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Journal of Clinical Microbiology, November 2008, p. 3653-3659, Vol. 46, No. 11
0095-1137/08/$08.00+0 doi:10.1128/JCM.01188-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Unité de virologie tropicale, Institut de Médecine tropicale du Service de Santé des Armées, BP 46, 13 998 Marseille armées, France,1 Unité de génétique moléculaire des Bunyavirus, Institut Pasteur, 25-28 rue du Dr Roux, 75724 Paris, Cedex 15, France2
Received 23 June 2008/ Returned for modification 29 July 2008/ Accepted 8 September 2008
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10 RNA copies per assay. However, the RT-LAMP assay is much faster than traditional RT-PCR and generates results in <30 min for most diluted samples. The specificity of the primers was established using other, related arboviruses as well as virus-containing and virus-free sera. The RT-LAMP assay reported here is thus a valuable tool for the rapid detection of RVFV in field diagnostic laboratories. |
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The virus is transmitted to animals mainly by hematophagous mosquitoes of many genera (Aedes, Anopheles, Culex, Eretmapodites, and Mansonia) during seasons of high rainfall (6). Domestic animals are sensitive to RVFV infection and amplify the virus to high titers (26). Among cattle, sheep, goats, pigs, and camels, infection causes fever and anorexia. Although fewer than 10% of infected animals die, abortions are frequently observed among infected pregnant animals. (26).
Human infections are due mainly to direct exposure to infected material from sick animals during handling or slaughter (26) and sometimes to infected-mosquito bites. Consumption of raw milk from infected animal is also considered a risk. In most human cases, the disease is characterized by a brief self-limited febrile illness lasting 2 to 5 days, which progresses in 1 to 2% of patients to serious complications, including retinitis, blindness, encephalitis, hepatitis, or hemorrhagic syndromes that may lead to death in 10 to 20% of the cases (2).
RVFV diagnosis relies on specific-antibody detection, virus isolation (3, 5), and genome amplification (8, 21). Protocols have been developed that specifically detect RVFV genomes through technology such as real-time quantitative PCR (RT-PCR) (8). Among the alternative methods for nucleic acid amplification is loop-mediated isothermal amplification (LAMP), developed in 2000 (13, 24). LAMP amplifies specific sequences on nucleic acids using a set of six primers and relies on the strand displacement activity of the DNA polymerase. It is performed at a constant temperature (60 to 65°C), without cyclic denaturation of the template. RNA can be amplified simply by the addition of avian myeloblastosis virus reverse transcriptase to the reaction mix, keeping the same reaction conditions as for DNA amplification (24). High amplification rates are observed, leading to the production of large amounts of double-stranded DNA (dsDNA) and leading as well to production of a white precipitate of magnesium pyrophosphate that can be observed with the naked eye. When primers are properly designed, the reaction is as specific and sensitive as traditional PCR or RT-PCR and is, moreover, faster (12). LAMP or RT-LAMP is thus efficient, fast, and inexpensive, and since isothermal reaction conditions are easy to provide, LAMP is of particular interest for field diagnosis of tropical diseases.
Currently, primers sets have been published for the detection of various arboviruses, such as dengue virus serotypes 1, 2, 3, and 4 (17), Chikungunya virus (14), West Nile virus (16), and Japanese encephalitis virus (25), thus further contributing to the ease of field trials of this assay.
The aims of this study were to develop and validate a reverse-transcription LAMP method (RT-LAMP) for RVFV RNA amplification with a real-time follow-up and to evaluate the potential of this method for diagnostic purposes.
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Virus strains. RVFVs of the four topotypes were used: RVFV (IMTSSA/H-2067, human serum, Chad, 2005) (5), Senegal (ArSEN84, ArD38661), Madagascar (AnMg990), Egypt (ZH548, HEgy93), Kenya (HKen98), and RVFV clone 13 (note that for three of these topotypes, we used two different viral strains, for a total of seven viral strains corresponding to the four topotypes). Other arboviruses were also used: Toscana (IMTSSA/H-4906, human LCR, France, 1998) (20), Sandfly Sicilian (Sabin strain), Sandfly Naples (Sabin strain), Belterra (Brazil, 1977), Punta Toro (Adames strain; kindly provided by D. H. L. Bishop), dengue virus strains 1, 2, 3, and 4 (dengue virus strain 1, IMTSSA/H-658, isolated from human serum, Cambodia, 1998; dengue virus strain 2, IMTSSA/H-1164, human serum, Somalia, 1994; dengue virus strain 3, IMTSSA/H-1731, human serum [18], Guadeloupe, 1994; dengue virus strain 4, IMTSSA/H-812, human serum, Indonesia, 1994), yellow fever virus (17D), Japanese encephalitis virus (Nakayama), West Nile virus (Tunisia, 1997), Saint Louis encephalitis virus (MSI-7), tick-borne encephalitis virus (Langat), and Chikungunya (IMTSSA/H-6368, human serum, Réunion, 2005) (1). The viruses were propagated in C6/36 cells or Vero cells as described previously (5).
Clinical samples and infected sera. Serum samples from patients with clinical suspicion of arbovirus infections were sent to the virological laboratory at the Institut de Médecine tropicale du Service de Santé des Armées. Control sera from healthy donors were also tested. All the samples were transported and stored at –80°C until use. Since we lacked human and animal RVFV-positive sera, we reconstituted sera and made them virus positive by mixing 200 µl of fetal calf serum with RVFV. Sera were then processed as described below.
RNA extraction. Viral RNA was extracted from 140 µl of infected cell supernatants or (patient) sera by using a High Pure viral RNA kit or an RNeasy minikit (Qiagen) following the manufacturer's protocol. The eluted RNA was stored at –70°C until used.
Primer design. The complete RVFV L segment sequences available in the GenBank database (see the legend to Fig. 1) were aligned using CLUSTAL software (23) to identify conserved regions (Fig. 1). Potential target regions were analyzed with the LAMP primer design software, and specific primers were automatically designed (www.http://primerexplorer.jp/elamp4.0.0/index.html). A set of six primers comprising two outer, two inner, and two loop primers was selected. FIP contained F1C (complementary to F1), a TTTT spacer, and the F2 sequence. BIP contained the B1C sequence (complementary to B1), a TTTT spacer, and the B2 sequence. All the described primers (Table 1) were ordered as standard desalted primers (Eurogentec, Angers, France).
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FIG. 1. Alignment of RVFV L segments (nucleotides 6117 to 6331) and positions of LAMP primers. The ends of the primers from which the elongation starts are indicated by arrows. Accession numbers for the strains aligned (top to bottom) are DQ375434.1, DQ375429.1, DQ375432.1, DQ375421.1, DQ375419.1, DQ375423.1, DQ375416.1, DQ375411.1, DQ375406.1, DQ375412.1, DQ375414.1, DQ375425.1, DQ375401.1, DQ375433.1, DQ375396.1, DQ375397.1, DQ375399.1, DQ375427.1, and DQ375428.1.
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TABLE 1. LAMP primers for RVFV amplificationa
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Analysis of RT-LAMP products. For agarose gel analysis, RT-LAMP products were incubated at 63°C, electrophoresed using a 2% agarose gel in Tris-borate buffer (Interchim, Montlucon, France) with EtBr, and visualized using a transilluminator (Bio-Rad laboratories). For naked-eye visualization following amplification, the tubes were examined for white turbidity or for the presence of a white pellet after a pulse spin. The positivity of the real-time RT-LAMP assay was determined as an increase of fluorescence above the baseline value and the time for positivity given by the CT value (second derivative maximum, 1 cycle corresponding to 1 min of reaction).
Real-time Taqman RT-PCR. The RVFV Taqman assay developed by Garcia et al. (8) was used as a reference. Briefly, the reaction was conducted in a 20-µl assay with 10 µl of buffer, 0.8 µl of enzyme mix from a Superscript III one-step RT-PCR system with Platinum Taq (Invitrogen), 0.5 µM of the forward primer S432 (5'-ATG ATG ACA TTA GAA GG GA-3'), 0.5 µM of the reverse primer NS3m (5'-ATG CTG GGA AGT GAT GAG-3'), and 0.5 µM probe CRSSAr (5'-ATT GAC CTG TGC CTG TTGCC-3') (8) during 30 min of RT at 50°C, 2 min of denaturation at 95°C, 50 cycles of 5 s at 95°C, and annealing/elongation for 1 min before fluorescence reading.
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200-nucleotide sequence fully conserved among all the RVFV L-segment genomes. However, we were unable to identify a stretch of nucleotides that met these criteria. Therefore, primers were designed by Primerexplorer software based on a conserved segment of the L gene (nucleotides 6115 to 6404) and modified to fit the viral sequences. A limited number of mismatches (one or two, in the middle or at the 5' ends of the primers) was thought to be acceptable; particular caution was exercised to avoid template and primer 3'-end mismatches (where elongation by the Bst DNA polymerase is initiated) (Fig. 1). A one-step, single-tube, real-time RT-LAMP assay was standardized with the selected primers under the conditions described above. A 282-nucleotide segment was then amplified (Table 1). The specificity was determined using RNA extracts of infected C6/36 and Vero cells. The reaction was monitored by naked-eye visualization, agarose gel deposition, and real-time follow-up. A total of
106 copies of viral RNA were tested in each sample. The seven RVFV strains were assayed, including the four RVFV subtypes: Chad, Senegal, Madagascar, Egypt (two strains), Kenya, and the vaccine candidate clone 13. All were positively amplified using this RT-LAMP protocol. The RVFV-specific RT-LAMP primers demonstrated a high degree of specificity for RVFV by yielding negative results for all other tested phleboviruses (Toscana, Sandfly Sicilian, Sandfly Naples, Belterra, and Punta Toro), flaviviruses (dengue virus types 1, 2, 3, and 4, yellow fever virus, Japanese encephalitis virus, West Nile virus, Saint Louis encephalitis virus, and tick-borne encephalitis virus), and an alphavirus (Chikungunya virus) (Table 2). |
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TABLE 2. Species specificity of RVFV RT-LAMPa
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101 RVFV RNA copies per assay (Fig. 2). The same analyses were performed on the other RVFV strains of this study: for all strains tested (Senegal, Kenya, Egypt [HEgy93 and ZH548], Madagascar, and clone 13), the detection limit corresponded to
101 RVFV RNA copies per assay (data not shown). This limit corresponded to that of Taqman RT-PCR (8). Note that clone 13 could not be amplified by the Taqman system, as described by others (8), since the primers are located in a genomic region that is not present in that attenuated strain. However, RT-LAMP amplification of clone 13 was not impaired, since the primers are in a genomic segment present in all strains.
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FIG. 2. Sensitivity of RVFV LAMP and real-time Taqman PCR (8). RVFV RNA extracted from supernatants of infected cells was serially diluted, and samples containing 105 to 10–2 copies were assayed in parallel using Taqman RT-PCR and our RT-LAMP assay. Real-time follow-up on a LightCycler (using channel F2/F3) and melting curve analysis for LAMP are reported. Reaction products were analyzed on agarose gels with ethidium bromide staining.
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105 RNA copies were present to 18.0 min when
10 copies of RNA were present, as compared to the Taqman RT-PCR CTs of 18.8 (corresponding to 30 min for RT plus 16.6 min for PCR) to 39.9 (30 min for RT plus 35 min for PCR) (Table 3). A standard curve showing the relationship between the concentrations of RVFV ranging from 101 to 105 RNA copies/assay and the time to positivity (CT) was built for the RT-LAMP (Fig. 3). A relationship was found between the number of RNA copies and the time to signal detection in the range of 100 to 100,000 copies, with a correlation coefficient (R2) of 0.95. No correlation (R2 < 0.8) was found in the range of 10 to 100,000 copies. |
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TABLE 3. Comparison of RVFV Taqman CT and LAMP times for detection using real-time follow-upa
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FIG. 3. Standard curve for the RVFV-specific RT-LAMP. Time for LAMP positivity (CT estimated by the LightCycler) was plotted against initial number of RNA copies, on 10-fold serial dilutions of RVFV viral RNA. A logarithmic regression curve was constructed to evaluate the relationship between the two elements. The equation and R2 coefficient are presented for the range of 100 to 100,000 copies, since no significant relationship was found for smaller amounts (R2 < 0.8). Results are from one experiment representative of three different assays.
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TABLE 4. Evaluation of RT-LAMP assay in serum samplesa
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The RVFV RT-LAMP developed in this work is an easy, rapid, specific, and sensitive assay. A one-step, single-tube, real-time RT-LAMP assay was optimized to allow RVFV L-segment detection in less than 30 min, with a limit of detection of
10 RNA molecules/assay. A low limit of detection is characteristic of the LAMP method (13). The unmatched characteristics of the RT-LAMP, compared to quantitative RT-PCR (2 to 3 h) (8), also offer the advantage of continuous amplification under isothermal conditions that can be provided with a simple water bath. Other isothermal amplification techniques, such as nucleic acid sequence-based amplification (4) and the self-sustained sequence reaction, are reported to be less specific, probably due to the low stringency (reaction temperature is
40°C), and require either a precision instrument or a complex method for the detection of the amplified products due to the poor specificity of target sequence selection (4). Nevertheless, when performing LAMP under "field-like" conditions with a simple water bath, we noticed, as others have done (18), that two aspects should be considered. First, special care should be taken to avoid any contamination with previously amplified LAMP products. Due to the high amplification rate, any trace of LAMP DNA concatemers will be easily reamplified and lead to false-positive results. Thus, end-point reading options that do not require opening reaction tubes (turbidity or fluorescence reading) should be preferred to agarose gel analysis. Second, reagents should be kept on ice until heating of the samples to 60°C, in order to prevent nonspecific start of the reaction and primer multimer amplification. For that reason, it would be relevant to develop a "hot start" LAMP, which already exists for PCR, to facilitate processing of the reaction in field conditions.
The real-time monitoring of LAMP offers the fastest and most sensitive protocol. The RT-LAMP reaction can be achieved by the follow-up of the ethidium bromide fluorescence detected in the F2 channel of the LightCycler or by using any other dsDNA-intercalating fluorescent molecule and apparatus. The use of this in-house-developed protocol allows LightCycler-equipped laboratories to test the potential of the LAMP technique for molecular diagnosis.
The RT-LAMP assay requires six primers that recognize eight distinct regions of the target and, when properly designed, prevent cross-reactions (Table 2). Due to the setting of these primers in a highly conserved RVFV genetic region, we assumed that the RT-LAMP assay would amplify all the RVFV genomes in the genetic clusters. Accordingly, all the RVFV strains we assayed, representing all the virus subtypes identified so far, led to efficient amplification in the RT-LAMP assay. We did not get any RVFV-positive human or animal sera, so we chose to simulate viremic sera by mixing RVFV with bovine or human serum before RNA extraction. The RVFV RT-LAMP assay was successfully performed using such reconstituted positive samples. The RVFV-negative sera were found to be negative by using the RVFV-specific RT-LAMP. Therefore, we obtained no interference between components of the serum and the RT-LAMP process. This expected result is compatible with the literature, since LAMP and RT-LAMP have already been shown to be well-suited tools for the detection of pathogens in diagnosis samples, including viruses, bacteria, parasites, and fungi (see for instance references 9, 14, and 16).
The poor quantitative parameters of the assay (R2 = 0.95; the imprecise estimation of the CT value) render the RVFV RT-LAMP inappropriate as a precise quantification tool, in contrast to Taqman RT-PCR. Kuhara and collaborators reported the same limited relationship between the LAMP CT and herpesvirus 8 DNA concentration (11). Similarly, other authors have shown the real-time follow up of LAMP or RT-LAMP, using specifically designed turbidimeters (LA-100 and LA-200; Eiken Company). The nonregular spacing between the amplification curves from serial dilutions of the target nucleic acid points out the nonlinearity of the CT-concentration relationship over a wide concentration range (10, 14, 15). Nevertheless, for diagnostic purposes, exact quantification of the pathogen load is not necessary. A semiquantitative result, such as high, medium, or low viral titers, will provide clinically useful information. In this regard, the real-time RT-LAMP follow-up can easily be achieved with a LightCycler or a turbidimeter.
RT-LAMP is a new technique with potential for continued development. The RT-LAMP method appears to be well adapted for molecular diagnosis in laboratories, considering its high specificity, high speed, and low cost. Specific turbidimeters are available for the RT-LAMP real-time follow-up (Eiken Company). The ability to visually assess the white magnesium pyrophosphate precipitate at the end point of the RT-LAMP assay is a distinct advantage in the development of this method for field diagnosis of infectious diseases. As interest in techniques allowing precise and rapid diagnosis of infectious agents under sometime difficult conditions is increasing, the characteristics and performance of the RT-LAMP deserve attention.
This work was funded by the French Armed Forces Medical Service and the French Délégation Générale pour l'Armement (contrat d'objectif 08co402).
The opinions and assertions contained herein are those of the authors and are not to be construed as official or reflecting the views of the French Armed Forces Medical Service or the French Army at large.
Published ahead of print on 17 September 2008. ![]()
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