Genome-wide tiled detection of circulating Mycobacterium tuberculosis cell-free DNA using Cas13.

Detection of microbial cell-free DNA (cfDNA) circulating in the bloodstream has emerged as a promising new approach for diagnosing infection. Microbial diagnostics based on cfDNA require assays that can detect rare and highly fragmented pathogen nucleic acids. We now report WATSON (Whole-genome Assay using Tiled Surveillance Of Nucleic acids), a method to detect low amounts of pathogen cfDNA that couples pooled amplification of genomic targets tiled across the genome with pooled CRISPR/Cas13-based detection of these targets. We demonstrate that this strategy of tiling improves cfDNA detection compared to amplification and detection of a single targeted locus. WATSON can detect cfDNA from Mycobacterium tuberculosis in plasma of patients with active pulmonary tuberculosis, a disease that urgently needs accurate, minimally-invasive, field-deployable diagnostics. We thus demonstrate the potential for translating WATSON to a lateral flow platform. WATSON demonstrates the ability to capitalize on the strengths of targeting microbial cfDNA to address the need for point-of-care diagnostic tests for infectious diseases.

Rapid identification and phylogenetic classification of diverse bacterial pathogens in a multiplexed hybridization assay targeting ribosomal RNA.

Rapid bacterial identification remains a critical challenge in infectious disease diagnostics. We developed a novel molecular approach to detect and identify a wide diversity of bacterial pathogens in a single, simple assay, exploiting the conservation, abundance, and rich phylogenetic content of ribosomal RNA in a rapid fluorescent hybridization assay that requires no amplification or enzymology. Of 117 isolates from 64 species across 4 phyla, this assay identified bacteria with >89% accuracy at the species level and 100% accuracy at the family level, enabling all critical clinical distinctions. In pilot studies on primary clinical specimens, including sputum, blood cultures, and pus, bacteria from 5 different phyla were identified.

Evaporative concentration on a paper-based device to concentrate analytes in a biological fluid.

We report the first demonstration of using heat on a paper device to rapidly concentrate a clinically relevant analyte of interest from a biological fluid. Our technology relies on the application of localized heat to a paper strip to evaporate off hundreds of microliters of liquid to concentrate the target analyte. This method can be used to enrich for a target analyte that is present at low concentrations within a biological fluid to enhance the sensitivity of downstream detection methods. We demonstrate our method by concentrating the tuberculosis-specific glycolipid, lipoarabinomannan (LAM), a promising urinary biomarker for the detection and diagnosis of tuberculosis. We show that the heat does not compromise the subsequent immunodetectability of LAM, and in 20 min, the tuberculosis biomarker was concentrated by nearly 20-fold in simulated urine. Our method requires only 500 mW of power, and sample flow is self-driven via capillary action. As such, our technology can be readily integrated into portable, battery-powered, instrument-free diagnostic devices intended for use in low-resource settings.

Functional role of methylation of G518 of the 16S rRNA 530 loop by GidB in Mycobacterium tuberculosis.

Posttranscriptional modifications of bacterial rRNA serve a variety of purposes, from stabilizing ribosome structure to preserving its functional integrity. Here, we investigated the functional role of one rRNA modification in particular-the methylation of guanosine at position 518 (G518) of the 16S rRNA in Mycobacterium tuberculosis. Based on previously reported evidence that G518 is located 5 Å; from proline 44 of ribosomal protein S12, which interacts directly with the mRNA wobble position of the codon:anticodon helix at the A site during translation, we speculated that methylation of G518 affects protein translation. We transformed reporter constructs designed to probe the effect of functional lesions at one of the three codon positions on translational fidelity into the wild-type strain, H37Rv, and into a ΔgidB mutant, which lacks the methyltransferase (GidB) that methylates G518. We show that mistranslation occurs less in the ΔgidB mutant only in the construct bearing a lesion in the wobble position compared to H37Rv. Thus, the methylation of G518 allows mistranslation to occur at some level in order for translation to proceed smoothly and efficiently. We also explored the role of methylation at G518 in altering the susceptibility of M. tuberculosis to streptomycin (SM). Using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS), we confirmed that G518 is not methylated in the ΔgidB mutant. Furthermore, isothermal titration calorimetry experiments performed on 70S ribosomes purified from wild-type and ΔgidB mutant strains showed that methylation significantly enhances SM binding. These results provide a mechanistic explanation for the low-level, SM-resistant phenotype observed in M. tuberculosis strains that contain a gidB mutation.

Mutations in gidB confer low-level streptomycin resistance in Mycobacterium tuberculosis.

The global threat posed by drug-resistant strains of Mycobacterium tuberculosis demands a greater understanding of the genetic basis and molecular mechanisms that govern how such strains develop resistance against various antituberculous drugs. In this report, we examine a new genetic basis for resistance to one of the oldest and most widely used second-line drugs employed in tuberculosis therapy, streptomycin (SM). This marker for SM resistance was first discovered on the basis of genomic data obtained from drug-resistant M. tuberculosis strains collected in Japan, wherein an association was observed between SM resistance and a mutation in gidB, a putative 16S rRNA methyltransferase. By evaluating an isogenic ΔgidB mutant strain constructed from strain H37Rv, we demonstrate the causal role of gidB in conferring a low-level SM-resistant phenotype in M. tuberculosis with a 16-fold increase in the MIC over the parent strain. Among clinical isolates, the modest increase in SM resistance conferred by a gidB mutation leads to an MIC distribution of gidB mutation-containing strains that spans the recommended SM breakpoint concentration currently used in drug susceptibility testing protocols. As such, some gidB mutation-containing isolates are found to be SM sensitive, while others are SM resistant. On the basis of a pharmacodynamic analysis and Monte Carlo simulation, those isolates that are found to be SM sensitive should still respond favorably to SM treatment, while nearly half of those found to be SM resistant will likely respond poorly. This report provides the first microbiological evidence for the contribution of gidB in streptomycin resistance and examines the clinical implications of mutations in the gidB gene.

Polymorphisms associated with resistance and cross-resistance to aminoglycosides and capreomycin in Mycobacterium tuberculosis isolates from South Korean Patients with drug-resistant tuberculosis.

The aminoglycosides streptomycin, amikacin, and kanamycin and the cyclic polypeptide capreomycin are all widely used in second-line therapy for patients who develop multidrug-resistant tuberculosis. We have characterized a set of 106 clinical isolates of Mycobacterium tuberculosis using phenotypic drug susceptibility testing (DST) to determine the extent of resistance to each agent and cross-resistance between agents. These results were compared with polymorphisms in the DNA sequences of ribosome-associated genes previously implicated in resistance and with the clinical outcomes of subjects from whom these isolates were obtained. Thirty-six (34%) of these isolates displayed resistance to one or more of these agents, and the majority of these (20 of 36) showed cross-resistance to one or more agents. Most (33 of 36) of the resistant isolates showed polymorphisms in the 16S ribosome components RpsL and rrs. Three resistant strains (3 of 36) were identified that had no known polymorphisms in ribosomal constituents. For kanamycin and streptomycin, molecular DST significantly outperformed phenotypic DST using the absolute concentration method for predicting 4-month sputum conversion (likelihood ratios of 4.0 and 2.0, respectively) and was equivalent to phenotypic DST using the National Committee for Clinical Laboratory Standards (NCCLS)-approved agar proportion method for estimating MIC (likelihood ratio, 4.0). These results offer insight into mechanisms of resistance and cross-resistance among these agents and suggest that the development of rapid molecular tests to distinguish polymorphisms would significantly enhance clinical utility of this important class of second-line antituberculosis drugs.

Combinatorial evaluation of cations, pH-sensitive and hydrophobic moieties for polymeric vector design.

Three combinatorial libraries of polymeric vectors were evaluated to investigate the functional roles of molecular weight (MW), cations, pH-sensitive moieties, and hydrophobic derivitization in polymer-mediated gene delivery. Four cationic and pH-sensitive moieties (imidazole, primary, secondary, and tertiary amino) and three hydrophobic residues (C4 butyl, C6 hexyl, and C8 octyl) were assessed in single and serially incremented, binary combinations. Three MWs were evaluated-10, 30, and 50 kDa. The highest levels of transfection, comparable to branched PEI (25 kDa), were achieved by 30 kDa and 50 kDa formulations containing primary amino and imidazole groups. Primary amino groups offered superior charge-neutralizing and size-condensing capacity, while imidazole groups appeared to bind with DNA via nonelectrostatically mediated interactions to produce stable polyplexes that were resistant to premature dissociation. Eight of the 10 highest-transfecting polymers possessed IC(50) values greater than the maximum concentration of free polymers exposed to cells (200 microg/ml). The results herein have identified highly efficient polymeric formulations with superb toxicity profiles and have revealed the functional roles that the investigated pendant groups play in the transfection process. The reported polymeric system offers a versatile and robust platform upon which future structure-function studies may be based to create safer and more efficient polymeric vectors.

Overcoming limiting side reactions associated with an NHS-activated precursor of polymethacrylamide-based polymers.

Combinatorial polymer libraries have recently gained popularity for the development of novel materials for a variety of biomedical applications including non-viral gene delivery systems and biodegradable polymers for tissue engineering. To streamline the nontrivial task of library synthesis, activated ester homopolymers have been used to serve as a backbone to which primary amine-containing functional groups (NH2-FGs) can be covalently bound at varying ratios. Polymethacryloxysuccinimide (poly(MAOS)) is one such homopolymer that was previously reported to be an attractive precursor for polymeric drug and gene delivery systems. The reported functionalization protocols entailed conjugating the precursor with 2 equiv of the NH2-FG at a reaction concentration of 25 mg poly(MAOS)/150 microL DMSO for either 5 h at 50 degrees C or 16 h at 25 degrees C. More recently, both protocols were revealed to be associated with ring-opening and glutarimide-forming side reactions that compromise the utility of the homopolymer. Using 1-dimensional and 2-dimensional NMR spectroscopy techniques, we have characterized the side product distributions that result from conjugations performed at 50 degrees C/5 h and 25 degrees C/16 h. Moreover, by systematically altering the equivalents of the NH2-FGs, polymer concentration, reaction time, and reaction temperature, we have established a protocol that overcomes these side reactions. Using a final reaction protocol of 5 equiv of the NH2-FG at a reaction concentration of 25 mg poly(MAOS)/600 microL DMSO for 24 h at 75 degrees C, we have obtained functionalized polymers with minimal side products. This protocol is applicable for polymers ranging from 5000 to 50,000 g/mol, compatible with a variety of functional groups, and amenable to conjugating combinations of functional groups.