Amplification-Free COVID-19 Detection by Digital Droplet REVEALR

Revealr-Based Diagnostic Panel for Rapid Detection of Acute Respiratory Infections

RNA-encoded viral nucleic acid analyte reporter (REVEALR) is a rapid and highly sensitive point-of-care diagnostic developed for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection, genotyping, and quantification. Here, we extend the breadth of this nucleic acid technology to include a viral respiratory panel that can detect low attomolar levels of influenza A (IAV), influenza B (IBV), SARS-CoV-2 (CoV2), and the respiratory syncytial virus (RSV). Of 39 clinical samples collected at the UCI Medical Center in Orange, California, the extended REVEALR panel showed a positive predictive agreement and negative predictive agreement of 100% for IAV, CoV2, and RSV in sequence-verified clinical samples, with 0 false positive results. Additionally, REVEALR was able to detect a synthetic IBV genome and precisely identify the viruses from clinical samples that were combined to simulate a patient infected with more than one virus. Together, these results demonstrate that the REVEALR respiratory panel provides a valuable diagnostic for identifying the pathogens responsible for causing lower respiratory infections that pose serious healthcare challenges in the United States.

PACRAT: pathogen detection with aptamer-observed cascaded recombinase polymerase amplification-in vitro transcription

The SARS-CoV-2 pandemic underscored the need for early, rapid, and widespread pathogen detection tests that are readily accessible. Many existing rapid isothermal detection methods use the recombinase polymerase amplification (RPA), which exhibits polymerase chain reaction (PCR)-like sensitivity, specificity, and even higher speed. However, coupling RPA to other enzymatic reactions has proven difficult. For the first time, we demonstrate that with tuning of buffer conditions and optimization of reagent concentrations, RPA can be cascaded into an in vitro transcription reaction, enabling detection using fluorescent aptamers in a one-pot reaction. We show that this reaction, which we term PACRAT (pathogen detection with aptamer-observed cascaded recombinase polymerase amplification-in vitro transcription) can be used to detect SARS-CoV-2 RNA with single-copy detection limits, Escherichia coli with single-cell detection limits, and 10-min detection times. Further demonstrating the utility of our one-pot, cascaded amplification system, we show PACRAT can be used for multiplexed detection of the pathogens SARS-CoV-2 and E. coli, along with multiplexed detection of two variants of SARS-CoV-2.

Engineering Gene-Specific DNAzymes for Accessible and Multiplexed Nucleic Acid Testing

The accurate and timely detection of disease biomarkers at the point-of-care is essential to ensuring effective treatment and epidemiological surveillance. Here, we report the selection and engineering of RNA-cleaving DNAzymes that respond to specific genetic markers and amplify detection signals. Because the target-specific activation of gene-specific DNAzymes (gDz) is like the trans-cleavage activity of clustered regularly interspaced short palindromic repeats (CRISPR) CRISPR-associated (Cas) machinery, we further developed a CRISPR-like assay using RNA-cleaving DNAzyme coupled with isothermal sequence and signal amplification (CLARISSA) for nucleic acid detection in clinical samples. Building on the high sequence specificity and orthogonality of gDzs, CLARISSA is highly versatile and expandable for multiplex testing. Upon integration with an isothermal recombinase polymerase amplification, CLARISSA enabled the detection of human papillomavirus (HPV) 16 in 189 cervical samples collected from cervical cancer screening participants (n = 189) with 100% sensitivity and 97.4% specificity, respectively. A multiplexed CLARISSA further allowed the simultaneous analyses of HPV16 and HPV18 in 46 cervical samples, which returned clinical sensitivity of 96.3% for HPV16 and 83.3% for HPV18, respectively. No false positives were found throughout our tests. Besides the fluorescence readout using fluorogenic reporter probes, CLARISSA is also demonstrated to be fully compatible with a visual lateral flow readout. Because of the high sensitivity, accessibility, and multiplexity, we believe CLARISSA is an ideal CRISPR-Dx alternative for clinical diagnosis in field-based and point-of-care applications.