Molecular diagnosis : a journal devoted to the understanding of human disease through the clinical application of molecular biology最新文献

Human parvovirus B19 is the cause of a common childhood disease that usually has a mild and self-limited course. Complete viral replication and subsequent cell lysis are limited to early erythroid precursor cells expressing the globoside receptor. Individuals with shortened red blood cell half-lives and immunocompromised or immunosuppressed patients, as well as pregnant women and developing fetuses, are at risk for severe anemia and/or persistent infection from human parvovirus B19. Selection of the diagnostic test(s) to use to detect parvovirus B19 is patient dependent. Serological testing is most appropriate in immunocompetent individuals, including children and pregnant women, who have symptoms consistent with parvovirus B19 infection or a history of recent exposure. Conversely, a molecular amplification assay should be chosen to detect parvovirus B19 DNA in individuals lacking an adequate antibody-mediated immune response. In summary, it is critical that clinicians are educated about the most appropriate diagnostic test to detect parvovirus B19 infection in their patients because selecting an inappropriate or inaccurate test for parvovirus B19 can lead to misinformation and/or misdiagnosis.

Viral resistance to antiretroviral agents may limit the efficacy of current treatment regimens for HIV-1 infection. The mutational patterns underlying resistance to each antiretroviral agent are often quite diverse, and cross-resistance patterns in each of the currently available classes are complex. Current methods for determining drug resistance include genotypic and phenotypic assays, and each has advantages and limitations. Prospective clinical trials assessing the utility of HIV-1 drug resistance testing have shown significant but modest improvement in virologic outcomes with genotypic assays. Some, but not all, trials of phenotypic resistance testing have demonstrated improved virologic outcomes. Resistance testing is currently recommended for patients who have virologic failure or have no response to an antiretroviral regimen, and for pregnant women. Testing should also be considered in treatment-naive patients in areas of high prevalence of transmitted drug-resistant virus.

Ten years ago, laboratory directors introducing molecular infectious disease diagnostics in the routine clinical setting had few resources to assist in their implementation and quality assurance programs. In the past 10 years, several organizations have recognized this need and have established standard reference materials, controls, external quality assessment programs, and written guidelines. It is a challenge for the clinical laboratory scientist to evaluate and incorporate these new programs and services in the context of traditional good laboratory practice and current laboratory regulations. This article presents many of the options available for control materials, proficiency programs, standard reference materials, and written guidelines. It shows where harmonization of new practice with long-standing convention and regulation is progressing and where questions remain.

For many years, sequencing of the 16S ribosomal RNA (rRNA) gene has served as an important tool for determining phylogenetic relationships between bacteria. The features of this molecular target that make it a useful phylogenetic tool also make it useful for bacterial detection and identification in the clinical laboratory. Sequence analysis of the 16S rRNA gene is a powerful mechanism for identifying new pathogens in patients with suspected bacterial disease, and more recently this technology is being applied in the clinical laboratory for routine identification of bacterial isolates. Several studies have shown that sequence identification is useful for slow-growing, unusual, and fastidious bacteria as well as for bacteria that are poorly differentiated by conventional methods. The technical resources necessary for sequence identification are significant. This method requires reagents and instrumentation for amplification and sequencing, a database of known sequences, and software for sequence editing and database comparison. Commercial reagents are available, and laboratory-developed assays for amplification and sequencing have been reported. Likewise, there are an increasing number of commercial and public databases. Despite the availability of resources, sequence-based identification is still relatively expensive. The cost is significantly reduced only by the introduction of more automated methods. As the cost decreases, this technology is likely to be more widely applied in the clinical setting.

Influenza viruses continually circulate and cause yearly epidemics, which kill 20,000 people in an average year in the United States. Occasionally and unpredictably, pandemic influenza strains sweep the world, infecting 20% to 40% of the world's population in a single year. In 1918, the worst influenza pandemic on record caused 675,000 deaths in the United States and up to 40 million deaths worldwide. Despite the prevalence of this virus, molecular assays for influenza diagnosis, surveillance, vaccine strain selection, and research have lagged behind such assays for other common viral pathogens. The extreme genetic variability of influenza viruses makes the design of useful molecular-based assays challenging, but several different approaches have been successfully used. RT-PCR is effective for the initial diagnosis and has greater sensitivity than other available rapid assays. Molecular assays also can be used to subtype influenza isolates, and sequence analysis of hemagglutinin may assist greatly in surveillance studies and vaccine strain selection. RT-PCR for influenza also can be performed from tissue biopsy specimens for both retrospective diagnosis and research.

Background: Cytomegalovirus (CMV) causes life-threatening infections in immunocompromised patients, especially those with acquired immunodeficiency or organ transplants. Therefore, early detection of CMV is important to guide the clinical management of actively infected patients. Because detection of replicative transcripts indicates that the virus is in the process of being replicated in the infected cell, we applied a novel, sensitive, ligation-dependent (LD)-PCR method to detect CMV immediate-early (IE) messenger RNA (mRNA), an indicator of viral replication. Methods and Results: Viral mRNAs were released from infected cells by incubation in 5 M guanidinium thiocyanate, and IE mRNAs were captured onto magnetic beads through oligo(dT) capture probes. Two hemiprobes, each containing an IE mRNA[ndash ]complementary region and a region for PCR primer binding, were captured by binding to the IE mRNA. These hemiprobes, bound on an IE mRNA in juxtaposition to one another, were linked together by a DNA ligase to form a full probe that served as the template for PCR amplification. This approach detected IE mRNAs in CMV-propagating cells, but not in supernatants containing only viral DNAs. Thirty-one clinical specimens were tested by LD-PCR; 18 specimens were positive (ten specimens, bronchoalveolar lavage [BAL]; five specimens, urine; two specimens, blood; one specimen, biopsy), 17 of which were confirmed by culture. Three culture-positive samples (two specimens, urine; one specimen, BAL) were missed by LD-PCR, and one urine sample was positive by LD-PCR but negative by culture. Conclusion: LD-PCR assay is a reliable test for the early diagnosis of active CMV infection in patient specimens.

Background: A method that provides standardized data and is relatively inexpensive and capable of high throughput is a prerequisite to the development of a meaningful gene expression database suitable for conducting multi-institutional clinical studies based on expression measurement. Standardized RT (StaRT)-PCR has all these characteristics. In addition, the method must be reproducible. StaRT-PCR has high intralaboratory reproducibility. The purpose of this study is to determine whether StaRT-PCR provides similar interlaboratory reproducibility. Methods and Results: In a blinded interlaboratory study, expression of ten genes was measured by StaRT-PCR in a complementary DNA sample provided to each of four laboratories. The average coefficient of variation for interlaboratory comparison of the nine quantifiable genes was 0.48. In all laboratories, expression of one of the genes was too low to be measured. Conclusion: Because StaRT-PCR data are standardized and numerical and the method is reproducible among multiple laboratories, it will allow development of a meaningful gene expression database.

Epstein-Barr virus (EBV) is associated with a wide variety of benign and neoplastic diseases. EBV viral load assays that may prove useful in rapid assessment of disease status are now available. The two most common approaches to viral load measurement are quantitative, competitive PCR, and real-time PCR. Laboratory studies have shown that these assays are sensitive and specific for measuring EBV DNA in blood samples. Clinical investigations suggest a role for viral load measurement in predicting and monitoring EBV-associated tumors, including nasopharyngeal carcinoma, post-transplant lymphoproliferative disorder, Hodgkin's disease, and AIDS-related lymphoma. These new laboratory tools show promise in improving clinical management of affected patients.