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(Clinical Chemistry. 1999;45:1932-1937.)
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Articles

Different Real-Time PCR Formats Compared for the Quantitative Detection of Human Cytomegalovirus DNA

Andreas Nitsche1,a, Nina Steuer1, Christian Andreas Schmidt1, Olfert Landt2 and Wolfgang Siegert1

1 Klinik für Innere Medizin m.S. Hämatologie und Onkologie, Charité-Campus Virchow Klinikum, Humboldt Universität, Augustenburger Platz 1, Forschungshaus 37 R 2.303, D-13353 Berlin, Germany.

2 TIB Molbiol, D-10829 Berlin, Germany.
a Author for correspondence. Fax 49-30-45053929; e-mail andreas.nitsche{at}charite.de


   Abstract
Top
Abstract
Introduction
Materials and Methods
Results
Discussion
References
 
Background: The aim of this study was to compare the ABI PRISM 7700 Sequence Detection System and the LightCycler to develop a quantitative real-time PCR assay for the detection of human cytomegalovirus (HCMV) DNA suitable for routine hospital application.

Methods: We used one exonuclease probe and five different hybridization probe sets as sequence-specific fluorescence detection formats. For the exonuclease assay and two hybridization probe sets, reproducibility and the detection limit were determined. To keep the total assay time to a minimum, we gradually shortened individual reaction steps on both instruments.

Results: The exonuclease assay can be interchangeably performed on the 7700 and the LightCycler. No change of reaction conditions is required, except for the addition of bovine serum albumin to the LightCycler reaction. The shortest possible total assay time is 80 min for the ABI PRISM 7700 Sequence Detection System and 20 min for the LightCycler. When the LightCycler is used, the exonuclease probe can be replaced by a set of hybridization probes. All assays presented here detected HCMV DNA in a linear range from 101 to 107 HCMV genome equivalents/assay (r >0.995) with low intraassay (<5%) and interassay (<10%) variation.

Conclusions: The ABI PRISM 7700 Sequence Detection System as well as the LightCycler are useful instruments for rapid and precise online PCR detection. Moreover, the two principles of fluorescence signal production allow HCMV quantification with the same accuracy.


   Introduction
Top
Abstract
Introduction
Materials and Methods
Results
Discussion
References
 
Active primary infection with human cytomegalovirus (HCMV)1 or its reactivation from the status of latency can be diagnosed by seroconversion and the demonstration of IgM antibodies (1), by the detection of infectious virus in cell culture, or by immunostaining of blood leukocytes with monoclonal antibodies against HCMV pp65 (2). Alternatively, the demonstration of viral DNA by PCR is used to diagnose HCMV infection. However, qualitative PCR cannot be used to discriminate between latent infection and active virus replication because of its extraordinarily high sensitivity (3)(4). Quantitative PCR has been shown to be helpful in determining the severity of an infection and to predict the risk of a patient developing HCMV disease (5). Furthermore, changes in the serum concentration of viral DNA over time mirror the course of infection or disease and, therefore, are thought to be a useful marker in patients under antiviral treatment.

Methods commonly described to quantify HCMV DNA include competitive PCR assays (6)(7) and hybridization of PCR products to probes in a microwell format. These tests are labor-intensive and require post-PCR handling. Recently, quantitative, fluorescence-based, real-time PCR assays in closed tube systems have been developed. Sequence detection systems commonly used include the exonuclease assay (8) and the hybridization probe assay, which are performed with an ABI PRISM 7700 Sequence Detection System (7700; PE Applied Biosystems) or the LightCycler (Roche Diagnostics) (9), respectively.

The exonuclease probe format is based on the 5'-nuclease activity of the DNA polymerase that cleaves a hybridized nonextendible exonuclease probe during the extension phase of the PCR (Fig. 1 ) (10). The exonuclease probe is designed to hybridize specifically to the amplicon and is dual-labeled with a reporter dye and a quencher dye. The 5'-exonuclease activity of the polymerase separates reporter dye and quencher dye by hydrolysis of the exonuclease probe during polymerization (11). Reporter dye fluorescence increases as it is progressively released from the proximity of the quencher. This fluorescence is cumulative and indirectly related to the amount of PCR product (12). An additional fluorescent dye, 6-carboxy-X-rhodamine (ROX), is added to serve as an internal passive reference.



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Figure 1. Schematic representation of the exonuclease probe format and the hybridization probe format for online PCR detection.

The exonuclease probe format (A) utilizes a nonextendible dual-labeled oligonucleotide that hybridizes internally to the flanking primers and is cleaved by the polymerase during the polymerization step. The hybridization probe format (B) utilizes two single-labeled, nonextendible oligonucleotides that produce a fluorescence signal following adjacent hybridization by FRET.

A second, fluorescence-based format for real-time PCR detection is the hybridization probe format (Fig. 1Up ). It uses two independent, single-labeled oligonucleotides that hybridize adjacently on the amplicon internal to the flanking PCR primers. The upstream oligonucleotide is labeled at its 3' end with fluorescein (FL) and the downstream oligonucleotide is labeled at its 5' end with LightCycler Red 640 (LC Red). Hybridization probes are nonextendible. After excitation by the light-emitting diode, a fluorescence resonance energy transfer (FRET) occurs from the FL (donor) to the LC Red (acceptor), increasing the LC Red signal, which is directly related to the amount of PCR product before the plateau is reached (12). In the hybridization probe format, as in the exonuclease probe format, the hybridization probes may be degraded during displacement from the amplicon. In contrast to the exonuclease probe format, the fluorescence signal in the hybridization probe format is read in the annealing phase and not in the extension phase. However, both formats allow the quantification of PCR products by measuring the fluorescence during each cycle. Fluorescence data are used to calculate the first cycle in which fluorescence exceeds the baseline value by 10 SD of the fluorescence increase during cycles 3–15. This cycle number is called the threshold cycle (CT). Comparison of CT values to a calibration curve allows the absolute quantification of unknown amounts of DNA.

To improve methods for diagnostic quantification of HCMV DNA in the plasma of patients, we studied whether the exonuclease assay could be performed on the LightCycler and compared the results with those obtained on the 7700. Furthermore, we compared the hybridization probe assay with the exonuclease probe assay, both performed on the LightCycler.


   Materials and Methods
Top
Abstract
Introduction
Materials and Methods
Results
Discussion
References
 
template dna
Assays were performed with serial dilutions (101 to 107) of a plasmid containing the major immediate early (MIE) gene region of HCMV. For plasmid construction, the corresponding sequence of the immediate early gene region was amplified using primers MIE4 and MIE5 (13) and inserted into a TA-Cloning Vector (Invitrogen), according to the manufacturer's instructions. After plasmid preparation, the DNA concentration was determined with a spectrophotometer at 260 nm, and the corresponding copy number was calculated. Serial dilutions of 101 to 107 plasmids were prepared in H2O.

pcr
The sequences of the primers, exonuclease probe, and hybridization probes are given in Table 1 . A schematic representation of the location and orientation of the oligonucleotides used is given in Fig. 2 .


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Table 1. Oligonucleotides used in this study.



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Figure 2. Diagrammatic representation of the oligonucleotides used in this study.

Schematic representation of primers, exonuclease probe, and hybridization probes indicating spacing, position, and orientation. The spacing between the hybridization probes is 1 base for AD/AA, BD/BA, and CD/CA; 7 bases for BD/AA; and -5 bases (overlap) for AD/BA.

All PCR reaction mixtures contained 10x PCR buffer (200 mmol/L Tris-HCl, pH 8.4, 500 mmol/L KCl), 4 mmol/L MgCl2, 0.8 mmol/L dNTP (Life Technologies), 0.8 µmol/L each primer, and 1 U of Platinum Taq DNA polymerase (Life Technologies). The exonuclease assay carried out on the 7700 contained an additional 50 nmol/L exonuclease probe TM2 and 1 µmol/L ROX (Molecular Probes) in a reaction volume of 50 µL. To the exonuclease assay performed on the LightCycler, 50 nmol/L exonuclease probe TM2 and 1.5 g/L bovine serum albumin (BSA; Sigma) were added. The hybridization probe assay contained an additional 150 nmol/L donor hybridization probe, 300 nmol/L acceptor hybridization probe, and 1.5 g/L BSA. Reactions on the LightCycler were performed in 20-µL volumes.

Using the 7700, we performed PCR in 96-well microtiter plates (Perkin-Elmer), whereas glass capillaries were used for PCR in the LightCycler (Roche Diagnostics).

The standard temperature profile for exonuclease assays included an initial denaturation for 3 min at 94 °C, followed by 45 cycles of denaturation at 94 °C for 10 s, annealing at 64 °C for 10 s, and an extension with fluorescence monitoring at 72 °C for 30 s. The standard temperature profile for hybridization probe assays included an initial denaturation for 3 min at 94 °C, followed by 45 cycles of denaturation at 94 °C for 0 s, annealing with fluorescence monitoring at 55 °C for 15 s, and extension at 72 °C for 15 s.


   Results
Top
Abstract
Introduction
Materials and Methods
Results
Discussion
References
 
exonuclease probe reaction
To determine whether the exonuclease assay can be performed interchangeably on the 7700 and the LightCycler, we carried out PCRs using the reaction conditions given above. As template, serial dilutions of a plasmid containing a fragment of the HCMV MIE gene region were added. The reaction mixtures for the 7700 and the LightCycler were identical except for the presence of ROX in the 7700 reaction and the presence of BSA in the LightCycler reaction. The presence of BSA in the LightCycler reaction is advantageous because it reduces binding of the polymerase to the glass capillaries. ROX is not required as a reference in the LightCycler. The results obtained with both devices are given in Fig. 3 . Amplification profiles of both reactions are nearly identical in the range of 101 to 107 HCMV genome equivalents (Fig. 3 , A and B). There is a good linear correlation (r >0.995) between the CT and the logarithm of DNA copy number (Fig. 3C ). All PCRs were performed in quadruplicate; the intraassay variation (CV) was <5%, and the interassay variation was <10% for both systems.



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Figure 3. Comparison of the 7700 and the LightCycler.

Exonuclease probe assay: amplification plots of identical serial dilutions from 101 to 107 copies of plasmid pMIE and the corresponding CT are shown for the 7700 (A) and the LightCycler (B). Fluorescence (in the LightCycler measured in channel 1) is plotted vs cycle number. The amplification plots are the results of quadruplicate experiments. (C), calibration curves obtained by correlation of CT values and plasmid copy number from amplification plots A and B.

To reduce the assay time, we gradually shortened the individual reaction steps of the PCR program. The most rapid assay that could be carried out on the 7700 without a loss of sensitivity or a decrease in precision consisted of an initial denaturation for 3 min at 94 °C, followed by 45 cycles of denaturation at 94 °C for 5 s, annealing at 64 °C for 15 s, and extension with fluorescence monitoring at 72 °C for 10 s. The minimal resulting total run time was ~80 min. Further shortening of the denaturation step was not possible because time intervals shorter than 5 s cannot be set on the 7700. With the LightCycler, because of its fast ramping, the minimal total reaction time was 20 min, corresponding to initial denaturation for 3 min at 94 °C, followed by 45 cycles of denaturation at 94 °C for 0 s, annealing at 64 °C for 15 s, and extension with fluorescence monitoring at 72 °C for 0 s. Using annealing times <10 s, we observed a loss in sensitivity (CT shift to higher values), annealing times <5 s produced no amplification (data not shown).

hybridization probe reaction
Hybridization probe reactions were carried out exclusively with the LightCycler, using the reaction conditions given above. To find the optimum conditions for the detection of HCMV DNA, we tested five different hybridization probe sets (Fig. 2Up ). As shown, all of the hybridization probes hybridized in the same region of the MIE gene as the exonuclease probe TM2, i.e., between 46 and 98 bp downstream from primer 1F. Two hybridization probe pairs (AD/AA and BD/BA) hybridized with the sense strand, in a position relatively close to the primer; the third hybridization probe pair (CD/CA) hybridized to the antisense strand. Additional hybridization probe pairs tested were BD/AA and AD/BA. Best results were obtained with hybridization probe pairs AD/AA and BD/AA (Fig. 4 ). There was a linear correlation for both hybridization sets (r >0.997 for BD/AA; r >0.998 for AD/AA) between the CT value and the template concentration in a range between 101 and 107 molecules of the target sequence per assay (Fig. 4C ). All of the hybridization probe PCR assays were performed in quadruplicate, the intraassay variation was <5%, the interassay variation was <10%. There was no difference in total fluorescence yield obtained with hybridization probe pairs AD/AA and BD/AA, although the distance between the FL and LC Red is 1 base for set AD/AA and 7 bases for set BD/AA. Hybridization probe set BD/BA gave a poor correlation between CT and template concentration. As expected, hybridization probe set AD/BA yielded very low fluorescence signals because of an overlap of the two probes for a length of 5 bases. Hybridization probe set CD/CA did not produce any fluorescence signals (data not shown). To optimize the fluorescence yield, we varied the hybridization probe concentration for set AD/AA and BD/AA. As one would suppose, a decrease of the hybridization probe concentration led to a loss of sensitivity, whereas a doubling of the hybridization probe concentration led to an increase in total fluorescence but also to increased background during the first 15 cycles (data not shown).



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Figure 4. Comparison of two hybridization probe assays.

Hybridization probe assay: amplification plots of hybridization probe set AD/AA, hybridizing with a gap of 1 base between the fluorophores (A), and of hybridization probe set BD/AA, hybridizing with a gap of 7 bases between the fluorophores (B). Amplification plots of identical serial dilutions from 101 to 107 copies of plasmid pMIE and the corresponding threshold are shown. Fluorescence (channel 2/channel 1) is plotted vs cycle number. The amplification plots are the results of quadruplicate experiments. (C), calibration curves obtained by correlation of CT values and input plasmid copy number from amplification plots shown in A and B.


   Discussion
Top
Abstract
Introduction
Materials and Methods
Results
Discussion
References
 
Quantitative PCR has become an important tool in research as well as in clinical diagnostics. However, established methods such as competitive PCR and hybridization assays in 96-well microtiter plates are either time-consuming and labor-intensive or require post-PCR handling steps that may give rise to contamination. New systems based on fluorescence signal detection during real-time PCR combine numerous advantages. These assays produce rapid results, allow precise quantification, and require no post-PCR handling. Currently, there are two types of real-time "hardware" available: the ABI PRISM 7700 Sequence Detection System and the LightCycler (8)(12).

To test for sensitivity, precision, reproducibility, and practicality, we compared the 7700 and the LightCycler for the quantification of HCMV DNA. Initially, we were interested to see whether the exonuclease probe format could be transferred from the 7700 to the LightCycler. Subsequently, we compared the results obtained in the exonuclease probe assay with those obtained in the hybridization probe assay.

We have shown that the exonuclease assay can be transferred to the LightCycler without any modifications of the temperature profile or the composition of the reaction mixture except for the addition of low concentrations of BSA to avoid binding of polymerase to the glass capillaries. The exonuclease probe assay enables reliable quantification on both instruments, producing calibration curves with strong correlations as well as low intraassay (<5%) and interassay (<10%) variation.

We chose a detection range of 101 to 107 HCMV genome equivalents/assay, which sufficiently covers the expected values for HCMV DNA load in plasma and peripheral blood leukocytes in immunosuppressed patients [reviewed in Ref. (14)].

Attempts to minimize the assay time by shortening individual reaction steps led to a minimum exonuclease probe assay on the 7700 of 80 min. With the LightCycler, because of its high temperature ramping rates and the good thermal conductivity of the glass capillaries, the exonuclease probe assay was reduced to a total run time of 20 min.

Our second intention was to compare the performance of the exonuclease assay to the hybridization probe assay, both carried out on the LightCycler. We chose three sets of hybridization probes located in the same region as the exonuclease probe and used them in five different pairings. The best results were obtained with hybridization probe sets AD/AA and BD/AA. They showed strong linear correlation between CT value and template concentration. The remaining probe sets produced inferior results. Our data suggest that results obtained with two of the selected hybridization probe sets are comparable to those obtained with the exonuclease probe assay.

According to theoretical considerations, FRET is only effective when energy donor and acceptor molecules are in close proximity, i.e., within a distance of <40 Å. This condition is fulfilled in both hybridization probe sets AD/AA and BD/AA, in which the distances are 1 and 7 bp, respectively. Both sets lead to comparable results. In addition to distance of donor and acceptor molecules, the quality of probe binding to the template is of importance. In the hybridization probe set BD/BA, signal production was inferior to AD/AA and BD/AA, although the gap between the bound probes was 1 bp and therefore fulfilled the theoretical conditions for an effective FRET. This is remarkable because the hybridization probes BA and AA have 16 bases in common and differ only in 6 and 8 nucleotides.

The probe pair AD/BA produced a weak signal that probably is explained by an overlap of both probes over the length of 5 bases. Interestingly, the probe set CD/CA that binds to the antisense strand did not lead to signal production. This phenomenon is as yet unexplained. It may be attributable to the high content of purine bases. We exclude poor probe quality as the reason for this finding because the quality of the fluorescence dye labeling was comparable for all hybridization probes. Moreover, the highest fluorescence dye/DNA ratio was found in hybridization set CD/CA, which produced no fluorescence signal during amplification.

In conclusion, when the exonuclease format is used, both the 7700 and the LightCycler allow quantification of HCMV DNA with the same precision. In the LightCycler, the exonuclease probe can be replaced by a set of hybridization probes without loss in sensitivity or reproducibility of quantification. The two principles of fluorescence signal production (exonuclease probe and hybridization probe) work equally well. However, the question of whether preference should be given to one instrument and/or one fluorescence detection format is as yet unanswered. The 7700 has the advantage of simultaneous analysis of 96 samples compared with only 32 samples in the LightCycler. Additional advantages include easier handling, better suitability to automation, and the ability to excite and detect a large number of fluorescent dyes. In contrast, the LightCycler in our assay system requires a minimum running time of only 20 min compared with 80 min with the 7700. The LightCycler can deal with both the exonuclease and the hybridization probe format, whereas the FRET process cannot be monitored with the 7700 because the long-wavelength acceptor dye LC Red is directly excited by the laser light source. Moreover, for the construction of two hybridization probes, more suitable target DNA sequences must be available than for the construction of one exonuclease probe. In contrast, the synthesis of a dual-labeled exonuclease probe is technically more demanding than the synthesis of two single-labeled hybridization probes.

Altogether, the 7700 appears to be useful for the processing of large numbers of sample under standard conditions, whereas the LightCycler has its strength in smaller sample numbers and the use of various reaction conditions.


   Acknowledgments
 
We would like to thank Ian M. Mackay (Sir Albert Sakzewski Virus Research Unit, Royal Children's Hospital, Brisbane, Australia) for helpful discussions and critical reading of the manuscript.


   Footnotes
 
1 Nonstandard abbreviations: HCMV, human cytomegalovirus; ROX, 6-carboxy-X-rhodamine; FL, fluorescein; LC Red, LightCycler Red 640; FRET, fluorescence resonance energy transfer; CT, threshold cycle; MIE, major immediate early; and BSA, bovine serum albumin.


   References
Top
Abstract
Introduction
Materials and Methods
Results
Discussion
References
 

  1. Plachter B, Wieczorek L, Scholl BC, Ziegelmaier R, Jahn G. Detection of cytomegalovirus antibodies by an enzyme-linked immunosorbent assay using recombinant polypeptides of the large phosphorylated tegument protein pp150. J Clin Microbiol 1992;30:201-206. [Abstract/Free Full Text]
  2. van der Bij W, Torensma R, van Son WJ, Anema J, Schirm J, Tegzess AM, The TH. Rapid immunodiagnosis of active cytomegalovirus infection by monoclonal antibody staining of blood leukocytes. J Med Virol 1988;25:179-188. [ISI][Medline] [Order article via Infotrieve]
  3. Schäfer P, Laufs R. Experience with quantitative PCR for the management of HCMV disease. Intervirology 1996;39:204-212. [ISI][Medline] [Order article via Infotrieve]
  4. Delgado R, Lumbreras C, Alba C, Pedraza MA, Otero JR, Gomez R, et al. Low predictive value of polymerase chain reaction for diagnosis of cytomegalovirus disease in liver transplant recipients. J Clin Microbiol 1992;30:1876-1878. [Abstract/Free Full Text]
  5. Spector SA, Wong R, Hsia K, Pilcher M, Stempien MJ. Plasma cytomegalovirus (CMV) DNA load predicts CMV disease and survival in AIDS patients. J Clin Investig 1998;101:497-502. [ISI][Medline] [Order article via Infotrieve]
  6. Boivin G, Olson CA, Quirk MR. St Cyr SM, Jordan MC. Quantitation of human cytomegalovirus glycoprotein H gene in cells using competitive PCR and a rapid fluorescence-based detection system. J Virol Methods 1995;51:329-342. [ISI][Medline] [Order article via Infotrieve]
  7. Shinkai M, Spector SA. Quantitation of human cytomegalovirus (HCMV) DNA in cerebrospinal fluid by competitive PCR in AIDS patients with different HCMV central nervous system diseases. Scand J Infect Dis 1995;27:559-561. [ISI][Medline] [Order article via Infotrieve]
  8. Livak KJ, Flood JA, Marmaro J, Giusti W, Deetz K. Oligonucleotides with fluorescent dyes at opposite ends provide a quenched probe system useful for detecting PCR product and nucleic acid hybridization. PCR Methods Appl 1995;4:357-362. [ISI][Medline] [Order article via Infotrieve]
  9. Wittwer CT, Ririe KM, Andrew RV, David DA, Gundry RA, Balis UJ. The LightCycler: a microvolume multisample fluorimeter with rapid temperature control. Biotechniques 1997;22:176-181. [ISI][Medline] [Order article via Infotrieve]
  10. Holland PM, Abramson RD, Watson R, Gelfand DH. Detection of specific polymerase chain reaction product by utilizing the 5'->3' exonuclease activity of Thermus aquaticus DNA polymerase. Proc Natl Acad Sci U S A 1991;88:7276-7280. [Abstract/Free Full Text]
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Direct Detection of Legionella Species from Bronchoalveolar Lavage and Open Lung Biopsy Specimens: Comparison of LightCycler PCR, In Situ Hybridization, Direct Fluorescence Antigen Detection, and Culture
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Quantitative Detection of Hepatitis C Virus RNA by Light Cycler PCR and Comparison with Two Different PCR Assays
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S. S. Biel, T. K. Held, O. Landt, M. Niedrig, H. R. Gelderblom, W. Siegert, and A. Nitsche
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H. H. Kessler, G. Mühlbauer, B. Rinner, E. Stelzl, A. Berger, H.-W. Dörr, B. Santner, E. Marth, and H. Rabenau
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J. Nurmi, A. Ylikoski, T. Soukka, M. Karp, and T. Lovgren
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