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Journal of Clinical Microbiology, December 2003, p. 5466-5472, Vol. 41, No. 12
0095-1137/03/$08.00+0 DOI: 10.1128/JCM.41.12.5466-5472.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.
School of Medicine, University of MarylandBaltimore, Baltimore, Maryland 21201-1559,1 Viral and Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 303332
Received 1 April 2003/ Returned for modification 9 June 2003/ Accepted 13 September 2003
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Because of the intracellular habitat of rickettsiae and their slow generation time, the use of traditional techniques to quantify the number of viable rickettsiae in a sample is laborious, inaccurate, and tedious. In principle, the absolute number of rickettsial particles can be determined by microscopic observation of smears prepared from cosuspension with a standardized bacterial suspension following staining with chemical or fluorescent dyes (3, 19) or fluorescein-labeled antibodies (20). Quantitation by this method may be inconsistent because of the variable distribution of microorganisms in the smear and because direct counts of bacterial particles by microscopic observation suffer from subjectivity and lack of reproducibility. The assay is also a time-intensive procedure that may not work well for infected animal tissues. Alternatively, the number of viable rickettsiae can be estimated by measurement of metabolically 35S-labeled rickettsiae or 32P-labeled rickettsiae (21, 22), by titration of infected samples in susceptible animals and embryonated chicken eggs (2, 5), and by tissue culture procedures, including plaque assays (23, 24). However, only infectious and/or metabolically active rickettsiae can be measured by using these biological approaches. These last techniques are expensive, require special facilities for work with radioactive materials or for housing of infected animals, and cannot be used with samples contaminated with other microorganisms or yeast. Except for the metabolic and tissue culture infectivity assays, they may require 5 to 10 days for completion.
Although quantitative PCR assays have been developed and applied to studies with rickettsial relatives in the family Anaplasmataceae (13, 14), a comparable procedure has not been developed and tested on diverse rickettsial samples. Rolain et al. (16) developed a quantitative PCR assay using the Roche LightCycler based on the conserved rickettsial gltA primers 877F and 1258R. The assay was used to monitor the growth kinetics and antibiotic susceptibility of R. conorii, R. typhi, and R. felis in Vero or XTC-2 cells. However, although both probe- and SYBR Green-based assays were mentioned, Rolain et al. did not specify the probe used or completely describe the methods for calibration and optimization of the assay. We describe here the detailed characterization of an alternative rOmpA-based spotted fever rickettsia quantitative PCR (SQ-PCR) assay that we found to be more suitable for quantifying R. rickettsii and other closely related spotted fever group (SFG) rickettsiae. The SQ-PCR assay was compared with the plaque assay for the ability to quantify R. rickettsii. Its utility for detection and quantitation of rickettsiae in experimental samples from cell cultures, animal tissues, and tick and clinical samples was determined.
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R. prowazekii Breinl, R. typhi Wilmington, R. canadensis McKiel and CA410, R. africae ETH SF2500, R. akari CW-PP Hartford, R. parkeri HmacA, R. sibirica 246, R. bellii 369C, R. australis Cutlack, R. montanensis OSU#85-930, R. rhipicephali 12T, human Astrakhan spotted fever rickettsia A-1, Israeli spotted fever rickettsia CDC, and Thai tick typhus rickettsia TT118 were cultivated in Vero cells as described elsewhere (8, 9).
Preparation of DNA template. Several methods were employed for the preparation of rickettsial DNA templates. R. rickettsii strain Bitterroot DNA was used for the evaluation of standard PCR conditions and was prepared by standard lysozyme and protease K treatment and phenol-chloroform extraction of purified rickettsiae (18). To obtain crude DNA extracts from R. rickettsii isolates, sucrose-purified rickettsiae were suspended in 100 µl of distilled water and boiled for 10 min and cell debris was removed by centrifugation. The cleared supernatant was used as DNA template for the PCR assay.
To obtain purified DNA from other spotted fever group rickettsiae and typhus group rickettsiae, infected Vero cells were lysed and total host and rickettsial DNA was extracted by use of the DNeasy kit (Qiagen, Germantown, Md.) according to the manufacturer's protocol (kit N69506). Briefly, infected Vero cells grown in a T150 (150 cm2) flask were concentrated by centrifugation for 30 min at 10,000 x g (Sorvall centrifuge) and the pellet was resuspended in 0.5 ml of Tris-EDTA buffer. AL lysis buffer (200 µl; Qiagen) and protease K (20 µl) were added, mixed with a vortex machine, and incubated for 10 min at 70°C. Undigested proteins were precipitated after the addition of 200 µl of ethanol, and DNA was separated by centrifugation of samples in a Qiagen column for 1 min at 10,000 x g in a MiniCentrifuge (Sorvall Fresco Biofuge). Purified DNA was eluted with 400 µl of distilled water, and the eluate was supplemented with 100 µl of Tris-EDTA buffer and refrigerated for 1 to 7 days prior to quantitation.
DNA from uninfected Vero cells was prepared according to a standard phenol-chloroform procedure (18).
Primer design and selection.
Primer sequences were selected with the aid of the software program Oligo 6.4.4.0 (Oligo MFC; W. Rychlik) and were derived from the gene sequence of rOmpA of R. rickettsii (GenBank accession number M31227.1 [1]). Primers were selected to amplify DNA fragments of 100 to 150 bp (Table 1). Primer sequences were selected based on lack of predicted formation of primer dimers, a predicted Tm of
60°C, and an absence of stretches of identical nucleotides. In addition, the 532- and 632-bp fragments of the rOmpA gene, amplified with Rr190.70n-601p and Rr190.70n-701p primers, respectively, and a 381-bp fragment of gltA (877 to 1,258 nucleotides [nt]) (15, 17) were evaluated as potential amplicons in the quantitative PCR assay.
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TABLE 1. Oligonucleotide primer pairs used for development of SQ-PCR assay for R. rickettsii
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Plasmid standard for absolute quantitation of DNA copy number.
A plasmid standard for template quantitation was prepared as follows. The 732-bp fragment of the rOmpA gene of R. rickettsii strain Bitterroot was PCR amplified with the primers Rr190.70n and Rr190.701p and cloned into the pCR2.1-TOPO plasmid by use of the TA cloning kit (Invitrogen, NV Leek, The Netherlands), and the vector was transformed into Escherichia coli DH5
competent cells (GIBCO BRL). The plasmid insert was sequenced to confirm that it was that expected for rOmpA from R. rickettsii. To standardize the gltA amplicon, the 381-bp DNA fragment from R. rickettsii was similarly cloned and analyzed.
Specificity and sensitivity of SQ-PCR. To determine the detection limits of the PCR assay, serial 10-fold dilutions of the plasmid standards were assayed. To determine the specificity of the PCR assay, its ability to amplify DNA obtained from a collection of spotted fever and typhus group rickettsiae was tested. The effect of heterologous DNA was determined by supplementing samples of R. rickettsii DNA with different concentrations of purified Vero cell DNA. The threshold was calculated using baseline cycles 2 to 10.
Cell culture infection. Confluent monolayer cultures of Vero cells were prepared in 25-cm2 flasks and infected with purified R. rickettsii Bitterroot at a multiplicity of infection of 0.2 and 2.0 rickettsial uncentrifuged PFU per cell. After rickettsiae were allowed to attach for 1 h at room temperature, the inoculum was aspirated, the monolayers were rinsed with phosphate-buffered saline (pH 7.6), and 5 ml of fresh RPMI 1640, with 5% fetal bovine serum and 1 mM L-glutamine, was added. Infected cells and media were harvested with 3-mm-diameter glass beads at time zero (after aspiration of the inoculum) and 8, 24, 48, 72, and 96 h after infection. Harvested suspensions were pelleted by centrifugation at 13,000 rpm for 5 min in a Sorvall Biofuge, the supernatant was discarded, and the cell pellet was frozen. To prepare DNA templates, uninfected and infected Vero cell pellets were suspended in distilled water and boiled for 10 min, membrane fragments and cell debris were pelleted by centrifugation for 10 min at 14,000 rpm, and the supernatants were used for PCR.
Other samples. DNA from brains and lungs of Microtus pinetorum infected with R. rickettsii strain Bitterroot and from uninfected control animals was prepared by use of a two-step Trizol RNA-DNA (Invitrogen, GIBCO BRL) extraction protocol and a DNeasy protocol (Qiagen) according to the manufacturers' instructions. Details on the animal infection protocol are described elsewhere (4). Qiagen kit-purified DNA from SFG rickettsiae-infected and uninfected Amblyomma americanum ticks and humans was a gift from John Sumner (Centers for Disease Control, Atlanta, Ga.).
Statistical analysis.
Where applicable, the experiments were conducted in three replicates for each experimental variable. The means, standard deviations, and standard errors of the means were calculated. Statistical significance was assessed by Student's t test (
= 0.05).
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To optimize amplification, the PCR cocktail mixture was supplemented with 1, 3, or 5 mM MgCl2, and the melting profile was determined for products that were amplified at temperatures ranging from 57 to 63°C. No amplification was obtained in the presence of 1 mM MgCl2, while amplification with 3 or 5 mM MgCl2 was equally efficient. An annealing temperature of 57°C and 3 mM MgCl2 were selected for further experiments to ensure high quality and stringency of amplification.
SQ-PCR using the Rr190.547F-701R primer pair could detect 5 copies of the cloned plasmid, while reagent controls containing no DNA were not amplified (Fig. 1). Amplification of 10-fold dilutions of standard plasmid exhibited linearity within the whole range of 9.5 x 107 to 4.75 copies per sample. Amplification efficiency averaged 0.99 ± 0.02 for 10 different experiments. Vero cell DNA at a final assay concentration of 0.4 µg/ml did not affect the efficiency of amplification of rickettsial DNA within the range of the calibration curve (Fig. 2). The correlation coefficient for the standard curves of two independently cloned plasmid preparations, with and without DNA, was 0.984 ± 0.004.
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FIG. 1. Standard calibration curve for SQ-PCR for Rickettsia with plasmid pCR2.1-TOPO containing the cloned Rr190.547F-Rr190.701R fragment of R. rickettsii Bitterroot. CF RFU, curve-fit relative fluorescence units.
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FIG. 2. Effect of added Vero cell DNA on detection and quantitation of the R. rickettsii rOmpA fragment, using the Rr190.547F and Rr190.701R primer pair. Serial dilutions of two independently isolated and cloned standard plasmid preparations (plasmid P1 and P2) were made in distilled water with or without Vero cell DNA to give a final assay concentration of 0.4 µg/ml. PCR conditions were described in Materials and Methods.
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TABLE 2. Effect of DNA extraction methods on the quantitation of R. rickettsii by SQ-PCR
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37. The latter Ct values were insignificant, as they were identical to those determined for a negative control containing DNA from uninfected Vero cells. Similarly, DNA from the typhus group rickettsiae, R. prowazekii, R. typhi, and R. canadensis was not amplified with these primers (Table 3). |
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TABLE 3. Specificity of SQ-PCR assay for different genotypes of Rickettsia
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TABLE 4. Quantitation of sucrose-purified seeds of different R. rickettsii isolates by plaque assay and SQ-PCR
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Quantitation of R. rickettsii growth in monolayers of Vero cells by SQ-PCR. The SQ-PCR assay was used to quantify the growth of R. rickettsii Bitterroot isolate in monolayers of Vero cells (Fig. 3). The Ct values for samples prepared from cells infected at 0.2 rickettsia per cell steadily decreased for the first 72 h after inoculation (P < 0.05), and this correlated with a logarithmic increase of DNA copies (from 1.3 x 103 per flask to 5.5 x 106 per flask) recovered from a T25 cell culture flask (P < 0.05). The number of rickettsiae declined to 1.9 x 106 per flask 96 h after infection (P < 0.05).
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FIG. 3. Detection of R. rickettsii growth in Vero cells by SQ-PCR. Vero cell monolayers were infected with 2.0 rickettsial PFU per cell (squares) or 0.2 rickettsial PFU per cell (diamonds). Each value is the average ± standard error of three replicates. Some error bars are too small to be seen.
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Detection and quantitation of rickettsiae in experimental, clinical, and field samples. The SQ-PCR assay was used to quantify DNA from R. rickettsii present in a blood sample obtained from a patient with Rocky Mountain spotted fever: 2.39 x 105 ± 0.02 x 105 DNA copies were detected per ml, while no background signal was detected with a healthy donor blood sample. A series of DNAs from blood samples that were negative for rickettsial DNA by conventional PCR amplification of endogenous rickettsial DNA were spiked with purified R. rickettsii DNA. Since similar Ct values (not shown) were found for the rickettsial DNA alone and in the spiked blood samples, SQ-PCR does not appear to be sensitive to potential inhibitors.
Rickettsemia was detected in the blood of experimentally infected M. pinetorum at 8.51 x 104 ± 2.74 x 104 DNA copies/ml, a value that is within the range of that detected in the clinical sample. The quantities of rickettsiae detected in the brains and lungs of acutely infected voles were 8.7 x 104 and 3.9 x 104 DNA copies/mg, respectively, although they were two to five times higher in tissues of animals that died from experimental infection (Table 5). With the exception of one animal, in which R. rickettsii persisted in the brain at day 23 of infection, other tissues were cleared of rickettsiae, so no signal was obtained with the quantitative PCR assay.
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TABLE 5. Detection and quantitation of R. rickettsii DNA in clinical and experimental samples
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The SQ-PCR assay is compatible with different procedures for DNA template preparation and also can detect rickettsial DNA in the presence of heterologous DNA of different origins. However, because different sample handling procedures can result in significantly different efficiencies of DNA extraction, adherence to a single extraction technique within an experiment is recommended to ensure reproducibility and comparability of quantitative data. Rickettsial DNAs from purified organisms, Vero cell culture samples, human and animal blood, animal tissues, and ticks were tested and found in the amounts expected.
SQ-PCR can be used for detection of R. rickettsii isolates and any other spotted fever group rickettsiae that share the Rr190.547F and Rr190.701R conserved rOmpA primer sequences (17). Since divergent homologous sequences are present in the rOmpA genes of R. akari, R. australis, R. bellii, and R. canadensis (10, 17) and since an intact rOmpA gene is not present in R. typhi and R. prowazekii (5), DNA from these species was not detected by SQ-PCR.
On a geometric scale, the number of DNA copies per sample determined by SQ-PCR matched very well the number of PFU determined by a classical centrifuged PFU titration method applied to samples of purified viable rickettsiae. Some discrepancy was expected since plaque assays are only accurate to a half-log (12) and the recovery of DNA from samples may vary. A boiling procedure was chosen to avoid losses from multiple-step processing, but it may not fully release all copies of DNA to hybridize with primers (Table 2). Also, the precise number of DNA copies per rickettsial cell that are present in stock cultures harvested under different growth conditions and passage levels is unknown and requires further examination.
The SQ-PCR assay was used to measure the growth of the R. rickettsii Bitterroot isolate in cell culture. Similar growth curves were obtained for two inoculation doses, 0.2 and 2 rickettsiae per cell, but less total replication was observed at the higher dose and the DNA degraded more rapidly from its maximum level. These results resembled the growth curve of R. rickettsii that was determined by counting of rickettsiae in Gimenez-stained slides (11, 24).
In conclusion, we have validated a new quantitative PCR assay that is highly versatile and sensitive and that is a valuable addition to current methods for quantifying rickettsiae.
We thank Robert Massung and Racheal Priestley for helpful discussions, John Sumner for the clinical and tick DNA samples, and Zhongxing Liang and Qiang Yu for their technical assistance with sample preparation.
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