and enabling efficient real time RT-PCR assay, according to an example method of pretreatment and amplification.
A suspension of 2000 CFU/mL Pseudomonas aeruginosa cells in 0.8 mM phosphate buffer with pH 7.4 was electrically lysed. The lysate was subjected to real time RT-PCR to prepare sufficient volume of amplicons for the experiment in this example. The forward and reverse primers used for RT-PCR were GGGCAGTAAGTTAATACCTTGC (SEQ. ID. 25) and TCTACGCATTTCACCGCTACAC (SEQ. ID. 26), respectively. The 16S rRNA gene fragment of 251 bases pair at a conserved region of P. aeruginosa (nucleotides 438 to 689 using P. aeruginosa D77P as a reference) was amplified. Human whole blood, which had been drawn into a collection tube with sodium citrate anticoagulant were subjected to the example sample pretreatment procedure described above with four wash cycles as described above (involving centrifugation). At the end of each wash cycle the removed supernatant was stored. A 5 μL volume of amplicon, prepared as described above, was added to 5 μL of the stored supernatant of each wash cycle. The fluorescence signal was read in Illumina machine. The signals were normalized to the signal of amlicons added to the clean phosphate buffer. The results of three different runs were presented in
The experiments presented in this example were performed to demonstrate how number of wash steps and microbial cell lysis method affect the inhibitory effects of the lysed blood debris on the downstream molecular assays.
Pseudomonas aeruginosa cells were used and the cell suspension was prepared as described above. Human whole blood was subjected to the sample pretreatment procedure as described above with the following exceptions. The wash cycles were performed by adding the respective volume of 0.8 mM phosphate buffer to the remaining liquid supernatant of 150 uL and mixing by inverting 10 times, without vortexing or centrifugation. Thus, the samples are simply the serial dilutions of the originally lysed blood. The dilution-based wash cycles were performed five times instead of four times as per the example sample pretreatment procedure described above that employed centrifugation when washing. The removed supernatant of each wash cycle was split into 3 aliquots and spiked with P. aeruginosa cells. Each aliquot of 75 μL included nominal 30 microbial cells. One aliquot was electrically lysed and one aliquot was heat lysed by heating the suspension at 95° C. for 10 minutes. The third aliquot was subjected to mechanical lysis using glass beads (GB). To perform GB lysis, an equal volume of glass beads (<106 μm, G4649 Sigma) was added to 75 μL of cell suspension and mechanically lysed by vortexing at a high speed for 2 minutes. The GB cell lysate was centrifuged at 14,000 rpm for 1 minute to separate the beads and the supernatant was collected for the assay.
All lysates of 5 μL each containing the equivalent of 2 lysed microbial cells were assayed with real-time RT-PCR alongside negative control (buffer) and positive control (buffer spiked with microbial cells and electrically lysed). The forward and reverse primers used for RT-PCR were GGGCAGTAAGTTAATACCTTGC (SEQ. ID. 25) and TCTACGCATTTCACCGCTACAC (SEQ. ID. 26), respectively. The 16S rRNA gene fragment of 251 bases pair at a conserved region of P. aeruginosa (nucleotides 438 to 689 using P. aeruginosa D77P as a reference) was amplified. The resulting signal versus real time PCR cycle # plots are presented in
The experiments presented in this example were performed to demonstrate how washing cycles and electrical treatment reduces the inhibitory effects of the lysed blood debris on the downstream molecular assays. The dependence of a typical RT-PCR assay on the number of washing cycles during the example sample pretreatment was tested.
Pseudomonas aeruginosa cells were used and the cell suspension was prepared as described above.
Human whole blood was subjected to the example sample pretreatment procedure with four wash cycles as described above. The removed supernatants of third and fourth wash cycles were spiked with P. aeruginosa cells and subjected to electrical lysis. Each wash cycle supernatant aliquot of 75 μL included nominal 30 microbial cells. All lysates of 5 μL each containing the equivalent of 2 lysed microbial cells were assayed with real-time RT-PCR alongside positive control (buffer spiked with microbial cells and electrically lysed). The forward and reverse primers used for RT-PCR were GGGCAGTAAGTTAATACCTTGC (SEQ. ID. 25) and TCTACGCATTTCACCGCTACAC (SEQ. ID. 26), respectively. The 16S rRNA gene fragment of 251 bases pair at a conserved region of P. aeruginosa (nucleotides 438 to 689 using P. aeruginosa D77P as a reference) was amplified.
The resulting signal versus cycle # plots is presented in
The experiments presented in the following examples were performed to demonstrate the efficiency by which the microbial cells in a whole blood sample are recovered into the pretreated sample and that molecular assay inhibitory compounds are removed or inactivated. As noted above, such methods may be applicable for downstream reagentless microbial cell lysis followed by a nucleic acid assay without requiring additional steps of nucleic acid extraction/purification and/or medium balance. The dependence of microbial cell recovery on blood cell lysis reagent composition, volume of cushioning liquid and interior surface property of the sample pretreatment vessel were verified.
In these experiments, the viability of the recovered microbial cells may not be of concern, which is in contrast to cases when microbial cells are intended for subsequent growth (such as in the disclosures of Dorn referenced above). Instead, it may be sufficient that the blood cell lysis reagent does not substantially damage the microbial cells, to the extent of releasing nucleic acids and other macromolecules of interest, and avoids the introduction of nucleic acid assay inhibitory agents in the pretreated sample. Accordingly, the blood cell lysis reagent composition may be selected such that it is appropriate for wide range of microorganisms, in particular Gram-negative bacteria that are less tolerant of strong blood cell lysis agents. In order to demonstrate the capability of the method for the preparation of such less tolerant bacteria, the following examples were performed with Pseudomonas aeruginosa as the test organism.
P. aeruginosa cells were cultured and the cell suspension was prepared as described above. 10 μL of Fluorinert™ was added to 2 mL siliconized microcentrifuge tubes, followed by the addition of 500 μL of the blood cell lysis reagent. Despite any variation is specified, human whole blood collected in BD vacutainer with sodium citrate (BD366415) is used. The blood spiked with P. aeruginosa in 1 mL volume at 600 CFU/mL was added to the tube containing the blood cell lysis reagent and the Fluorinert™ and mixed by inverting 10 times and vortexing at low speeds for 10 sec. The sample pretreatment was performed as described above. After the last wash, most of the supernatant was removed and the sedimented cells were re-suspended in 300 μL of 0.8 mM phosphate buffer pH 7.4. The resulting pretreated sample contained a nominal cell number of 600. A 60 μL volume of the pretreated samples and the positive control were lysed by electrical lysis as described above. 5 μL of the cell lysate, containing the equivalent of 10 lysed microbial cells, and the negative control were assayed with real-time RT-PCR. The forward and reverse primers used for RT-PCR were GGGCAGTAAGTTAATACCTTGC (SEQ. ID. 25) and TCTACGCATTTCACCGCTACAC (SEQ. ID. 26), respectively. The 16S rRNA gene fragment of 251 bases pair at a conserved region of P. aeruginosa (nucleotides 438 to 689 using Pseudomonas aeruginosa D77P as a reference) was amplified.
Blood cell lysis reagent with varying concentrations of saponin and SPS, and varying volumes of Fluorinert™ were tested to verify the significance of each component in the pretreatment mixture. Then, using the optimized composition of the pretreatment mixture, bacteria recovery from pretreatment vessels with or without interior surface treatment was investigated.
Human whole blood of 1 mL, spiked to 600 CFU/mL P. aeruginosa was added to 0.5 mL of the pretreatment mixture containing 10 μL of Fluorinert™ FC-40, 4.5 to 240 mg/mL saponin, 15 mg/mL SPS and 1% PPG, in a 2 mL siliconized microcentrifuge tube. The final concentrations of the components in the mixture were 1.5 to 80 mg/mL saponin, 5 mg/mL SPS and 0.33% PPG. The sample pretreatment procedure was performed and the pretreated samples and positive controls were electrically lysed. The real time RT-PCR assay signal of the bacteria in the pretreated sample recovered from the whole blood after the sample pretreatment is presented in
Human whole blood of 1 mL, spiked at 600 CFU/mL P. aeruginosa was added to 0.5 mL of the pretreatment mixture containing 10 μL of Fluorinert™ FC-40, 75 mg/mL saponin, SPS in the range of 0.5-20 mg/mL and 1% PPG, in 2 mL siliconized microcentrifuge tube. The final concentrations of the components in the mixture were 25 mg/mL saponin, 0.5 to 20 mg/mL SPS and 0.33% PPG The real time RT-PCR assay signal of the bacteria in the pretreated sample recovered from the whole blood after the sample pretreatment is presented in
Human whole blood, which had been drawn into BD Vacutainer collection tubes with different anticoagulants. The collection tubes used were supplied with buffered sodium citrate (BD366415, normally used for coagulation testing), K2 EDTA (BD367863, normally used for hematology testing), sodium heparin (BD367871, normally used for chemistry testing) and SPS containing 1.7 mL of 0.35% SPS and 0.85% sodium chloride (BD364960, specialty tubes normally used for blood culture specimen collection). The standard volume of blood specified by the manufacturer was drawn into each tube. Human whole blood collected in citrate, EDTA and Heparin tubes of 1 mL each, spiked at 600 CFU/mL P. aeruginosa was added to 0.5 mL of the pretreatment mixture containing 10 μL of Fluorinert™ FC-40, 75 mg/mL saponin, 15 mg/mL SPS and 1% PPG, in 2 mL (T-3531, Sigma) siliconized microcentrifuge tubes. The final concentrations of the components in the mixture were 25 mg/mL saponin, 5 mg/mL SPS and 0.33% PPG. For the blood collected in SPS tube, due to the presence of additional SPS in the anticoagulant solution in the tube, the pretreatment mixture was adjusted as 0.5 mL of the mixture containing 10 μL of Fluorinert™ FC-40, 112.5 mg/mL saponin, 7.5 mg/mL SPS and 1% PPG.
The pretreatment procedure was performed and the samples were electrically lysed. The real time RT-PCR assay signal of the bacteria in the pretreated sample recovered from the whole blood after the sample pretreatment is presented in
Human whole blood of 1 mL, spiked at 600 CFU/mL P. aeruginosa was added to 0.5 mL of the pretreatment mixture containing different volumes of Fluorinert™ FC-40, 75 mg/mL saponin, 15 mg/mL SPS and 1% PPG. In addition the effect of variation in Fluorinert™ volume was tested in 2 different siliconized microcentrifuge tubes with different tube bottom geometry; 2 mL tubes (T-3531, Sigma) and 1.7 mL tubes (T-3406, Sigma). The final concentrations of the components in the mixture were 25 mg/mL saponin, 5 mg/mL SPS and 0.33% PPG. The pretreatment procedure was performed and the samples were electrically lysed. The real time RT-PCR assay signal of the bacteria in the pretreated sample recovered from the whole blood after the sample pretreatment is presented in
Human whole blood of 1 mL, spiked at 600 CFU/mL P. aeruginosa was added to 0.5 mL of the pretreatment mixture containing 10 μL of Fluorinert™ FC-40, 75 mg/mL saponin, 15 mg/mL SPS and 1% PPG, in 2 mL microcentrifuge tube with or without interior surface treatment. In one group, regular 2 mL polypropylene microcentrifuge tubes (B71420, Bioplastics) were used. In the other group, 2 mL siliconized microcentrifuge tubes (T-3531, Sigma) were used. The final concentrations of the components in the mixture were 25 mg/mL saponin, 5 mg/mL SPS and 0.33% PPG. The real time RT-PCR assay signal versus cycle number of the bacteria in the pretreated sample recovered from whole blood after sample pretreatment is presented in
Human whole blood of 1 mL, spiked at 600 CFU/mL P. aeruginosa was added to the pretreatment mixture containing 10 μL of Fluorinert™ FC-40 in a 2 mL microcentrifuge tube. The pretreatment reagent used in this example were (a) 500 μL of saponin mixture containing 75 mg/mL saponin, 15 mg/mL SPS and 1% PPG and (b) 1 mL of 1% Triton X-100 in Sodium Carbonate buffer pH 10. After the centrifugation, following the cell lysis step, the supernatant was removed, leaving 150 μL of the liquid supernatant, Fluorinert™ and the sedimented microbial cells. Five washing cycles of pretreatment procedure were performed and the samples were electrically lysed. The real time RT-PCR assay signal of the bacteria in the treated sample recovered from the whole blood indicated that the Ct values of the two blood cell lysing reagents formulations were similar within 1 cycle.
Human whole blood of 1 mL, spiked at 600 CFU/mL P. aeruginosa was added to the pretreatment mixture containing 10 μL of Fluorinert™ FC-40 in a 2 mL microcentrifuge tube. The pretreatment reagent of 500 μL used in this example were (a) saponin mixture containing 75 mg/mL saponin, 15 mg/mL SPS and 1% PPG, (b) 1.5% Triton X-100 and 18.75 mg/mL SPS in Sodium Phosphate buffer pH 7.4, (c) 1.5% Triton X-100 and 22.5 mg/mL SPS in Sodium Phosphate buffer pH 7.4, (d) 4.5% Triton X-100 and 15 mg/mL SPS in Sodium Phosphate buffer pH 7.4 and (e) 3% Triton X-100 and 22.5 mg/mL SPS in Sodium Phosphate buffer pH 7.4. After the centrifugation, following the cell lysis step, the supernatant was removed, leaving 150 μL of the liquid supernatant, Fluorinert™ and the sedimented microbial cells. Five washing cycles of the pretreatment procedure were performed and the samples were electrically lysed. The real time RT-PCR assay signal of the bacteria in the treated sample recovered from the whole blood indicated that the Ct values of the blood cell lysing reagents were similar within 1 to 2 cycles.
The three examples presented in this section demonstrate the ability of the device to detect microbial cells in human whole blood with a detection limit in the range of 1-10 cells per mL for fungi, Gram-positive bacteria and Gram-negative bacteria.
Human whole blood (Bioreclemation Inc.) of 1 mL volume was spiked with the microbial cells specific to each example below and subjected to pretreatment and electrical lysis as described above. As a positive control, the same concentration of the microbial cells in 0.8 mM phosphate buffer was subjected to electrical lysis without pretreatment.
Human whole blood of 1 mL spiked with 300 and 30 CFU/mL of microbial cells was added to the tube containing blood cell lysis reagent and Fluorinert™, and the example sample pretreatment procedure described above was performed.
After the last wash, the supernatant was removed and the sedimented cells were re-suspended in 300 μL of 0.8 mM phosphate buffer pH 7.4 (resulting in a nominal concentration of 103 and 102 CFU/mL).
A 60 μL volume of the pretreated samples and the positive controls were subjected to electrical lysis. In each case, a cell lysate volume of 10 μL (nominally 10 and 1 cells respectively per sample) was subjected to amplification by RT-PCR.
In the following examples, RT-PCR reaction mixture of 25 μL volume was prepared by mixing 10 μL of sample, 12.5 μL of 2×PCR reaction mix (2G Robust HotStart, KAPA Biosystems), 1.3 μL of reverse transcriptase (GoScript, Promega), 0.6 μl of forward primer (10 μM) and 0.6 μL of reverse primer (10 μM). One-step real time RT-PCR was performed by reverse transcription at 55° C. for 5 min, inactivation of reverse transcription at 95° C. for 2 min, followed by 35 cycles of cDNA amplification (denaturation at 95° C. for 3 sec, annealing at 55° C. for 3 sec, and extension at 72° C. for 3 sec) and final extension at 72° C. for 1 min in Eco Real-Time PCR System (illumina). The resulting RT-PCR product of 15 μL was resolved by gel electrophoresis on 1% agarose gel in 0.5×TBE buffer and 0.5 μg/mL ethidium bromide at 150 volts for 30 min. The specific nucleotide sequences within the amplified region were detected using specific molecular beacon. RT-PCR product of 5 μL was mixed with 1 μL of the buffer containing 20 mM Tris-HCl pH 8, 10 mM KCl and 7 mM MgCl2 as well as 1 μM of molecular beacon. The mixture was heated at 95° C. for 30 sec to denature the amplicon and the molecular beacon, followed by cooling to room temperature, allowing hybridization of the molecular beacon to the target sequence. The resulting mixture of 6 μL was transferred to a micro-well and the fluorescence intensity of excitation at 492 nm and emission at 517 nm was measured using fluorescence microscopy (LumaScope, etaluma).
Samples spiked with C. albicans were prepared and processed as described above for RT-PCR assay. The one-step RT-PCR protocol used UFF3 forward primer (5′-AACGAAAGTTAGGGGATCGAAG-3′) (SEQ. ID. 15) and UFR3 reverse primer (5′-CTTTAAGTTTCAGCCTTGCGA-3′) (SEQ. ID. 16). The 18S rRNA gene fragment of 167 bases pair at a hypervariable region of all fungi species (nucleotides 940 to 1107 using Candida albicans AB013586 as a reference) was amplified.
The resulting RT-PCR product of 15 μL was resolved by gel electrophoresis and the amplified region of 18S rRNA was observed in
The specific nucleotide sequences within the amplified region were detected using the molecular beacon 6-FAM-5′-CCGAGCCGTAGTCTTAACCATAAACTATGCGCT-3′-DABCYL (SEQ. ID. 17) (nucleotides 977 to 997 using Candida albicans AB013586 as a reference), designed to detect all fungal pathogens. The detection signals of the positive controls and the spiked blood samples recovered from blood pretreatment are presented in
Samples spiked with S. pneumoniae were prepared and processed as described above for RT-PCR assay. The one-step RT-PCR protocol used Ubea primer pair (UbeaF forward primer; 5′-GACAGGTGGTGCATGGTTGTC-3′ (SEQ. ID. 18) and UbeaR reverse primer, 5′-ACGTCATCCCCACCTTCCTC-3′) (SEQ. ID. 19) and GP1 primer pair (GP1F forward primer; 5′-ATGCATAGCCGACCTGAGAG-3′ (SEQ. ID. 11) and GP1R reverse primer; 5′-AGTTAGCCGTSSCTTTCTG-3′) (SEQ. ID. 12). The 16S rRNA gene fragment of 170 bases pair at a hypervariable region of all bacterial species (nucleotides 1035 to 1185 using Streptococcus pneumonia G54 as a reference) was amplified by universal bacterial Ubea primer pair and the 16S rRNA gene fragment of 230 base pairs at a hypervariable region of all Gram-positive bacterial species (nucleotide 290 to 520 using Staphylococcus aureus NR 037007 as reference) was amplified by Gram-positive specific GP1 primer pair.
The resulting amplified product using GP1 primer pair, targeting all Gram-positive bacterial species was resolved by gel electrophoresis and the amplified fragment of 16S rRNA was observed in
The Gram-positive specific nucleotide sequences within the amplified product using Ubea universal bacterial primer pair, targeting all bacterial species were detected using the molecular beacon; 6-FAM-5′-CCGAGCTTAGTTGCCATCATTTAGTTGGGCACTCTAGCTCGG-3′-DABCYL (SEQ. ID. 20) (nucleotides 1113 to 1142 using Streptococcus pneumonia G54 as a reference) designed to detect all Gram-positive bacterial pathogens. The detection signals of the positive controls and the spiked blood samples recovered from blood pretreatment were presented in
Samples spiked with E. coli were prepared and processed as described above for RT-PCR assay. The one-step RT-PCR protocol used UB primer pair (UBF8 forward primer; 5′-CGGCTAACTCCGTGCCAGCAG-3′ (SEQ. ID. 12) and UBRs reverse primer; 5′-ATCTCTACGCATTTCACCGCTACAC-3′) (SEQ. ID. 2) and GN1 primer pair (GN1F forward primer; 5′-GTTACCCGCAGAAGAAGCAC-3′ (SEQ. ID. 13) and GN1R reverse primer; 5′-ACCTGAGCGTCAGTCTTCGT-3′ (SEQ. ID. 14) targeting all Gram-negative bacterial species. The 16S rRNA gene fragment of 203 base pairs at a hypervariable region of all bacterial species (nucleotides 504 to 707 using Escherichia coli O104:H4 str. 2011C-3493 as a reference) was amplified by universal bacterial UB primer pair and the 16S rRNA gene fragment of 278 bases pair in a hypervariable region of all Gram-negative bacterial species (nucleotide 475 to 753 using Escherichia coli NR 024570.1 as reference) was amplified by Gram-negative specific GN1 primer pair.
The resulting amplified product using GN1 primer pair, targeting all Gram-negative bacterial species was resolved by gel electrophoresis and the amplified fragment of 16S rRNA was observed in
The Gram-positive specific nucleotide sequences within the amplified product using UB universal bacterial primer pair, targeting all bacterial species were detected using the molecular beacon; 6-FAM-5′-CCGAGCGGTGCAAGCGTTAATCGGAATTACTGGGCGCTCGG-3′-DABCYL (SEQ. ID. 5) (nucleotides 541-569 using Escherichia coli O104:H4 str. 2011C-3493 as a reference) designed to detect all Gram-negative bacterial pathogens. The detection signals of the spiking controls and the spiked blood samples recovered from blood pretreatment were presented in
This example demonstrates the repeatability of the detection of microbial cells in 1 mL of human whole blood sample within a total run-time of 30 minutes. Although the end goal is a multiplexed detection scheme, the present example is the detection of each species by individual RT-PCR assays.
Five different species each of Gram-positive, Gram-negative and fungal microbial cells described in
The duration of sample pretreatment process was 6 minutes. The electrical lysis of samples or controls in steps of 10 μL/10 s took place in 1 minute. The RT-PCR assay with real time detection was under 20 minutes. Therefore, the total run-time for the detection of microbial cells in 1 mL of raw human whole blood was 27 minutes.
The detectability criterion was defined as the following. The RT-PCR fluorescence signal versus cycle number for the case of a single Enterococcus faecalis cell in human whole blood is presented in
Five pathogenic species were tested: EF (Enterococcus faecalis), SS (Streptococcus sanguis), SP (Streptococcus pneumonia), SA (Staphylococcus aureus), and SPy (Streptococcus pyogenes). Spiked blood samples, and positive and negative controls were prepared and subjected to electrical lysis as described above. The RT-PCR protocol used GPF8 forward primer; 5′-GCTCGTGTCGTGAGATGTTGGG-3′ (SEQ. ID. 21) and GPR8 reverse primer, 5′-CAGGTCATAAGGGGCATGATGAT-3′ (SEQ. ID. 22). The 16S rRNA gene fragment of 151 base pairs at a hypervariable region of all Gram-positive bacterial species (nucleotides 1069 to 1220 using Staphylococcus sp. LS255 as a reference) was amplified.
The resulting CT values for different species over five independent runs are presented in
Five pathogenic species were tested: KP (Klebsiella pneumoniae), PA (Pseudomonas aeruginosa), EC (Escherichia coli), ECL (Enterobacter cloacae), and AB (Acinetobacter baumannii). Spiked blood samples, and positive and negative controls were prepared and subjected to electrical lysis as described above. The RT-PCR protocol used GNF8 forward primer; 5′-GTTACCCGCAGAAGAAGCACCG-3′ (SEQ. ID. 23) and GNR8 reverse primer, 5′-ATGCAGTTCCCAGGTTGAGCC-3′ (SEQ. ID. 24). The 16S rRNA gene fragment of 151 base pairs at a hypervariable region of all Gram-negative bacterial species (nucleotides 484 to 635 using Escherichia coli IaI1 as a reference) was amplified. The resulting CT values for different species over five independent runs are presented in
Five pathogenic species were tested: CA (Candida albicans), CrN (Cryptococcus neoformans), CG (Candida glabrata), CK (Candida krusei, and AF (Aspergillus fumigatus). Spiked blood samples, and positive and negative controls were prepared and subjected to electrical lysis as described above. The RT-PCR protocol used UFF2 forward primer; 5′-ACGGGGAGGTAGTGACAATAAAT-3′ (SEQ. ID. 9) and UFR2 reverse primer, 5′-CCCAAGGTTCAACTACGAGCTT-3′ (SEQ. ID. 10). The 18S rRNA gene fragment of 190 base pairs at a hypervariable region of all fungal species (nucleotide 434 to 624 using Candida albicans AB013586 as a reference) was amplified. The resulting CT values for different species over five independent runs are presented in
The specific embodiments described above have been shown by way of example, and it should be understood that these embodiments may be susceptible to various modifications and alternative forms. It should be further understood that the claims are not intended to be limited to the particular forms disclosed, but rather to cover all modifications, equivalents, and alternatives falling within the spirit and scope of this disclosure.
This application is a National Phase application claiming the benefit of the international PCT Patent Application No. PCT/CA2013/000992, filed on Nov. 26, 2013, in English, which claims priority to U.S. Provisional Application No. 61/731,809, titled “APPARATUS AND METHOD FOR PRE-TREATMENT OF MICROBIAL SAMPLES” and filed on Nov. 30, 2012, the entire contents of which is incorporated herein by reference, U.S. Provisional Application No. 61/750,242, titled “APPARATUS AND METHOD FOR PRE-TREATMENT OF MICROBIAL SAMPLES” and filed on Jan. 8, 2013, the entire contents of which is incorporated herein by reference, and to U.S. patent application Ser. No. 13/833,872, titled “APPARATUS AND METHOD FOR PRE-TREATMENT OF MICROBIAL SAMPLES” and filed on Mar. 15, 2013, the entire contents of which are incorporated herein by reference.
| Filing Document | Filing Date | Country | Kind |
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| WO2014/082160 | 6/5/2014 | WO | A |
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| Number | Date | Country | |
|---|---|---|---|
| 20160068897 A1 | Mar 2016 | US |
| Number | Date | Country | |
|---|---|---|---|
| 61750242 | Jan 2013 | US | |
| 61731809 | Nov 2012 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 13833872 | Mar 2013 | US |
| Child | 14648161 | US |
