This research was supported by Naval Medical Research Center, research work unit 6000.RAD1.J.A0310. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government. Wei-Mei Ching is an employee of the U.S. Government. This work was prepared as part of her official duties. Title 17 U.S.C. &#167;105 provides that &#39;Copyright protection under this title is not available for any work of the United States Government.&#39; Title 17 U.S.C. &#167;101 defines a U.S. Government work as a work prepared by military service member or employee of the U.S. Government as part of that person&#39;s official duties.

1. Prepare Plasmid DNA Dilutions as Standard for LAMP Reaction
<ol>
	<li>Use a spectrophotometer to measure the optical density (O.D.) at 260 nm to determine the plasmid (containing target gene IS1111a of C. burnetii RSA 493) DNA concentration. An O.D.260 of 1 equates to 50 &#181;g/&#181;l of DNA.</li>
	<li>Convert the amount of plasmid DNA into the copy number. Since the size of the plasmid is 6,330 bp, the molecular weight of this plasmid is 4.1 x 106 g (6,330 bp x 649 g/bp). The DNA concentration of the plasmid is 34.2 ng/&#181;l (as determined from step 1.1). 1 &#181;l of this DNA sample contains 34.2 ng of plasmid DNA, equating to 5 x 109 copies (34.2 x 10-9 g / 4.1 x 106 g x 6.02 x 1023) of DNA.</li>
	<li>Add 10 &#181;l of plasmid DNA (5 x 109 copies/&#181;l) to 90 &#181;l of water for a 10-fold dilution to make a DNA sample of 5 x 108 copies/&#181;l.</li>
	<li>Repeat step 1.3 to prepare DNA samples of 5 x 107, 5 x 106, 5 x 105, 5 x 104, 5 x 103, 5 x 102, 5 x 101, and 5 x 100 copies/&#181;l .</li>
</ol>
2. Prepare DNA Template from Samples for LAMP Reaction
<ol>
	<li>Perform DNA extraction from human plasma samples using a commercial DNA mini kit according to manufacturer&#39;s protocol. Use a total of 200 &#181;l&#160;sample for extraction and elute extracted DNA in a 20 &#181;l volume.</li>
</ol>
3. Prepare 2x&#160;LAMP Reaction Buffer
<ol>
	<li>Mix 200 &#181;l of 10x&#160;Pol Buffer, 320 &#181;l of 5 M trimethylglycine, 12 &#181;l of 1 M MgSO4, 280 &#181;l of dNTP mixture (10 mM each) and 188 &#181;l of water to make 1 ml of 2x LAMP buffer. Mix by pulse-vortexing for 10 sec.</li>
</ol>
4. Perform Standard LAMP Reaction
<ol>
	<li>Mix 12.5 &#181;l of 2x LAMP buffer (as prepared in step 3; 40 mM Tris-HCl (pH 8.8), 20 mM KCl, 16 mM MgSO4, 20 mM (NH4)2SO4, 0.2% Triton X-100, 1.6 M trimethylglycine, 1.4 mM dNTP mixture), 1.2 &#181;l of primer mix, 1 &#181;l of Bst DNA polymerase (8 U/&#181;l), and 5.3 &#181;l of water to make reaction mixture (20 &#181;l) in a 0.2 ml PCR tube.</li>
	<li>Add 5 &#181;l of DNA (from step 1 or 2) to the 20 &#181;l reaction mixture and mix well.</li>
	<li>Close tube and incubate at 60 &#176;C for 60 min in a water bath or heating block. This is the optimal reaction temperature determined previously.</li>
	<li>Add 5 &#181;l of 10x gel loading buffer to terminate the reaction.</li>
	<li>Load 5 &#181;l of reaction products to a 2% agarose gel stained with intercalating nucleic acid stain.</li>
	<li>Run gel at 100 V for 35 min in 1x TBE buffer.</li>
	<li>Visualize the results by UV light.</li>
</ol>
5. Perform LAMP Reaction with Reconstituted Reagents
<ol>
	<li>Mix 125 &#181;l of 10x Pol Buffer, 200 &#181;l of 5 M trimethylglycine, 7.5 &#181;l of 1 M MgSO4, 667.5 &#181;l of water to make 1 ml of reconstitution buffer. Mix by pulse-vortexing for 10 sec.</li>
	<li>Remove tubes which contain the lyophilized reagents from the sealed aluminum foil bag. Do not use the tubes if the aluminum foil bag is not sealed or if it is damaged.</li>
	<li>Add 20 &#181;l of reconstitution buffer into each tube to re-suspend lyophilized reagents.</li>
	<li>Mix by pipetting buffer up and down 5 times. Take a look to make sure the lyophilized reagents are completely re-suspended. The white powder should disappear in the tube.</li>
	<li>Add 5 &#181;l of DNA template (from step 1 or 2) to the reconstituted reagents and mix well.</li>
	<li>Close tube and incubate at 60 &#176;C for 60 min in a water bath or heating block.</li>
	<li>Add 5 &#181;l of 10x gel loading buffer to terminate the reaction.</li>
	<li>Load 5 &#181;l of reaction products to a 2% agarose gel stained with intercalating nucleic acid stain.</li>
	<li>Run gel at 100 V for 35 min in 1x TBE buffer.</li>
	<li>Visualize the results by UV light.</li>
</ol>
6. Perform LAMP Reaction with Reconstitution Buffer Containing HNB or Fluorescent Intercalating Dye
<ol>
	<li>Mix 125 &#181;l of 10x Pol Buffer, 200 &#181;l of 5 M trimethylglycine, 7.5 &#181;l of 1 M MgSO4, 7.5 &#181;l of 20 mM HNB (or 12.5 &#181;l of 100x fluorescent intercalating dye) and 660 &#181;l (or 655 &#181;l) of water to make 1 ml of reconstitution buffer. Mix by pulse-vortexing for 10 sec.</li>
	<li>Use the reconstituted buffer prepared in section 6 to repeat the steps 5.2 - 5.6.</li>
	<li>Visualize the results by the naked eye (reaction containing HNB) or a UV light (reaction containing fluorescent intercalating dye).</li>
</ol>
7. Perform Real-time LAMP Reaction with Tube Scanner
<ol>
	<li>Add 5 &#181;l DNA to the reconstituted reagents containing fluorescent intercalating dye, close tube and insert it to the tube scanner.</li>
	<li>Set incubation temperature at 60 &#176;C. Measure the fluorescence at 520 nm for 60 min.</li>
</ol>

<ol>
	<li>Anderson, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnosis+and+management+of+Q+fever+United+States,+2013:+recommendations+from+CDC+and+the+Q+Fever+Working+Group.">Diagnosis and management of Q fever United States, 2013: recommendations from CDC and the Q Fever Working Group.</a> MMWR Recomm. Rep. 62 (3), 1-30 (2013).</li><li>Rolain, J. M., Boulos, A., Mallet, M. N., Raoult, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Correlation+between+ratio+of+serum+doxycycline+concentration+to+MIC+and+rapid+decline+of+antibody+levels+during+treatment+of+Q+fever+endocarditis.">Correlation between ratio of serum doxycycline concentration to MIC and rapid decline of antibody levels during treatment of Q fever endocarditis.</a> Antimicrob. Agents and Chemother. 49 (7), 2673-2676 (2005).</li><li>Fournier, P. E., Raoult, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+PCR+and+serology+assays+for+early+diagnosis+of+acute+Q+fever.">Comparison of PCR and serology assays for early diagnosis of acute Q fever.</a> J. Clin. Microbiol. 41 (11), 5094-5098 (2003).</li><li>Schneeberger, P. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Real-time+PCR+with+serum+samples+is+indispensable+for+early+diagnosis+of+acute+Q+fever.">Real-time PCR with serum samples is indispensable for early diagnosis of acute Q fever.</a> Clin. Vaccine Immunol. 17 (2), 286-290 (2010).</li><li>Turra, M., Chang, G., Whybrow, D., Higgins, G., Qiao, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnosis+of+acute+Q+fever+by+PCR+on+sera+during+a+recent+outbreak+in+rural+South+Australia.">Diagnosis of acute Q fever by PCR on sera during a recent outbreak in rural South Australia.</a> Ann. N Y Acad. Sci. 1078, 566-569 (2006).</li><li>Notomi, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Loop-mediated+isothermal+amplification+of+DNA.">Loop-mediated isothermal amplification of DNA.</a> Nucleic Acids Res. 28 (12), (2000).</li><li>Paris, D. H., Blacksell, S. D., Newton, P. N., Day, N. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simple,+rapid+and+sensitive+detection+of+Orientia+tsutsugamushi.+by+loo-isothermal+DNA+amplification.">Simple, rapid and sensitive detection of Orientia tsutsugamushi. by loo-isothermal DNA amplification.</a> Trans. R. Soc. Trop. Med. Hyg. 102 (12), 1239-1246 (2008).</li><li>Huber, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Loop-mediated+isothermal+amplification+assay+targeting+the+47-kDa+gene+of+Orientia+tsutsugamushi.:+A+rapid+and+sensitive+alternative+to+real-time+PCR.">Loop-mediated isothermal amplification assay targeting the 47-kDa gene of Orientia tsutsugamushi.: A rapid and sensitive alternative to real-time PCR.</a> J. Med. Microb. Diagn. 1 (112), (2012).</li><li>Pan, L., Zhang, L., Wang, G., Liu, Q. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rapid,+sensitive+detection+of+the+ompB+gene+of+spotted+fever+group+rickettsiae+by+loop-mediated+isothermal+amplification.">Rapid, sensitive detection of the ompB gene of spotted fever group rickettsiae by loop-mediated isothermal amplification.</a> BMC Infect. Dis. 12 (254), (2012).</li><li>Mori, Y., Nagamine, K., Tomita, N., Notomi, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Detection+of+loop-mediated+isothermal+amplification+reaction+by+turbidity+derived+from+magnesium+pyrophosphate+formation.">Detection of loop-mediated isothermal amplification reaction by turbidity derived from magnesium pyrophosphate formation.</a> Biochem. Biophys. Res. Commun. 289 (1), 150-154 (2001).</li><li>Qiao, Y. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Loop-mediated+isothermal+amplification+for+rapid+detection+of+Bacillus+anthracis.spores.">Loop-mediated isothermal amplification for rapid detection of Bacillus anthracis.spores.</a> Biotechnol. Lett. 29 (12), 1939-1946 (2007).</li><li>Tomita, N., Mori, Y., Kanda, H., Notomi, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Loop-mediated+isothermal+amplification+(LAMP)+of+gene+sequences+and+simple+visual+detection+of+products.">Loop-mediated isothermal amplification (LAMP) of gene sequences and simple visual detection of products.</a> Nat. Protoc. 3 (5), 877-882 (2008).</li><li>Thekisoe, O. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stability+of+Loop-Mediated+Isothermal+Amplification+(LAMP)+reagents+and+its+amplification+efficiency+on+crude+trypanosome+DNA+templates.">Stability of Loop-Mediated Isothermal Amplification (LAMP) reagents and its amplification efficiency on crude trypanosome DNA templates.</a> J. Vet. Med. Sci. 71 (4), 471-475 (2009).</li><li>Chen, H. W., Ching, W. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+loop-mediated+isothermal+amplification+assays+for+rapid+and+easy+detection+of+Coxiella+Burnetii.">Development of loop-mediated isothermal amplification assays for rapid and easy detection of Coxiella Burnetii.</a> J. Microbiol Methods. 107, 176-181 (2014).</li><li>Wang, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Comparison+of+In-House+Real-Time+LAMP+Assays+with+a+Commercial+Assay+for+the+Detection+of+Pathogenic+Bacteria.">A Comparison of In-House Real-Time LAMP Assays with a Commercial Assay for the Detection of Pathogenic Bacteria.</a> Molecules. 20 (6), 9487-9495 (2015).</li></ol>

The authors have nothing to disclose.

Previously, we developed a sensitive and specific LAMP assay targeting the insertion element IS1111a14. The IS1111 element was selected because it is highly conserved among the different strains of C. burnetii and its high number of copies (7 to 110) in the bacteria (Klee 2006). Our results showed that LAMP can detect about 25 copies of the IS1111 element, which may correlate to as little as one chromosomal copy of Coxiella DNA. In this study, Bst DNA polymerase, LAMP primers, and dNTPs were lyophilized and packaged in a zipped aluminum foil bag. The sensitivity of these lyophilized reagents remains at 25 copies; similar to the freshly prepared reagents for at least one month when stored at RT. It is very important to make sure the aluminum foil bag is properly sealed before opening it. Do not use the tubes if the aluminum foil bag is not sealed or if it is damaged. This may cause the rehydration of the lyophilized reagents which leads to the loss of its reactivity. The other critical step is the re-suspension of the lyophilized reagents with reconstitution buffer. The LAMP reaction will not work properly with reagents that are not fully re-suspended. Because of the high salt concentrations of the reaction buffer and high viscosity of the trimethylglycine solution, they cannot be successfully lyophilized with Bst DNA polymerase, LAMP primers, and dNTPs. A special step is required to prepare the reconstitution buffer with those components. Potentially the LAMP reaction can be tested at low salt concentrations with low or no trimethylglycine. If there is a reaction condition that has the same detection sensitivity but with low salt and low trimethylglycine concentration, the lyophilized reagent only needs to be reconstituted with water. This will further simplify the reaction steps.
Recently, Wang et al.15 compared twelve in-house LAMP assays with the commercialized isothermal Master Mix kit and found the in-house assays have false-positive results. In our laboratory, we have developed several LAMP assays for the detection of different bacteria and have never found false-positive results in these in-house assays. Furthermore, in the beginning stages of the development of the LAMP method, the assays were tested with both in-house prepared master mix and commercialized master mix and no difference was observed in the assays&#39; sensitivity and specificity.
Our study also presents several methods that not only can detect the LAMP products without opening the reaction tubes to decrease the likelihood of laboratory cross contamination but also have a shorter process time to read results compare to gel electrophoresis method. The advantage of using these detection methods will greatly enhance our ability to quickly perform the assay and diagnose an individual with C. burnetii infection in resource-limited areas. This will allow rapid and appropriate treatment of acute Q fever and lessen the potential of future chronic infection.
Unlike PCR-based methods where a thermocycler is needed, a heating block, water bath or incubator maintaining a constant temperature around 60 &#176;C is all that is required for the LAMP assay. This makes the assay particularly suitable in resource-limited setting. Unlike the original LAMP assay, Bst DNA polymerase, LAMP primers, and dNTPs need to be stored at -20 &#176;C. These lyophilized reagents can be stored at room temperature which makes it even more useful for a resource-limited setting where Q fever is endemic. The long term stability study of the lyophilized reagents at 4 &#176;C, 25 &#176;C, and 37 &#176;C is currently ongoing. In the future, we would like to demonstrate that this LAMP assay using lyophilized reagents can detect C. burnetii with sensitivity similar to that of PCR in a remote setting.

The small Gram-negative bacterium Coxiella burnetii is the causative agent of Q fever, which is a worldwide zoonosis. Due to Q fever&#39;s worldwide distribution and the high infectivity of C. burnetii, US military and civilian personnel deployed overseas are at risk of being infected in the endemic areas.
Q fever manifests in two forms: acute and chronic infections. Acute Q-fever presents itself with flu-like symptoms, hepatitis, or pneumonia, and is usually a self-limiting disease with a low mortality rate. Chronic Q-fever, while less prevalent, often results in endocarditis, which has a much higher mortality rate if left untreated1,2. Therefore, early diagnosis to guide an appropriate treatment is critical for patient care. Polymerase chain reaction (PCR) and quantitative real time PCR (qPCR) assays have been developed for detecting C. burnetii DNA in cell cultures and clinical samples3-5. Both PCR and qPCR are costly and often not readily available in resource-constrained areas for routine work.
Originally described by Notomi6, loop-mediated isothermal amplification (LAMP) offers an alternative DNA amplification method. LAMP uses Bst DNA polymerase for strand displacement DNA synthesis along with specially designed primer sets that recognize at least six independent regions of the target gene. The most significant advantage of LAMP is that amplification occurs under isothermal conditions. Therefore, only a water bath, heating block or an incubator is required. This method has been used to detect several rickettsial pathogens7-9. Visualization of amplified DNA products by gel electrophoresis is the most accurate method which can differentiate true positives from false positives due to nonspecific amplification. However the procedures involved in gel electrophoresis are not practical for resource-limited areas. Several alternative methods were developed to detect the reaction products. These alternative, such as turbidity derived from magnesium pyrophosphate formation10 or using a fluorescent intercalating dye to be visualized under UV light11,12 are more favorable than running a gel. The LAMP reagents were stable for one month when stored at 25 &#176;C and 37 &#176;C, which are ambient temperatures in tropical and sub-tropical countries where Q fever is endemic13.
A LAMP assay was developed in our laboratory to detect the presence of C. burnetii in plasma samples14. Here we describe a simple protocol for the preparation of the LAMP reaction mixture from the lyophilized reagents. The lyophilized reagents are stable for one month when stored at RT. When combined with an easy visualization method, this is an ideal method to use for detecting C. burnetii in a resource-limited setting.

<table border="0" cellpadding="0" cellspacing="0" width="773">
	<tbody>
		<tr height="26">
			<td height="26" style="height:27px;width:215px;">LAMP primers</td>
			<td style="width:188px;">Eurofins MWG operon</td>
			<td style="width:131px;">10 nmol, salt free</td>
			<td style="width:240px;">Sequence designed by customer</td>
		</tr>
		<tr height="26">
			<td height="26" style="height:27px;width:215px;">Bst DNA polymerase</td>
			<td style="width:188px;">New England Biolabs</td>
			<td style="width:131px;">M0275L</td>
			<td style="width:240px;">8 units/ml</td>
		</tr>
		<tr height="26">
			<td height="26" style="height:27px;width:215px;">10X Thermo pol buffer</td>
			<td style="width:188px;">New England Biolabs</td>
			<td style="width:131px;">B9004S</td>
			<td style="width:240px;"></td>
		</tr>
		<tr height="26">
			<td height="26" style="height:27px;width:215px;">dNTP mixture</td>
			<td style="width:188px;">New England Biolabs</td>
			<td style="width:131px;">N0447L</td>
			<td style="width:240px;">10 mM each</td>
		</tr>
		<tr height="26">
			<td height="26" style="height:27px;width:215px;">Betaine</td>
			<td style="width:188px;">Sigma-Aldrich</td>
			<td style="width:131px;">B0300</td>
			<td style="width:240px;">5 M, Trimethylglycine</td>
		</tr>
		<tr height="26">
			<td height="26" style="height:27px;width:215px;">Magnesium Sulfate</td>
			<td style="width:188px;">Sigma-Aldrich</td>
			<td style="width:131px;">M3409-1ML</td>
			<td style="width:240px;">1 M</td>
		</tr>
		<tr height="26">
			<td height="26" style="height:27px;width:215px;">10X Bluejuice</td>
			<td style="width:188px;">Invitrogen</td>
			<td style="width:131px;">10816-015</td>
			<td style="width:240px;">gel loading buffer</td>
		</tr>
		<tr height="26">
			<td height="26" style="height:27px;width:215px;">SYBR green</td>
			<td style="width:188px;">Invitrogen</td>
			<td style="width:131px;">S7585</td>
			<td style="width:240px;">10,000X, visualize products in tubes</td>
		</tr>
		<tr height="26">
			<td height="26" style="height:27px;width:215px;">GelRed</td>
			<td style="width:188px;">Phenix Research Products</td>
			<td style="width:131px;">RGB-4103</td>
			<td style="width:240px;">10,000X, visualize products in gels</td>
		</tr>
		<tr height="26">
			<td height="26" style="height:27px;width:215px;">Lyophilized reagents</td>
			<td style="width:188px;">Gene Reach</td>
			<td style="width:131px;"></td>
			<td style="width:240px;"></td>
		</tr>
		<tr height="26">
			<td height="26" style="height:27px;width:215px;">Hydroxynaphthol blue</td>
			<td style="width:188px;">Fluka</td>
			<td style="width:131px;">33936-10G</td>
			<td style="width:240px;"></td>
		</tr>
		<tr height="26">
			<td height="26" style="height:27px;width:215px;">ESEQuant tube scanner</td>
			<td style="width:188px;">Qiagen</td>
			<td style="width:131px;"></td>
			<td style="width:240px;">real-time detection</td>
		</tr>
	</tbody>
</table>

the development of lyophilized loop-mediated isothermal amplification reagents for the detection of coxiella burnetii

Coxiella burnetii, the agent causing Q fever, is an obligate intracellular bacterium. PCR based diagnostic assays have been developed for detecting C. burnetii DNA in cell cultures and clinical samples. PCR requires specialized equipment and extensive end user training, and therefore, it is not suitable for routine work especially in a resource-constrained area. We have developed a loop-mediated isothermal amplification (LAMP) assay to detect the presence of C. burnetii in patient samples. This method is performed at a single temperature around 60 &#176;C in a water bath or heating block. The sensitivity of this LAMP assay is very similar to PCR with a detection limit of about 25 copies per reaction. This report describes the preparation of the reaction using lyophilized reagents and visualization of results using hydroxynaphthol blue (HNB) or a UV lamp with fluorescent intercalating dye in the reaction. The LAMP reagents were lyophilized and stored at room temperature (RT) for one month without loss of detection sensitivity. This LAMP assay is particularly robust because the reaction mixture preparation does not involve complex steps. This method is ideal for use in resource-limited settings where Q fever is endemic.

The lyophilized LAMP reagents inside the 0.2 ml tube contains Bst DNA polymerase, primers, and dNTPs. 20 &#181;l of reconstitution buffer is used to re-suspend the lyophilized reagents. Figure 1 shows the LAMP reaction results on agarose gels with freshly prepared reagents and lyophilized reagents. The lyophilized reagent does not reduce its activity. LAMP reactions prepared by both reagents can detect 25 copies of DNA template. Figure 2 shows the detection of the reaction products with HNB or fluorescent intercalating dye present in the reaction. Addition of HNB to the reaction produces a visual color change from purple to blue with 25, 50 and 100 copies of DNA template present in the reactions. The inclusion of fluorescent intercalating dye in the reaction shows a strong fluorescence signal with UV light when 25, 50, and 100 copies of DNA templates are present. A tube scanner was used in this study for real-time detection. This machine can perform 8 reactions simultaneously. Figure 3 shows using the tube scanner to monitor the fluorescence signals in real-time with fluorescent intercalating dye presence. The fluorescence signals are above baseline after 14, 18, 21, and 23 min with 106, 104, 103, and 100 copies of DNA template in the reactions.
<img alt="Figure 1" src="/files/ftp_upload/53839/53839fig1.jpg" /> 
Figure 1. LAMP Results on Agarose Gel with Freshly Prepared Reagents (A) and Lyophilized Reagents (B). Reaction mixtures were incubated at 60 &#176;C for 60 min. (A) Lane 1, 100 bp ladder; Lane 2 - 3, 4 - 5, 6 - 7 and 8 - 9 are reactions with 2.5 x 103, 2.5 x 102, 2.5 x 10, and no copies of plasmid DNA. (B) Lane 10 - 11, 12 - 13, 14 - 15, and 16 - 17 are reactions with 2.5 x 103, 2.5 x 102, 2.5 x 10, and 0 copies of plasmid DNA. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/53839/53839fig1large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 2" src="/files/ftp_upload/53839/53839fig2.jpg" /> 
Figure 2. Methods to Detect LAMP Products. HNB (A) or fluorescent intercalating dye (B) were used to detect LAMP products. Reactions were carried out at 60 &#176;C for 60 min. Lane 1 to 5, reactions with 0, 10, 25, 50, and 100 copies of plasmid. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/53839/53839fig2large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 3" src="/files/ftp_upload/53839/53839fig3.jpg" /> 
Figure 3. Real-time Detection of LAMP Products. Reactions were carried out at 60 &#176;C for 60 min. Reactions with 106 (black), 104 (red), 103 (green), 100 (yellow), 10 (blue), 1 (orange) and 0 (brown and light brown) copies of plasmid. Three detections were performed independently. They were highly reproducible. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/53839/53839fig3large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>

Watch this Scientific Journal Video about The Development of Lyophilized Loop-mediated Isothermal Amplification Reagents for the Detection of Coxiella burnetii at JoVE.com

The Development of Lyophilized Loop-mediated Isothermal Amplification Reagents for the Detection of Coxiella burnetii

We described here a simple loop-mediated isothermal amplification (LAMP) method using lyophilized reagents for the detection of C. burnetii in patient samples.

The Development of Lyophilized Loop-mediated Isothermal Amplification Reagents for the Detection of Coxiella burnetii

Coxiella burnetii, the agent causing Q fever, is an obligate intracellular bacterium. PCR based diagnostic assays have been developed for detecting C. ...

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10.4K Views.  Naval Medical Research Center. We described here a simple loop-mediated isothermal amplification (LAMP) method using lyophilized reagents for the detection of C. burnetii in patient samples.

Video: The Development of Lyophilized Loop-mediated Isothermal Amplification Reagents for the Detection of Coxiella burnetii

Detection of Infectious Virus from Field-collected Mosquitoes by Vero Cell Culture Assay

Mosquitoes transmit a number of distinct viruses including important human pathogens such as West Nile virus, dengue virus, and chickungunya virus. Many of these viruses have intensified in their endemic ranges and expanded to new territories, necessitating effective surveillance and control programs to respond to these threats. One strategy to monitor virus activity involves collecting large numbers of mosquitoes from endemic sites and testing them for viral infection. In this article, we describe how to handle, process, and screen field-collected mosquitoes for infectious virus by Vero cell culture assay. Mosquitoes are sorted by trap location and species, and grouped into pools containing &le;50 individuals. Pooled specimens are homogenized in buffered saline using a mixer-mill and the aqueous phase is inoculated onto confluent Vero cell cultures (Clone E6). Cell cultures are monitored for cytopathic effect from days 3-7 post-inoculation and any viruses grown in cell culture are identified by the appropriate diagnostic assays. By utilizing this approach, we have isolated 9 different viruses from mosquitoes collected in Connecticut, USA, and among these, 5 are known to cause human disease. Three of these viruses (West Nile virus, Potosi virus, and La Crosse virus) represent new records for North America or the New England region since 1999. The ability to detect a wide diversity of viruses is critical to monitoring both established and newly emerging viruses in the mosquito population.

We describe a method to process and screen field-collected mosquitoes for a diversity of viruses by Vero cell culture assay. By employing this technique, we have detected 9 different viruses from 4 taxonomic families in mosquitoes collected in Connecticut.

Mosquitoes transmit a number of distinct viruses including important human pathogens such as West Nile virus, dengue virus, and chickungunya virus. Many ...

Generation of Recombinant Arenavirus for Vaccine Development in FDA-Approved Vero Cells

The development and implementation of arenavirus reverse genetics represents a significant breakthrough in the arenavirus field 4. The use of cell-based arenavirus minigenome systems together with the ability to generate recombinant infectious arenaviruses with predetermined mutations in their genomes has facilitated the investigation of the contribution of viral determinants to the different steps of the arenavirus life cycle, as well as virus-host interactions and mechanisms of arenavirus pathogenesis 1, 3, 11 . In addition, the development of trisegmented arenaviruses has permitted the use of the arenavirus genome to express additional foreign genes of interest, thus opening the possibility of arenavirus-based vaccine vector applications 5 . Likewise, the development of single-cycle infectious arenaviruses capable of expressing reporter genes provides a new experimental tool to improve the safety of research involving highly pathogenic human arenaviruses 16 . The generation of recombinant arenaviruses using plasmid-based reverse genetics techniques has so far relied on the use of rodent cell lines 7,19 , which poses some barriers for the development of Food and Drug Administration (FDA)-licensed vaccine or vaccine vectors. To overcome this obstacle, we describe here the efficient generation of recombinant arenaviruses in FDA-approved Vero cells.

Rescue of recombinant arenaviruses from cloned cDNAs, an approach referred to as reverse genetics, allows researchers to investigate the role of specific viral gene products, as well as the contribution of their different specific domains and residues, to many different aspects of the biology of arenavirus. Likewise, reverse genetics techniques in FDA-approved cell lines (Vero) for vaccine development provides novel possibilities for the generation of effective and safe vaccines to combat human pathogenic arenaviruses.

The development and implementation of arenavirus reverse genetics represents a significant breakthrough in the arenavirus field  4. The use of cell-based ...

Assessing the Development of Murine Plasmacytoid Dendritic Cells in Peyer's Patches Using Adoptive Transfer of Hematopoietic Progenitors

This protocol details a method to analyze the ability of purified hematopoietic progenitors to generate plasmacytoid dendritic cells (pDC) in intestinal Peyer&#39;s patch (PP). Common dendritic cell progenitors (CDPs, lin- c-kitlo CD115+ Flt3+) were purified from the bone marrow of C57BL6 mice by FACS and transferred to recipient mice that lack a significant pDC population in PP; in this case, Ifnar-/- mice were used as the transfer recipients. In some mice, overexpression of the dendritic cell growth factor Flt3 ligand (Flt3L) was enforced prior to adoptive transfer of CDPs, using hydrodynamic gene transfer (HGT) of Flt3L-encoding plasmid. Flt3L overexpression expands DC populations originating from transferred (or endogenous) hematopoietic progenitors. At 7-10 days after progenitor transfer, pDCs that arise from the adoptively transferred progenitors were distinguished from recipient cells on the basis of CD45 marker expression, with pDCs from transferred CDPs being CD45.1+ and recipients being CD45.2+. The ability of transferred CDPs to contribute to the pDC population in PP and to respond to Flt3L was evaluated by flow cytometry of PP single cell suspensions from recipient mice. This method may be used to test whether other progenitor populations are capable of generating PP pDCs. In addition, this approach could be used to examine the role of factors that are predicted to affect pDC development in PP, by transferring progenitor subsets with an appropriate knockdown, knockout or overexpression of the putative developmental factor and/or by manipulating circulating cytokines via HGT. This method may also allow analysis of how PP pDCs affect the frequency or function of other immune subsets in PPs. A unique feature of this method is the use of Ifnar-/- mice, which show severely depleted PP pDCs relative to wild type animals, thus allowing reconstitution of PP pDCs in the absence of confounding effects from lethal irradiation.

This protocol describes experimental procedures to assess the differentiation of plasmacytoid dendritic cells in Peyer&#8217;s patch from common dendritic cell progenitors, using techniques involving FACS-mediated cell isolation, hydrodynamic gene transfer, and flow analysis of immune subsets in Peyer&#8217;s patch.

This protocol details a method to analyze the ability of purified hematopoietic progenitors to generate plasmacytoid dendritic cells (pDC) in intestinal ...

In Vitro Analysis of Myd88-mediated Cellular Immune Response to West Nile Virus Mutant Strain Infection

An attenuated West Nile virus (WNV), a nonstructural (NS) 4B-P38G mutant, induced higher innate cytokine and T cell responses than the wild-type WNV in mice. Recently, myeloid differentiation factor 88 (MyD88) signaling was shown to be important for initial T cell priming and memory T cell development during WNV NS4B-P38G mutant infection. In this study, two flow cytometry-based methods &#8211; an in vitro T cell priming assay and an intracellular cytokine staining (ICS) &#8211; were utilized to assess dendritic cells (DCs) and T cell functions. In the T cell priming assay, cell proliferation was analyzed by flow cytometry following co-culture of DCs from both groups of mice with carboxyfluorescein succinimidyl ester (CFSE) - labeled CD4+ T cells of OTII transgenic mice. This approach provided an accurate determination of the percentage of proliferating CD4+ T cells with significantly improved overall sensitivity than the traditional assays with radioactive reagents. A microcentrifuge tube system was used in both cell culture and cytokine staining procedures of the ICS protocol. Compared to the traditional tissue culture plate-based system, this modified procedure was easier to perform at biosafety level (BL) 3 facilities. Moreover, WNV- infected cells were treated with paraformaldehyde in both assays, which enabled further analysis outside BL3 facilities. Overall, these in vitro immunological assays can be used to efficiently assess cell-mediated immune responses during WNV infection.

In Vitro Analysis of Myd88-mediated Cellular Immune Response to West Nile Virus Mutant Strain Infection

Two flow cytometry-based methods &#8211; an in vitro T cell priming assay and intracellular cytokine staining were utilized to measure antigen presenting capacity of dendritic cells and antigen-specific T cell responses to a West Nile virus mutant infection in mice.

An attenuated West Nile virus (WNV), a nonstructural (NS) 4B-P38G mutant, induced higher innate cytokine and T cell responses than the wild-type WNV in ...

Development of an in vitro model system for studying the interaction of Equus caballus IgE with its high-affinity receptor Fc&#949;RI

The interaction of IgE with its high-affinity Fc receptor (Fc&#949;RI) followed by an antigenic challenge is the principal pathway in IgE mediated allergic reactions. As a consequence of the high affinity binding between IgE and Fc&#949;RI, along with the continuous production of IgE by B cells, allergies usually persist throughout life, with currently no permanent cure available. Horses, especially race horses, which are commonly inbred, are a species of mammals that are very prone to the development of hypersensitivity responses, which can seriously affect their performance. Physiological responses to allergic sensitization in horses mirror that observed in humans and dogs. In this paper we describe the development of an in situ assay system for the quantitative assessment of the release of mediators of the allergic response pertaining to the equine system. To this end, the gene encoding equine Fc&#949;RI&#945; was transfected into and expressed onto the surface of parental Rat Basophil Leukemia (RBL-2H3.1) cells. The gene product of the transfected equine &#945;-chain formed a functional receptor complex with the endogenous rat &#946;- and &#947;-chains 1. The resultant assay system facilitated an assessment of the quantity of mediator secreted from equine Fc&#949;RI&#945; transfected RBL-2H3.1 cells following sensitization with equine IgE and antigenic challenge using &#946;-hexosaminidase release as a readout 2, 3. Mediator release peaked at 36.68% &#177; 4.88% at 100 ng ml-1 of antigen. This assay was modified from previous assays used to study human and canine allergic responses 4, 5. We have also shown that this type of assay system has multiple applications for the development of diagnostic tools and the safety assessment of potential therapeutic intervention strategies in allergic disease 6, 2, 3.

The current study describes the development and applications of a genetically engineered assay system based on the transfection of rat basophilic leukemia cells with the equine Fc&#949;RI&#945; gene. Transfected cells express a functional receptor where the release of mediators of the allergic response can be activated by IgE and antigen.

The interaction of IgE with its high-affinity Fc receptor (Fc&#949;RI) followed by an antigenic challenge is the principal pathway in IgE mediated ...

Loop-mediated Isothermal Amplification (LAMP) Assays for the Species-specific Detection of Eimeria that Infect Chickens

Eimeria species parasites, protozoa which cause the enteric disease coccidiosis, pose a serious threat to the production and welfare of chickens. In the absence of effective control clinical coccidiosis can be devastating. Resistance to the chemoprophylactics frequently used to control Eimeria is common and sub-clinical infection is widespread, influencing feed conversion ratios and susceptibility to other pathogens such as Clostridium perfringens. Despite the availability of polymerase chain reaction (PCR)-based tools, diagnosis of Eimeria infection still relies almost entirely on traditional approaches such as lesion scoring and oocyst morphology, but neither is straightforward. Limitations of the existing molecular tools include the requirement for specialist equipment and difficulties accessing DNA as template. In response a simple field DNA preparation protocol and a panel of species-specific loop-mediated isothermal amplification (LAMP) assays have been developed for the seven Eimeria recognised to infect the chicken. We now provide a detailed protocol describing the preparation of genomic DNA from intestinal tissue collected post-mortem, followed by setup and readout of the LAMP assays. Eimeria species-specific LAMP can be used to monitor parasite occurrence, assessing the efficacy of a farm&#8217;s anticoccidial strategy, and to diagnose sub-clinical infection or clinical disease with particular value when expert surveillance is unavailable.

Loop-mediated Isothermal Amplification LAMP Assays for the Species-specific Detection of Eimeria that Infect Chickens

Diagnosis of Eimeria infection in chickens remains demanding. Parasite morphology- and host pathology-led approaches are commonly inconclusive, while molecular approaches based on PCR have proven demanding in cost and expertise. The aim of this protocol is to establish loop-mediated isothermal amplification (LAMP) as a straightforward molecular diagnostic for eimerian infection.

Eimeria species parasites, protozoa which cause the enteric disease coccidiosis, pose a serious threat to the production and welfare of chickens. In the ...

Generation and Multi-phenotypic High-content Screening of Coxiella burnetii Transposon Mutants

Invasion and colonization of host cells by bacterial pathogens depend on the activity of a large number of prokaryotic proteins, defined as virulence factors, which can subvert and manipulate key host functions. The study of host/pathogen interactions is therefore extremely important to understand bacterial infections and develop alternative strategies to counter infectious diseases. This approach however, requires the development of new high-throughput assays for the unbiased, automated identification and characterization of bacterial virulence determinants. Here, we describe a method for the generation of a GFP-tagged mutant library by transposon mutagenesis and the development of high-content screening approaches for the simultaneous identification of multiple transposon-associated phenotypes. Our working model is the intracellular bacterial pathogen Coxiellaburnetii, the etiological agent of the zoonosis Q fever, which is associated with severe outbreaks with a consequent health and economic burden. The obligate intracellular nature of this pathogen has, until recently, severely hampered the identification of bacterial factors involved in host pathogen interactions, making of Coxiella the ideal model for the implementation of high-throughput/high-content approaches.

Generation and Multi-phenotypic High-content Screening of Coxiella burnetii Transposon Mutants

Coxiella burnetii is an obligate intracellular Gram-negative bacterium responsible for the zoonotic disease Q fever. Here we describe methods for the generation of Coxiella fluorescent transposon mutants as well as the automated identification and analysis of the resulting internalization, replication and cytotoxic phenotypes.

Invasion and colonization of host cells by bacterial pathogens depend on the activity of a large number of prokaryotic proteins, defined as virulence ...

Qualitative and Quantitative Assays for Detection and Characterization of Protein Antimicrobials

Initial evaluations of large microbial libraries for potential producers of novel antimicrobial proteins require both qualitative and quantitative methods to screen for target enzymes prior to investing greater research effort and resources. The goal of this protocol is to demonstrate two complementary assays for conducting these initial evaluations. The microslide diffusion assay provides an initial or simple detection screen to enable the qualitative and rapid assessment of proteolytic activity against an array of both viable and heat-killed bacterial target substrates. As a counterpart, the increased sensitivity and reproducibility of the dye-release assay provides a quantitative platform for evaluating and comparing environmental influences affecting the hydrolytic activity of protein antimicrobials. The ability to label specific heat-killed cell culture substrates with Remazol brilliant blue R dye expands this capability to tailor the dye-release assay to characterize enzymatic activity of interest.

Here, we present protocols to rapidly screen and characterize enzymes for antimicrobial activity. The microslide diffusion assay and the dye-release assay utilize target bacterial substrates for qualitative and quantitative enzymatic activity evaluation.

Initial evaluations of large microbial libraries for potential producers of novel antimicrobial proteins require both qualitative and quantitative methods ...

Applying Fluorescence Resonance Energy Transfer (FRET) to Examine Effector Translocation Efficiency by Coxiella burnetii during siRNA Silencing

Coxiella burnetii, the causative agent of Q fever, is an intracellular pathogen that relies on a Type IV Dot/Icm Secretion System to establish a replicative niche. A cohort of effectors are translocated through this system into the host cell to manipulate host processes and allow the establishment of a unique lysosome-derived vacuole for replication. The method presented here involves the combination of two well-established techniques: specific gene silencing using siRNA and measurement of effector translocation using a FRET-based substrate that relies on &#946;-lactamase activity. Applying these two approaches, we can begin to understand the role of host factors in bacterial secretion system function and effector translocation. In this study we examined the role of Rab5A and Rab7A, both important regulators of the endocytic trafficking pathway. We demonstrate that silencing the expression of either protein results in a decrease in effector translocation efficiency. These methods can be easily modified to examine other intracellular and extracellular pathogens that also utilize secretion systems. In this way, a global picture of host factors involved in bacterial effector translocation may be revealed.

Applying Fluorescence Resonance Energy Transfer FRET to Examine Effector Translocation Efficiency by Coxiella burnetii during siRNA Silencing

Investigating the interactions between bacterial pathogens and their hosts is an important area of biological research. Here, we describe the necessary techniques to measure effector translocation by Coxiella burnetii during siRNA gene silencing using BlaM substrate.

Coxiella burnetii, the causative agent of Q fever, is an intracellular pathogen that relies on a Type IV Dot/Icm Secretion System to establish a ...

Development of a More Sensitive and Specific Chromogenic Agar Medium for the Detection of Vibrio parahaemolyticus and Other Vibrio Species

Foodborne infections in the US caused by Vibrio species have shown an upward trend. In the genus Vibrio, V. parahaemolyticus is responsible for the majority of Vibrio-associated infections. Thus, accurate differentiation among Vibrio spp. and detection of V. parahaemolyticus is critically important to ensure the safety of our food supply. Although molecular techniques are increasingly common, culture-depending methods are still routinely done and they are considered standard methods in certain circumstances. Hence, a novel chromogenic agar medium was tested with the goal of providing a better method for isolation and differentiation of clinically relevant Vibrio spp. The protocol compared the sensitivity, specificity and detection limit for the detection of V. parahaemolyticus between the new chromogenic medium and a conventional medium. Various V. parahaemolyticus strains (n=22) representing diverse serotypes and source of origins were used. They were previously identified by Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC), and further verified in our laboratory by tlh-PCR. In at least four separate trials, these strains were inoculated on the chromogenic agar and thiosulfate-citrate-bile salts-sucrose (TCBS) agar, which is the recommended medium for culturing this species, followed by incubation at 35-37 &#176;C for 24-96 hr. Three V. parahaemolyticus strains (13.6%) did not grow optimally on TCBS, nonetheless exhibited green colonies if there was growth. Two strains (9.1%) did not yield the expected cyan colonies on the chromogenic agar. Non-V. parahaemolyticus strains (n=32) were also tested to determine the specificity of the chromogenic agar. Among these strains, 31 did not grow or exhibited other colony morphologies. The mean recovery of V. parahaemolyticus on the chromogenic agar was ~96.4% relative to tryptic soy agar supplemented with 2% NaCl. In conclusion, the new chromogenic agar is an effective medium to detect V. parahaemolyticus and to differentiate it from other vibrios.

Development of a More Sensitive and Specific Chromogenic Agar Medium for the Detection of Vibrio parahaemolyticus and Other Vibrio Species

Detection and isolation of clinically relevant Vibrio species require selective and differential culture media. This study evaluated the ability of a new chromogenic medium to detect and identify V. parahaemolyticus and other related species. The new medium was found to have better sensitivity and specificity than the conventional medium.

Foodborne infections in the US caused by Vibrio species have shown an upward trend. In the genus Vibrio, V. parahaemolyticus is responsible for the ...