A multiplex real-time PCR assay for routine diagnosis of bacterial vaginosis.

A semi-quantitative multiplex PCR assay for the diagnosis of bacterial vaginosis (BV) was evaluated in a prospective study in a population of Dutch women with complaints of abnormal vaginal discharge. The PCR targets Gardnerella vaginalis, Atopobium vaginae, Megasphaera phylotype 1, Lactobacillus crispatus and Lactobacillus iners. Together with a short questionnaire, a vaginal swab for PCR and vaginal smear for microscopy were taken by their general practitioner or gynaecologist. Data from 151 women (median age 32) were available. Nugent Score (NS) was used to classify the samples and 83 samples were classified as normal (NS 0-3), 13 as intermediate (NS 4-6), and 55 as bacterial vaginosis (NS 7-10). In women with a NS of 7-10, PCR detected Gardnerella vaginalis, Atopobium vaginae and Megasphaera phylotype 1 in respectively, 96 %, 87 % and 60 %, whereas in women with a NS of 1-3 these species were detected in 27 %, 6 % and 2 % (P <0.001). A ratio of Lactobacillus crispatus over Lactobacillus iners of <1 (as calculated from the quantification cycle value (Cq)) was present in women with a NS of 7-10 in 66 % versus 33 % in women with a NS of 1-3 (P <0.001). The BV-PCR displayed a sensitivity of 92 % and specificity of 96 % with a positive predictive value of 94 % and a negative predictive value of 95 %. The Lactobacillus-index improved the correct classification of samples where only one of the other bacterial species was detected. Compared to the Nugent Score this multiplex qPCR offers a convenient tool for performing observer independent diagnosis of BV.

Impact of transition from microscopy to molecular screening for detection of intestinal protozoa in Dutch patients.

Detection of intestinal protozoa by PCR methods has been described as being sensitive and specific, and as improving the diagnostic yield. Here we present the outcome of the transition from microscopy to molecular screening for detection of a select group of intestinal protozoa in faeces in our laboratory. Introduction of molecular screening for intestinal protozoa resulted in higher sensitivity, reduced hands-on-time, reduced time-to-results, leading to improved diagnostic efficiency.

Detection of intestinal protozoa in paediatric patients with gastrointestinal symptoms by multiplex real-time PCR.

The performance of a multiplex real-time PCR for the detection of Blastocystis, Dientamoeba fragilis, Giardia lamblia, Cryptosporidium species and Entamoeba species in faecal samples was evaluated in an observational prospective study. Paediatric patients (0-18 years) presenting with gastrointestinal symptoms and suspected of having enteroparasitic disease were included. A questionnaire on gastrointestinal symptoms and the chosen treatment was completed at the start of the study and after 6 weeks. Of 163 paediatric patients (mean age, 7.8 years), 114 (70%) had a PCR-positive faecal sample. D. fragilis was detected most frequently, in 101 patients, followed by Blastocystis in 49. In faecal samples of 47 patients, more than one protozoan was detected, mainly the combination of D. fragilis and Blastocystis. Reported gastrointestinal symptoms were abdominal pain (78%), nausea (30%), and altered bowel habits (28%). Eighty-nine of the PCR-positive patients were treated with antibiotics. A significant reduction in abdominal pain was observed both in treated and in untreated patients. This study demonstrated that multiplex real-time PCR detects a high percentage of intestinal protozoa in paediatric patients with gastrointestinal symptoms. However, interpretation and determination of the clinical relevance of a positive PCR result in this population are still difficult.

Substitution rate of the hepatitis B virus surface gene.

Molecular epidemiology of hepatitis B virus (HBV) often relies on the comparison of HBV surface (S) gene sequences, although little is known about the substitution rate of the HBV S-gene. In this study, we compared HBV S-gene sequences in longitudinal sample pairs of 40 untreated, chronically HBV-infected patients, spanning 210 years of cumulative follow-up. The 40 patients included HBV e-antigen positive and negative persons; with HBV DNA levels ranging from 10(3) to 10(9) cps/mL and belonging to HBV genotypes A, B, C, D and E. In the 40 sample pairs, 70 nucleotide changes occurred in the HBV S-gene (0-8 per patient), resulting in an average substitution rate of 5.1 x 10(-4) nucleotide changes/site/year (range: 0-1.3 x 10(-2)). Surprisingly, the number of substitutions was strongly associated with the inverse level of viremia; and only weakly with the duration of follow-up: in 11 highly viremic patients (HBV DNA > or =10(8) cps/mL), only four substitutions occurred despite a cumulative observation period of 56 years (substitution rate: 1.1 x 10(-4)), while in the 10 patients with viremia below 10(4) cps/mL, 29 substitutions occurred during 30 years of follow-up (substitution rate: 14.6 x 10(-4)). We conclude that in chronic hepatitis B virus infection the rate of nucleotide substitution in the HBV S-gene is inversely related to the level of viremia and thus varies widely from person to person; hampering the phylogenetic analysis of possible chains of HBV infection.

Biochemical characterization of glutathione-deficient mutants of Escherichia coli K12 and Salmonella strains TA1535 and TA100.

Glutathione-deficient mutants of Escherichia coli K12/343/408 and Salmonella typhimurium TA1535 and TA100 were characterized biochemically by measuring the rate of formation of (14C)gamma-glutamylcysteine and (14C)glutathione in cell-free extracts of the strains. gamma-Glutamylcysteine synthetase activity was found to be absent in the NGR-2 mutant of E. coli and in the Salmonella mutants TA1535/NG-19, TA100/NG-57 and TA100/NG-11, while only low activities were found in the NGR-9 and NG-54 mutant of E. coli and Salmonella respectively. These results correspond with the decreased levels of glutathione found in these strains. Extracts of the parent strains have normal glutathione levels and show high gamma-glutamylcysteine synthetase activities. It is concluded that the present GSH-deficient strains of E. coli and Salmonella are gshA mutants, analogous to those previously described in E. coli. In addition, the present results show that the fluorometric method used for the determination of glutathione, employing o-phthalaldehyde as a reagent, is not specific for glutathione (at pH 8.0), but also sensitively reacts with gamma-glutamylcysteine.

Mutagenicity of halogenated and other substituted dinitrobenzenes in Salmonella typhimurium TA100 and derivatives deficient in glutathione (TA100/GSH-) and nitroreductase (TA100NR).

In a previous study, it was shown that 1-chloro-2,4-dinitrobenzene (CDNB) was less mutagenic in a glutathione (GSH)-deficient derivative of Salmonella typhimurium TA100 (TA100/GSH-) than in TA100 itself, suggesting that the mutagenicity of the compound is dependent on GSH, possibly mediated by the action of a bacterial nitroreductase(s) on the CDNB-GSH conjugate. In the present study a series of mutagenicity tests were performed to determine how CDNB could be activated after reaction with GSH. In liquid preincubation assays, strains TA100, TA100/GSH- and TA100NR, a nitroreductase-deficient derivative of TA100, were treated with CDNB and its fluoro and bromo analogues (FDNB and BDNB), further with its GSH conjugate (S-GSH-DNB) and possible metabolic products, such as S-cysteine-dinitrobenzene (S-Cys-DNB) and S-methyl-dinitrobenzene (S-methyl-DNB), and with 2 more analogues, O-methyl-dinitrobenzene (O-methyl-DNB) and dinitrobenzene (DNB). CDNB, FDNB and BDNB were found to be mutagenic in TA100 and TA100NR, while TA100/GSH- was much less sensitive to the mutagenic action of these halogenated dinitrobenzenes. DNB, O-methyl-DNB, S-methyl-DNB and S-Cys-DNB induced equal numbers of His+ revertants in TA100 and TA100/GSH-, but were not mutagenic in TA100NR. S-GSH-DNB showed no mutagenic activity in any of the 3 strains under the present experimental conditions. These results suggest that the halogenated aromatics may react with bacterial DNA and produce pre-mutagenic alterations according to 2 mechanisms: direct attack on the DNA through nucleophilic substitution (SN2) of the halogen atoms; activation through GSH conjugation and subsequent nitroreduction of the conjugate or its metabolic products to more reactive intermediates.

Evaluation of the DNA repair host-mediated assay. II. Presence of genotoxic factors in various organs of mice treated with chemotherapeutic agents.

The DNA repair host-mediated assay was further calibrated by testing 7 chemotherapeutic agents known to possess carcinogenic activity, namely bleomycin (BLM), cis-diamminedichloroplatinum-II (cis-Pt), cyclophosphamide (CP), diethylstilboestrol (DES), isonicotinic acid hydrazide (isoniazid, INH), natulan (NAT) and mitomycin C (MMC). Differential survival of wild-type and uvrB/recA E. coli strains served as a measure of genotoxic activity. In in vitro assays, BLM, cis-Pt and MMC exhibited high genotoxic activity. The other 4 compounds had no measurable effect on the survival of the two strains, either with or without mouse liver preparations. In the host-mediated assays BLM, cis-Pt, MMC and also NAT induced strong killing of the DNA repair-deficient bacteria recovered from liver, spleen, lungs, kidneys and the blood of treated mice compared to the wild-type strain. The results are not indicative of large organ-specific differences in genotoxically active amounts of the drugs immediately after their application to the host animals. CP, INH and DES did not show geneotix activity in these assays even at very high exposure levels. To compare the genetic endpoint measured in the DNA repair assays, i.e. induction of repairable DNA damage, with the induction of gene mutations, the ability of the 7 drugs to induce valine-resistant (VALr) mutants in E. coli was measured in host-mediated assays under identical treatment conditions. INH showed considerable mutagenic activity in E. coli cells recovered from liver and spleen, while BLM and MMC induced a 3-4-fold increase in VALr mutants above spontaneous levels. The other compounds showed no mutagenic activity under these in vivo conditions. From these results it can be concluded that the type of primary DNA lesions produced by these chemotherapeutic agents (cross-links by MMC and cis-Pt, and strand breaks by BLM and possibly by NAT; base alkylation by INH) appears to determine whether a compound will be highly positive in the DNA repair assay as in the case of BLM, cis-Pt, MMC and NAT, and less effective in inducing mutations under similar conditions, or whether the opposite will occur, as in the case of INH; DES and CP probably do not interact sufficiently with bacterial DNA to show an effect in either of the genetic endpoints; and the present DNA repair host-mediated assay may represent a sensitive, rapid and economic method for monitoring genotoxic factors in various organs of experimental animals which have been treated with cytostatic drugs.

The effect of mixed-function oxidase and amine oxidase inhibitors on the activation of dialkylnitrosamines and 1,2-dimethylhydrazine to bacterial mutagens in mice.

The effect of the mixed-function oxidase inhibitor phenylimidazole (PI) and the amine oxidase inhibitors iproniazid (IPRO) and aminoacetonitrile (AAN) on the mutagenic activity of various carcinogens was determined in intrasanguineous host-mediated assays, using mice as hosts and E. coli 343/113 as an indicator of mutagenic activity. The carcinogenic compounds dimethyl-, diethyl-, methylethyl-, and diethanolnitrosamine (DMNA, DENA, MENA, and DELNA respectively) and 1,2-dimethylhydrazine (SDMH) were administered i.p. to mice pretreated or not with one of the inhibitors. After 4 h exposure to each of the carcinogens, E. coli cells recovered from the liver of non-pretreated mice showed considerable induction of VALr mutations; after pretreatment of the hosts with the three inhibitors, significant reduction of the amounts of induced mutants in vivo was observed. Particularly, PI proved a very efficient inhibitor of DENA, MENA, DELNA, and SDMH mutagenicity (93%-97% reduction), suggesting that these carcinogens are mainly activated by cytochrome P-450-dependent enzymes. However, since PI might also inhibit the NAD-mediated activation of DELNA by alcohol dehydrogenase (ADH), the present experiments do not rule out an additional role of ADH in the in vivo mutagenic activation of DELNA. AAN and IPRO were less and much less effective, respectively, in reducing the mutagenic activity of all compounds. Surprisingly, PI showed less inhibition of the mutagenic activity of DMNA (60% reduction), as compared to the other carcinogens; this indicates that metabolic routes other than the cytochrome P-450-dependent enzyme system may be important for the activation of DMNA.

Evaluation of the DNA-repair host-mediated assay. I. Induction of repairable DNA damage in E. coli cells recovered from liver, spleen, lungs, kidneys, and the blood stream of mice treated with methylating carcinogens.

The DNA-repair host-mediated assay was further calibrated by determining the genotoxic activities of 4 methylating carcinogens, namely, dimethylnitrosamine (DMNA), 1,2-dimethylhydrazine (SDMH), methyl nitrosourea (MNU) and methyl methanesulphonate (MMS) in various organs of treated mice. The ranking of the animal-mediated genotoxic activities of the compounds was compared with that obtained in DNA repair assays performed in vitro. The differential survival of strain E. coli K-12/343/113 and of its DNA-repair-deficient derivatives recA, polA and uvrB/recA, served as a measure of genotoxic potency. In the in vitro assays and at equimolar exposure concentrations, MMS and MNU are the most active chemicals, followed by DMNA, which shows a slight genotoxic effect only in the presence of mouse liver homogenate; SDMH has no activity under these conditions. In the host-mediated assays, the order of genotoxic potency of the compounds was quite different: those carcinogens which require mammalian metabolic activation, namely, DMNA and SDMH, show strong effects in liver and blood, a lesser effect in the lungs and kidneys and the least effect in the spleen. The activity of MNU, a directly acting compound, is similar in all organs investigated, but it is clearly lower than that of DMNA and SDMH. MMS, also a directly acting carcinogen, causes some (barely significant) effect at the highest dose tested. A similar order of potency was observed when the compounds were tested in intrasanguineous host-mediated assays with gene mutation as an endpoint. DMNA and SDMH induce comparable frequencies of L-valine-resistant mutants in E. coli K-12/343/113 recovered from liver and spleen of treated mice, the effect in the liver being the strongest. MNU is mutagenic only at a higher dose, while MMS shows no effect. The results are discussed with respect to the literature data on organ-specific DNA adduct formation induced by the compounds. It is concluded that qualitatively there is a good correlation between the degree of genotoxic activity found in the DNA repair host-mediated assay and DNA adduct formation in the animal's own cells. This is exemplified by the finding that the relative order of genotoxic activity of the 4 methylating agents in bacteria recovered from various organs (DMNA approximately equal to SDMH greater than MNU greater than MMS) is reflected by the same order of magnitude in DNA alkylation in corresponding mammalian organs. Quantitatively, the indirectly acting agents DMNA and SDMH seem to induce fewer genotoxic effects in bacteria present in the liver than would be expected on the basis of DNA-adduct formation data.

Factors influencing the mutagenic activity of the colon carcinogen 1,2-dimethylhydrazine in Salmonella typhimurium strain TA 1535 in vitro.

The colon carcinogen 1,2-dimethylhydrazine (SMDH), a non-mutagen in the standard Ames assay, has been shown in previous experiments to become weakly mutagenic in Salmonella TA 1535 in vitro, when specific test conditions were used. The present studies were performed to determine more precisely the nature of metabolic factors and experimental conditions for optimal mutagenesis of SDMH in the same strain of Salmonella. First, it was confirmed that both the presence of rat liver S9 fractions (25 microliters/ml incubation mixture) and prolonged pre-incubation periods in liquid medium of at least 120 min were necessary to elicit SDMH mutagenesis. In contrast to results obtained with dimethylnitrosamine, which served as a model compound for the activation through oxidative, cytochrome P-450- and NADPH-dependent enzymatic processes, the activation of SDMH to mutagenic factors was not dependent on the presence of NADPH: in fact, NADPH strongly reduced the SDMH-induced mutation yields. It was also observed that growth of the indicator bacteria is an important prerequisite for mutation induction by SDMH. Aminoacetonitrile and disulfiram, two inhibitors of SDMH metabolism and carcinogenicity in mammals, also strongly inhibited SDMH mutagenesis in the present in vitro assay. It can, therefore, be concluded that (i) the right test protocol is of crucial importance for the detection of SDMH as a bacterial mutagen, and (ii) that activation pathways in vitro are (partially) different from presumed in vivo metabolism and activation.

Isolation of a mutant of Salmonella typhimurium strain TA1535 with decreased levels of glutathione (GSH-). Primary characterization and chemical mutagenesis studies.

A mutant of Salmonella typhimurium strain TA1535 with decreased glutathione (GSH) levels was isolated after treatment with UV and selection for N-ethyl-N'-nitro-N-nitrosoguanidine (ENNG) resistance; this GSH- mutant also exhibited increased resistance to MNNG, the methyl analog of ENNG. Estimation of the cellular GSH content showed that the GSH- derivative contained about 20% of the GSH levels found in TA1535. In mutagenicity tests (hisG46 leads to His+), the GSH- strain required the presence of GSH or L-cysteine in the medium for an optimal phenotypic expression and/or growth of spontaneous and induced His+ revertants, and may, therefore, be allelic to cys mutants of Salmonella described earlier. The mutagenic activity of MNNG, ENNG and 1,2-dibromoethane (DBE), but not that of N-ethylnitrosourea (ENU), was strongly reduced in TA1535/GSH-; pretreatment of the strain with GSH restored the mutagenicity of the first 3 chemicals to levels normally found in TA1535. The results support the current view that MNNG, ENNG and DBE, but not ENU, can be activated via reaction with GSH to species of higher reactivity and mutagenicity. It is concluded that the present GSH- strain can be used to study more systematically the role of GSH in the bioactivation and -deactivation of xenobiotics to mutagenic factors.

Activation of nitrosamines and other carcinogens by mouse-liver S9, mouse hepatocytes and in the host-mediated assay produces different mutagenic responses in Salmonella TA1535.

5 indirect alkylating carcinogens, namely, dimethylnitrosamine (DMNA), methylethylnitrosamine (MENA), diethylnitrosamine (DENA), 1,2-dimethylhydrazine (DMH) and cyclophosphamide (CP), were tested in liquid incubation assays for their mutagenic activity towards Salmonella TA1535 in the presence of mouse-liver homogenate (S9) or freshly isolated, single liver-cell preparations. The capacity of these mouse-liver preparations to activate the compounds to mutagens for TA1535 was compared with the mutagenic effect of low doses of the carcinogens in intrasanguineous host-mediated assays, with the same strain of mice as host. Although the mouse hepatocytes retained their activating capacity longer than S9 preparations did during incubation at 37 degrees C, the latter gave much higher yields of mutants with 10 mM (DMNA, MENA, DMH) and 5 mM (CP) of 4 out of the 5 compounds. DENA was not mutagenic in either assay. These differences between whole cell and disrupted cell preparations were reduced or absent when the concentrations of the test compounds were reduced by a factor of 10. It was concluded that hepatocytes at the maximal concentration of cells have a limited capacity to metabolize the mutagens. On the basis of protein concentration, hepatocytes are more effective (nitrosamines) or equally effective (CP and DMH) in activating the compounds. Compared with the host-mediated assays, both liver fractions have only a marginal potential to activate equal low amounts of the carcinogens. The present results do not indicate that hepatocytes take an 'intermediate' position between existing in vitro and in vivo activation systems, although they do suggest that these mouse hepatocyte preparations activate the nitrosamines DMNA and MENA in a quantitatively or qualitatively different way than do mouse-liver homogenates.

Mutagenic activity of 2-(2',4'-diaminophenoxy)ethanol in strains TA1538 and TA98 of Salmonella typhimurium.

The mutagenicity of 2-(2',4'-diaminophenoxy)ethanol (2,4-DAPE) was compared with that of 2,4-diaminoanisole (2,4-DAA), a chemically related compound previously used in hair-dye formulations. Both chemicals were tested in standard procedures with the Salmonella/microsome mutagenicity test as described by Ames and colleagues. In several experiments, which extended over a total period of 2 years, 2,4-DAA exhibited definite, but variable mutagenicity toward strain TA1538 when S9 preparations of rat liver induced with Aroclor 1254 were present in the incubation mixtures. The compound 2,4-DAPE did not exhibit detectable mutagenic activity when tested concomitantly under the same experimental conditions. We conclude that 2,4-DAPE is not mutagenic for Salmonella under conditions of the standard mammalian microsome assay with strain TA1538 and TA98 as indicators.

Mutagenic activity of three isomeric N-nitroso-N-methylaminopyridines towards Escherichia coli K-12 in in vitro and animal-mediated assays.

Three isomeric nitrosomethylaminopyridines (2-NMPY, 3-NMPY, and 4-NMPY), of which only the 2-isomer exerts significant carcinogenic activity in rats, were tested in vitro and in the host-mediated assay for their activity to induce gene mutations in E. coli K-12 strain 343/113. Two related carcinogenic nitrosamines were also tested, namely, nitrosodimethylamine (NDMA) and nitrosomethylaniline (NMA). The in vitro mutagenicity tests were performed either without or in the presence of various fractions (S-9, microsomes, S-100) of rodent liver homogenates. The in vivo mutagenicity was determined in host-mediated assays, in which the indicator E. coli cells were recovered for the liver of treated animals. In experiments involving the S-9 liver fraction, only 2-NMPY among the nitrosomethylaminopyridines exerted a slight mutagenic effect. The low mutagenicity of this isomer, and the non-mutagenicity of the remaining 3- and 4-isomer could be partly explained in experiments involving microsomes and the S-100 fraction of rodent liver: 2-NMPY and 4-NMPY were activated to mutagenic factors by microsomes, but their mutagenic effect was completely abolished when S-100 was added. 3-NMPY, on the other hand, was directly mutagenic for E. coli but, again, its mutagenic potential was abolished when S-100 liver fraction was added to the incubation mixtures. NDMA was activated to mutagenic factors with both microsomes and S-9 fractions, whereas NMA could not be shown as mutagenically active under any of the present experimental conditions. It could be shown that the deactivating effect of the S-100 fraction was of nonenzymatic nature, and probably was due to the presence of thiol-containing "scavenger" molecules in this fraction. In the host-mediated assays, only the 2-isomer among the three exerted a mutagenic affect. The present results indicate that the three isomers investigated here are mutagenic either directly (3-NMPY) or upon microsomal activation (2-NMPY and 4-NMPY). The non-carcinogenicity of 3-NMPY and 4-NMPY, and the non-mutagenicity of these compounds in host-mediated assays, is probably the result of very efficient deactivation by cytosolic (thiol-group-containing?)factors.

Comparison of the mutagenic activity of dialkylnitrosamines in animal-mediated and in vitro assays using an Escherichia coli indicator.

An intrasanguineous host-mediated assay was used to establish the mutagenic potential of a series of dialkylnitrosamines to E. coli K12/343/113 in the liver and spleen of mice. For calibrating purposes, dose- and time-dependent kinetics of mutation induction by the model compound diethylnitrosamine in this assay was determined. Comparison with the results of the same compound in vitro reveals that activation in the intact liver of living mice is more efficient and proceeds for a longer period of time than during incubation in the presence of a liver homogenate. The mutagenicity of five other dialkylnitrosamines (dimethyl-, diethanol-, diisopropyl-, methylethyl-, and methyl-n-propylnitrosamine) was also determined. The results of host-mediated assays in livers and spleens of mice indicate a good correlation with the carcinogenic properties of these compounds as far as the effect on the liver is concerned. The mutagenic activity in vitro shows, however, a poor correlation with carcinogenicity data, mainly because some of the carcinogenicity data, mainly because some of the carcinogenic nitrosamines are not detectable in those tests. It is concluded that, under the present experimental conditions, intrasanguineous host-mediated assays are more sensitive and more representative of the carcinogenic activity of dialkylnitrosamines than in vitro assays using S-9 liver fractions.