Validation of the performance of a point of care molecular test for leprosy: From a simplified DNA extraction protocol to a portable qPCR

PLoS Negl Trop Dis. 2024 Oct 7;18(10):e0012032. doi: 10.1371/journal.pntd.0012032. eCollection 2024 Oct.

Abstract

The study aimed to optimize qPCR reactions using oligonucleotides from the first Brazilian molecular diagnostic kit for leprosy on a portable platform (Q3-Plus). In addition, we sought to develop a simplified protocol for DNA extraction that met point-of-care criteria. During optimization on the Q3-Plus, optical parameters, thresholds, and cutoffs for the 16S rRNA and RLEP targets of M. leprae were established using synthetic DNA, purified DNA from M. leprae, and pre-characterized clinical samples. For the simplified extraction protocol, different lysis solutions were evaluated using chaotropic agents, and purification was carried out by transferring the lysed material to FTA cards. The complete protocol (simplified extraction + qPCR on the portable platform) was then evaluated with pre-characterized clinical skin biopsy samples and compared with standard equipment (QuantStudio-5). LOD95% for the optimized reactions was 113.31 genome-equivalents/μL for 16S rRNA and 17.70 genome-equivalents/μL for RLEP. Among the lysis solutions, the best-performing was composed of urea (2 M), which provided good dissolution of the skin fragment and a lower Ct value, indicating higher concentrations of DNA. The complete technological solution showed a sensitivity of 52% in reactions. Our results highlight the need for additional optimization to deal with paucibacillary samples, but also demonstrate the feasibility of the portable platform for the qPCR detection of M. leprae DNA in low infrastructure settings.

Publication types

  • Validation Study

MeSH terms

  • Brazil
  • DNA, Bacterial* / genetics
  • DNA, Bacterial* / isolation & purification
  • Humans
  • Leprosy* / diagnosis
  • Leprosy* / microbiology
  • Molecular Diagnostic Techniques / methods
  • Mycobacterium leprae* / genetics
  • Mycobacterium leprae* / isolation & purification
  • Point-of-Care Systems
  • RNA, Ribosomal, 16S* / genetics
  • Real-Time Polymerase Chain Reaction* / methods
  • Sensitivity and Specificity
  • Skin / microbiology

Substances

  • DNA, Bacterial
  • RNA, Ribosomal, 16S

Grants and funding

This study was supported by grants from Carlos Chagas Filho Research Support Foundation of the State of Rio de Janeiro (Faperj, E-26/203.913/2022, www.faperj.br, to FSNM) Carlos Chagas Institute Research Stimulus Program (ICC 008 FIO 21 – SUB 22, www.icc.fiocruz.br, to ADTC) and by the National Fund for Health/Brazilian Ministry of Health (TED 69/2021, www.gov.br/saude/pt-br, to MOM). LSD is a CNPq fellowship holder, FSNM is a Faperj fellowship holder, and ADTC is a CNPq productivity fellow (level 2). The funders played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.