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ComparisonofP1and16SrRNAgenesfordetectionofMycoplasmapneumoniaebyoptimizednestedPCRinadultpatientsinZhejiang,China1ComparisonofP1and16SrRNAgMycoplasmapneumoniaeisafrequentcauseofcommunity-acquiredpneumoniafor10-40%inchildrenandadults.BecauseofthetreatmentofM.pneumoniainfectionwithβ-lactamantibioticsisineffectiveandtheclinicalmanifestationsofM.pneumoniaeinfectionarecomplicatedandnonspecific,soarapid,sensitiveandspecificlaboratorytestisvitalforearlydiagnosisofM.pneumoniaeinfection.ConventionaltestsfordetectingM.pneumoniaehavetheirlimitations.Introduction2MycoplasmapneumoniaeisafreIntroduction
SeveralPCR-relatedmethodsprovideenhancedsensitivityandhavebeensuccessfullyappliedforresearchpurposessuchasnestedPCR.TheP1adhesiongeneandthe16SrRNAgenehavebeenutilizedwidelyinPCRtechniquesasthetargetsfordetectionofM.pneumoniae.Inthisstudy,wesoughttoidentifythemoresensitiveandspecifictarget(P1or16SrRNA)inM.pneumoniaedetectionandtoevaluatetheuseofnestedPCRforthediagnosisofMPinfectionfrompatientsinwhomM.pneumoniaewassuspected.3Introduction
SeveralPCR-relatMaterialsandmethodsStrainsandclinicalsamplesDNApreparationOrthogonalarraydesignOptimizationofsinglefactorconditionsNestedPCRsensitivitytestDetectionofclinicalsamples4MaterialsandmethodsStrainsaOrthogonalarraydesign
Table1NestedPCRfactorsandtheirlevelsfororthogonalprojects(Theannealingtemperatureof16SrRNAgeneisexpressedinthebrackets)5Orthogonalarraydesign
TableOrthogonalarraydesign
Table2OrthogonalarraydesignfornestedPCR(Theannealingtemperatureof16SrRNAgeneisexpressedinthebrackets)
6Orthogonalarraydesign
TableFigure1:ElectrophoresisanalysisofvariednestedPCRproductsofMycoplasmapneumoniaeFHwiththetargetoftheP1adhesion(16SrRNA)gene.M1234567
8
9100bp→150bp→←107bpM123456789144bp150bp→P1gene16SrRNA7Figure1:ElectrophoresisanalSinglefactorexperiment
Atlast,wedeterminedthefinaloptimalnestedPCRreactionconditions:FortheP1gene,theoptimalcombinationofMg2+concentration3mM,primerconcentration0.3uM,annealingtemperature60℃,thefirstroundPCRproduct50-folddilution;Forthe16Sgene,themostexcellentcombinationofMg2+concentration3mM,primerconcentration0.3uM,annealingtemperature56℃,thefirstroundPCRproduct50-folddilution.P1gene16SrRNA8SinglefactorexperimentAtlaNestedPCRsensitivitytestsensitivitiesofnestedPCRforM.pneumoniae:LaneM:DNAmarker.Lane1:20ngofM.pneumoniaeFHstrain;Lane2:10ng;Lane3:10-1ng;Lane4:10-2ng;Lane5:10-3ng;Lane6:10-4ng;Lane7:10-5ng;Lane8:10-6ng;Lane9:negativecontrol.M123456789P1gene:1pg12345678912345678916SrRNA;0.1pg9NestedPCRsensitivitytestsenDetectionofclinicalsamplesP1adhesiongene:(25/55;43.6%)10DetectionofclinicalsamplesPDetectionofclinicalsamples16SrRNAgene(30/55;56.3%)11Detectionofclinicalsamples1discussionWiththedevelopmentofmolecularbiologytechniques,PCRtechnologyhasbecomethemostvaluablemethodforrapiddiagnosisofMycoplasmapneumoniaeinfection.BothP1adhesiongeneand16SrRNAgenearewidelyusedastargetsfordetectionofM.pneumoniaebyPCR.However,itisstillinconclusiveforwhichtargetisbetterandoureffortistofindthemostsuitableone.Inthisstudy,wejointedorthogonalexperimentandsinglefactorteststooptimizeseveralcrucialconditionsofnestedPCRandfinallyconcludedtheoptimumreactionconditionsofthetwotargets.Thenwedetectedthesensitivityofthetwotargetsonthebasisoftheoptimalconditionsandtheresultsshowedthatthe16SrRNAgeneismoresensitivethantheP1adhesiongene.Wealsopresentedastudybyusingclinicalspecimensfromadultpatientsandfoundthat16SrRNAgenehasahigherpositiveratethantheP1adhesiongene.Sothe16SrRNAgeneisthemostexcellenttargetfordetectionofM.pneumoniaebynestedPCR.12discussionWiththedevelopmentdiscussionInthisstudy,weadoptednestedPCRtocomparethetwotargets.ThesuperiorsensitivityisthemajoradvantageofnestedPCR.ThesensitivitycanbeincreasedbynestedPCRbecauseitinvolvesthereamplificationofaPCRproductwithasecondprimerset.NestedPCRmayleadtoa103-foldincreaseinsensitivitythansingle-stepPCR,asnestedPCRenablesthedetectionof1-100fgofDNA,andsingle-stepPCRassayscanonlydetect10-100pgofDNA.Abele-Hornetal.candetect30-100fgofM.pneumoniaeDNAbynestedPCR,andthesensitivityis103-foldbetterthanthatforsingle-stepPCRandexceedsthatforantigencaptureenzymeimmunoassayandcultureby104-to105-fold.13discussionInthisstudy,weaddiscussionAlthoughnestedPCRisarapidandsensitivemethodforearlydiagnosisofM.pneumoniaeinfection,theimpactofnestedPCRreactionconditionsisnumerousanditistime-consumingtofindtheoptimalcondition.Whatismore,onlyonthebasisoftheoptimumconditionscanobtainamoreaccurateandobjectiveresults.SoweadoptedtheorthogonalarraydesigntooptimizeseveralcrucialfactorsaffectingthenestedPCRusing
thestandardstrainofM.pneumoniae,sinceorthogonaltestdesigncangreatlyshortenthetestnumberandcanquicklyarriveatamoreappropriatereactioncondition.Thenwealsoutilized
acompletelysinglefactortestdesignbasedontheresultsoftheorthogonaldesign.Atlast,thefinaloptimalreactionconditionsofnestedPCRaredeterminedbyintegratedtheresultsofthemethodsabove,sothecomparisonoftheP1adhesiongeneandthe16SrRNAgeneprimersunderthisoptimalconditioncanbemoreobjectivethanthatofotherlaboratories.14discussionAlthoughnestedPCRdiscussionInourstudy,OrthogonalarraydesignwasadoptedtooptimizefourcommonfactorsaffectingthenestedPCR,whichweretheconcentrationofprimersandMg2+,dilutionmultipleofthefirstroundPCRproduct,annealingtemperature.AllofthemarethecriticalelementintheperformanceofnestedPCR.Firstly,throughthetestwefoundthatexcessivelylowprimerconcentrationcanreducePCRyieldandexcessivelyhighprimerconcentrationincreasetheprobabilityofmisprimingandgenerationsofnon-specificPCRproducts.Secondly,formourexperiments,IfMg2+concentrationwastoolow,theyieldofPCRproductcouldbereduced,sinceTapDNApolymerasesareMg2+-dependentenzymeanditissensitivetotheconcentrationofMg2+.Thirdly,
ourresultsshowsthatpoorspecificityofamplifiedbandappearsatlowannealingtemperature,andweakenedamplifiedbandsathighannealingtemperature.ForthespecificityofPCRmainlydependsonannealingtemperatureandimprovetheannealingtemperaturewithinacertainrangecanincreasethespecificityofthePCRreaction.Lastly,wealsofoundthatalotofnon-specificbandsappearifnotdilution,thatwasprobablybecausethetemplateconcentrationofsecondroundofPCRisexcessivelyhigh.15discussionInourstudy,OrthogdiscussionAccordingtoourresultsfromclinicaltest,16SrRNAgeneprovedclearlytobethebesttargetforthispurpose,yieldingapositivePCRresultin56.3%ofcases,whilethepositiveratewas43.6%fortheP1adhesiongene.TheresultsalsoshowedthattherewasanexcellentcorrespondenceofpositivesubjectsdetectedbytheP1adhesiongeneand16SrRNAgeneprimers,andthecoincidencerateofthetwogeneprimerscanreach76.4%(42/55),forbothP1adhesiongeneand16SrRNAgeneweretheidealtargetsforPCRasbothofthemwerethehighlyconservativerepetitivesequence.ThemajordifficultiesfortheinterpretationofthePCRdatewerethediscordantresult,ninepatientswerepositivebythe16SrRNAgeneprimersbutnegativebytheP1adhesiongeneprimersandfourpatientswerepositivebytheP1adhesiongenebutnegativebythe16SrRNAones.Theformermainlybecausethe16SrRNAgeneprimersaremoresensitivethantheP1adhesiongene,asitcanbeprovedbythesensitivetestweaccomplishedbefore.ThelatterpossiblyduetotheP1adhesiongeneprimersarelessspecificthanthatof16SrRNAones.16discussionAccordingtoourresComparisonofP1and16SrRNAgenesfordetectionofMycoplasmapneumoniaebyoptimizednestedPCRinadultpatientsinZhejiang,China17ComparisonofP1and16SrRNAgMycoplasmapneumoniaeisafrequentcauseofcommunity-acquiredpneumoniafor10-40%inchildrenandadults.BecauseofthetreatmentofM.pneumoniainfectionwithβ-lactamantibioticsisineffectiveandtheclinicalmanifestationsofM.pneumoniaeinfectionarecomplicatedandnonspecific,soarapid,sensitiveandspecificlaboratorytestisvitalforearlydiagnosisofM.pneumoniaeinfection.ConventionaltestsfordetectingM.pneumoniaehavetheirlimitations.Introduction18MycoplasmapneumoniaeisafreIntroduction
SeveralPCR-relatedmethodsprovideenhancedsensitivityandhavebeensuccessfullyappliedforresearchpurposessuchasnestedPCR.TheP1adhesiongeneandthe16SrRNAgenehavebeenutilizedwidelyinPCRtechniquesasthetargetsfordetectionofM.pneumoniae.Inthisstudy,wesoughttoidentifythemoresensitiveandspecifictarget(P1or16SrRNA)inM.pneumoniaedetectionandtoevaluatetheuseofnestedPCRforthediagnosisofMPinfectionfrompatientsinwhomM.pneumoniaewassuspected.19Introduction
SeveralPCR-relatMaterialsandmethodsStrainsandclinicalsamplesDNApreparationOrthogonalarraydesignOptimizationofsinglefactorconditionsNestedPCRsensitivitytestDetectionofclinicalsamples20MaterialsandmethodsStrainsaOrthogonalarraydesign
Table1NestedPCRfactorsandtheirlevelsfororthogonalprojects(Theannealingtemperatureof16SrRNAgeneisexpressedinthebrackets)21Orthogonalarraydesign
TableOrthogonalarraydesign
Table2OrthogonalarraydesignfornestedPCR(Theannealingtemperatureof16SrRNAgeneisexpressedinthebrackets)
22Orthogonalarraydesign
TableFigure1:ElectrophoresisanalysisofvariednestedPCRproductsofMycoplasmapneumoniaeFHwiththetargetoftheP1adhesion(16SrRNA)gene.M1234567
8
9100bp→150bp→←107bpM123456789144bp150bp→P1gene16SrRNA23Figure1:ElectrophoresisanalSinglefactorexperiment
Atlast,wedeterminedthefinaloptimalnestedPCRreactionconditions:FortheP1gene,theoptimalcombinationofMg2+concentration3mM,primerconcentration0.3uM,annealingtemperature60℃,thefirstroundPCRproduct50-folddilution;Forthe16Sgene,themostexcellentcombinationofMg2+concentration3mM,primerconcentration0.3uM,annealingtemperature56℃,thefirstroundPCRproduct50-folddilution.P1gene16SrRNA24SinglefactorexperimentAtlaNestedPCRsensitivitytestsensitivitiesofnestedPCRforM.pneumoniae:LaneM:DNAmarker.Lane1:20ngofM.pneumoniaeFHstrain;Lane2:10ng;Lane3:10-1ng;Lane4:10-2ng;Lane5:10-3ng;Lane6:10-4ng;Lane7:10-5ng;Lane8:10-6ng;Lane9:negativecontrol.M123456789P1gene:1pg12345678912345678916SrRNA;0.1pg25NestedPCRsensitivitytestsenDetectionofclinicalsamplesP1adhesiongene:(25/55;43.6%)26DetectionofclinicalsamplesPDetectionofclinicalsamples16SrRNAgene(30/55;56.3%)27Detectionofclinicalsamples1discussionWiththedevelopmentofmolecularbiologytechniques,PCRtechnologyhasbecomethemostvaluablemethodforrapiddiagnosisofMycoplasmapneumoniaeinfection.BothP1adhesiongeneand16SrRNAgenearewidelyusedastargetsfordetectionofM.pneumoniaebyPCR.However,itisstillinconclusiveforwhichtargetisbetterandoureffortistofindthemostsuitableone.Inthisstudy,wejointedorthogonalexperimentandsinglefactorteststooptimizeseveralcrucialconditionsofnestedPCRandfinallyconcludedtheoptimumreactionconditionsofthetwotargets.Thenwedetectedthesensitivityofthetwotargetsonthebasisoftheoptimalconditionsandtheresultsshowedthatthe16SrRNAgeneismoresensitivethantheP1adhesiongene.Wealsopresentedastudybyusingclinicalspecimensfromadultpatientsandfoundthat16SrRNAgenehasahigherpositiveratethantheP1adhesiongene.Sothe16SrRNAgeneisthemostexcellenttargetfordetectionofM.pneumoniaebynestedPCR.28discussionWiththedevelopmentdiscussionInthisstudy,weadoptednestedPCRtocomparethetwotargets.ThesuperiorsensitivityisthemajoradvantageofnestedPCR.ThesensitivitycanbeincreasedbynestedPCRbecauseitinvolvesthereamplificationofaPCRproductwithasecondprimerset.NestedPCRmayleadtoa103-foldincreaseinsensitivitythansingle-stepPCR,asnestedPCRenablesthedetectionof1-100fgofDNA,andsingle-stepPCRassayscanonlydetect10-100pgofDNA.Abele-Hornetal.candetect30-100fgofM.pneumoniaeDNAbynestedPCR,andthesensitivityis103-foldbetterthanthatforsingle-stepPCRandexceedsthatforantigencaptureenzymeimmunoassayandcultureby104-to105-fold.29discussionInthisstudy,weaddiscussionAlthoughnestedPCRisarapidandsensitivemethodforearlydiagnosisofM.pneumoniaeinfection,theimpactofnestedPCRreactionconditionsisnumerousanditistime-consumingtofindtheoptimalcondition.Whatismore,onlyonthebasisoftheoptimumconditionscanobtainamoreaccurateandobjectiveresults.SoweadoptedtheorthogonalarraydesigntooptimizeseveralcrucialfactorsaffectingthenestedPCRusing
thestandardstrainofM.pneumoniae,sinceorthogonaltestdesigncangreatlyshortenthetestnumberandcanquicklyarriveatamoreappropriatereactioncondition.Thenwealsoutilized
acompletelysinglefactortestdesignbasedontheresultsoftheorthogonaldesign.Atlast,thefinaloptimalreactionconditionsofnestedPCRaredeterminedbyintegratedtheresultsofthemethodsabove,sothecomparisonoftheP1adhesiongeneandthe16SrRNAgeneprimersunderthisoptimalconditioncanbemoreobjectivethanthatofotherlaboratories.30discussionAlthoughnestedPCRdiscussionInourstudy,OrthogonalarraydesignwasadoptedtooptimizefourcommonfactorsaffectingthenestedPCR,whichweretheconcentrationofprimersandMg2+,dilutionmultipleofthefirstroundPCRproduct,annealingtemperature.AllofthemarethecriticalelementintheperformanceofnestedPCR.Firstly,throughthetestwefoundthatexcessivelylowprimerconcentrationcanreducePCRyieldandexcessivelyhighprimerconcentrationincreasetheprobabilityofmisprimingandgenerationsofnon-specificPCRproducts.Secondly,formourexperiments,IfMg2+concentrationwastoolow,theyieldofPCRproductcouldbereduced,sinceTapDNApolymerasesareMg2+-dependentenzymeanditissensitivetotheconcentrati
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