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Applied and Environmental Microbiology, June 2006, p. 4484-4488, Vol. 72, No. 6
0099-2240/06/$08.00+0 doi:10.1128/AEM.00189-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.
Quantification of In Vitro and In Vivo Cryptosporidium parvum Infection by Using Real-Time PCR
Nihal T. Godiwala,1
Alain Vandewalle,2
Honorine D. Ward,1 and
Brett A. Leav1*
Division of Geographic Medicine and Infectious Diseases, Tufts-New England Medical Center, Boston, Massachusetts 02111,1
INSERM, U773, Centre de Recherche Biomédicale Bichat-Beaujon (CRB3), BP 416, F-75018 Paris Université Paris 7Denis Diderot, site Bichat, F-75870 Paris, France2
Received 24 January 2006/
Accepted 9 April 2006

ABSTRACT
Established methods for quantifying experimental
Cryptosporidium infection are highly variable and subjective. We describe a
new technique using quantitative real-time PCR (qPCR) that can
be used to measure in vitro and in vivo laboratory infections
with
Cryptosporidium. We show for the first time that qPCR permits
absolute quantification of the parasite while simultaneously
controlling for the amount of host tissue and correlates significantly
with established methods of quantification in in vitro and in
vivo laboratory models of infection.

INTRODUCTION
Cryptosporidium spp. are waterborne protozoan parasites that
cause a range of diseases in humans, including self-limited
diarrhea in immunocompetent hosts, persistent diarrhea in children
living in developing countries, and severe infections in individuals
with compromised immune systems. A massive waterborne outbreak
in 1993 in Milwaukee, Wisconsin, resulted in over 400,000 human
cases of cryptosporidiosis, and the parasite continues to cause
sporadic water- and food-borne outbreaks in the United States
(
17,
31). The environmental form of the parasite, the oocyst,
is resistant to chlorination, and effective therapies for human
infection are limited. The Centers for Disease Control and the
National Institutes of Health, acknowledging the potential risk
of intentional dissemination, included the parasite on their
priority lists of bioterrorism agents (
24).
Research on the pathogenesis of C. parvum has been hampered by several factors, including inadequate animal models, inability to propagate the parasite in vitro, and imprecise methods for quantification of infection. Laboratory models of C. parvum infection have a critical role in advancing our understanding of many different aspects of the basic biology of the parasite and are also essential for the testing of potential interventions. Accurate, objective, and reproducible methods of quantifying C. parvum infection are necessary for these studies. Established methods of quantification of experimental C. parvum infection, such as counting intracellular forms of the parasite on hematoxylin-eosin-stained histopathologic specimens (7, 8), counting shed oocysts in stool (13), and enumerating intracellular stages by immunofluorescence assays (IFA) in in vitro samples, are imprecise, time-consuming, and subjective (25).
The use of molecular techniques, PCR in particular, has significantly advanced our understanding of C. parvum epidemiology, taxonomy, and biology (18, 20, 26, 27) and may have applications in the clinical setting (21). Semiquantitative PCR and quantitative real-time PCR (qPCR) have been used to detect C. parvum in environmental (9, 10) as well as fecal (30) samples. Either DNA or RNA that has been reverse transcribed into cDNA can be quantified using this technique. Recently, this technique has also been applied to measurement of in vitro laboratory infections (3, 6, 11, 14, 15). Using qPCR analysis, we developed an objective and reproducible technique that can be used to quantify experimental C. parvum infections in in vitro and in vivo models. We demonstrate for the first time that qPCR analysis positively correlates with established techniques for the measurement of in vivo and in vitro experimental C. parvum infections.

qPCR correlates significantly with the IFA for the measurement of experimental Cryptosporidium infection in vitro.
We used an established technique, IFA, for quantifying in vitro
infection (
12) and compared the results with those provided
by qPCR. The statistical methods used to compare these and all
subsequent techniques were as follows: after normal distribution
was demonstrated by use of the Kolgorov-Smirnov test, linear
regression was then used to correlate qPCR results with the
dose of parasite used (in vitro) as well as with results obtained
with a "gold standard" method of quantification, such as IFA
or the enumeration of the parasite in histological sections
(in vitro and in vivo). All in vitro analyses were performed
in duplicate or in triplicate. The relationships were analyzed
by plotting least-squares linear regression lines and computing
coefficients of determination (
r2) and corresponding
P values.
When data were not normally distributed, the Spearman rank correlation
was used, and a two-tailed test of significance was used to
determine
P values. All statistical analyses were performed
with SPSS 10.0 (Chicago, IL).
Two intestinal epithelial cell lines which support C. parvum infection in vitro, one of murine (16) and the other of human (12) origin, were used. The murine m-ICcl2 cell line was derived from the small intestine of a transgenic L-PK-tag 1 mouse carrying the simian virus 40 large T antigen under the control of the 5' regulatory sequence of the L-type pyruvate kinase promoter (2). The human intestinal-like Caco2A cell line was originally obtained by the GRASP digestive disease center from H. Buller (Academic Medical Center, Amsterdam, The Netherlands) (28). Collagen-coated glass chamber slides (BD Falcon, Bedford, MA) were seeded with 4 x 104 cells/well, and 24-well plates (Costar; Corning, NY) were seeded with 2 x 105 cells/well, which were grown to confluence under previously defined conditions (2, 28). Confluent cells grown on glass slides or cultured plates were then infected with various doses of C. parvum oocysts (IOWA isolate; Bunch Grass Farms, Deary, ID) for 24 h as described previously (12). All experiments were performed in triplicate except where stated otherwise.
IFA was performed as described previously (12). Twenty-four hours after infection, the cells were washed with complete medium and then fixed with methanol for 30 min at room temperature. After nonspecific binding was blocked with 5% normal goat serum in phosphate-buffered saline (PBS), intracellular stages of the parasite were detected with the monoclonal antibody 4E9, which is specific for a carbohydrate epitope on the sporozoite antigens gp40 and gp900 (4). After being washed with PBS, cells were incubated with Alexafluor 488-conjugated goat anti-rabbit immunoglobulin M and counterstained with 4',6'-di-amidino-2-phenylindole (DAPI; Vector Laboratories, Burlingame, CA). Slides were examined by fluorescence microscopy, and parasitic stages were counted in a blinded manner in 20 high-powered fields and expressed in terms of the number of parasites per high-powered field. Using IFA, we found that murine m-ICcl2 cells contained fewer parasites than human Caco2A cells after infection with equivalent doses of C. parvum, which is in agreement with a previous report (see Fig. 2) (16).
We then used qPCR to measure
C. parvum infection from cells
infected in parallel to those in which infection was quantified
by IFA. Total RNA was isolated with an RNeasy kit (QIAGEN, Valencia,
CA). After DNase (Ambion, Austin, TX) treatment, a reverse transcription
reaction was performed using Stratascript (Stratagene, La Jolla,
CA). Total DNA was extracted from intestinal tissue by using
a GNOME DNA kit, (Qbiogene, Irvine, CA). qPCR was performed
by using primers designed with Primer Express (Applied Biosystems,
Foster City, CA) to amplify a conserved region of the gp15 portion
of the
Cpgp40/15 gene (
4,
27). The sequences of these primers
were as follows: forward, 5'-TCA TTT GTA ATG TGG TTC GGA GAA-3',
and reverse, 5'-AGG GTA AAG GCA AAC AAA TCG A-3'. Primers designed
to amplify the murine housekeeping genes encoding nidogen (
22)
and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) (
23) and
the human gene encoding ß-actin (
1) were used as the
internal standard as previously described. qPCR was performed
using an ABI Prism 7700 thermocycler (Applied Biosystems) with
the following conditions: 95°C for 15 min, followed by 40
cycles of 94°C for 30 s, 60°C for 1 min, and 72°C
for 30 s. The
Cpgp40/15 primers produced a single PCR product
when used to measure
C. parvum in in vitro and in vivo samples,
thus demonstrating specificity for the target gene (Fig.
1).
For each sample, infection was quantified by dividing the number
of copies of
Cpgp40/15 by the number of copies of the respective
endogenous control as described previously (
22). We found that
in comparison with qPCR performed using cDNA, qPCR performed
using DNA could not reliably distinguish between viable and
heat-inactivated parasites in vitro (data not shown). Therefore,
qPCR using cDNA was used for all subsequent in vitro experiments.
Linear regression was then used to correlate the results of
qPCR with the dose of parasite used to infect the intestinal
epithelial cells. We found that the values obtained by qPCR
positively correlated with the dose of parasite used to infect
both the m-IC
cl2 (
r2 = 0.930;
P < 0.0001) and the Caco
2A (
r2 = 0.912;
P < 0.0001) cells over a fourfold log range
(Fig.
2). Again, we used linear regression to correlate the
results of qPCR and IFA. We found that qPCR positively correlated
with the established technique of IFA for measurement of infection
in both m-IC
cl2 (
r2 = 0.959;
P < 0.0001) and Caco
2A (
r2 =
0.853;
P < 0.0001) cells (Fig.
3). Therefore, qPCR correlates
well with IFA when used to measure
C. parvum in vitro infection
over a wide range of parasite doses.

qPCR correlates significantly with histological measurement of experimental Cryptosporidium infection in vivo.
C. parvum-infected intestinal samples from a previously published
study were used to compare techniques for quantifying infection
(
19). For histological analysis, portions of the terminal ilea
of 10
C. parvum-infected mice were removed and flushed with
PBS prior to either fixation in 10% buffered formalin or freezing
in liquid nitrogen. After paraffin embedding, sections of the
intestine were stained with hematoxylin-eosin. The parasite
burden for each animal was determined by counting the mean number
of intracellular forms of the parasite within a 10-by-10 grid
counted in five separate high-powered fields within each sample
(
7).
C. parvum infection was also quantified in parallel by
qPCR performed using DNA and extracted from a segment of the
terminal ilea adjacent to that used for histological analysis.
qPCR was performed as described above for the in vitro experiments,
and the parasite burden was expressed as the number of copies
of
Cpgp40/15 divided by the number of copies of the endogenous
control, the gene encoding nidogen. Comparison of qPCR with
histological analysis using linear regression demonstrated a
statistically significant positive correlation (
r2 = 0.761 and
P = 0.001) (Fig.
4). qPCR was performed in parallel on cDNA
obtained after reverse transcription of RNA extracted from adjacent
segments of terminal ileum. We found that the results obtained
by use of cDNA correlated poorly with histological analyses
and therefore did not use them for further analysis (data not
shown).
In summary, we found that qPCR compared favorably with other
established methods of quantification used in experimental infections
with
C. parvum. Unlike other microbial organisms that can readily
be propagated in cell-free medium in vitro and are thus more
easily quantified, the parasite
C. parvum has traditionally
required direct visualization for its enumeration. However,
techniques such as IFA and histological measurements are labor-intensive
and prone to interobserver variability. The development of objective
and less time-consuming assays to measure infection is therefore
desirable. Enzyme-linked immunosorbent assay-based assays are
an objective and reliable alternative and have been used successfully
for in vitro (
29) and in vivo (
5) infections. However, these
assays have several drawbacks, including an inability to absolutely
quantify the parasite and a reliance on oocyst shedding, which
may be temporally dissociated from the actual infection in in
vivo experiments. While there have been several other recent
reports demonstrating that qPCR can be used to quantify in vitro
C. parvum infection (
3,
6,
14,
15), qPCR was not validated by
comparison with gold standard techniques. Additionally, only
one of these studies used host genes to correct for the amount
of sample when quantifying
C. parvum in vitro (
3). Importantly,
we demonstrate that qPCR can be used to measure parasite burden
in an in vivo model of
C. parvum infection and have correlated
this technique with histological quantification. To our knowledge
there has been only one previous study in which qPCR was used
to detect, but not quantify,
C. parvum in a tissue sample (
11).
In this report we show that qPCR can be used to quantify parasites in in vitro and in vivo laboratory models of C. parvum infection. Objective and reproducible assays for the measurement of experimental infection in animals are particularly relevant for studies of the host immune responses to C. parvum. In these circumstances, targeted gene deletions or neutralization of target proteins affecting the immune response of the host may result in slight but significant differences in parasite burden which might not be detectable by use of more-subjective methods of quantification. Our technique permits absolute quantification of parasites while simultaneously controlling for the amount of host tissue and thus may be useful in such future studies.

ACKNOWLEDGMENTS
We thank Carla Ciugini for initial assistance with qPCR and
Robin Ruthazer for assistance with statistical methods.
This work was supported by NIAID grant AI51518A, the Center for Gastroenterology Research on Absorptive and Secretory Processes (GRASP), NIDDK P30 DK-34928-19, and the Center for AIDS Research (CFAR) P30 AI42853-06 (B.A.L.) and AI52786 and AI068535 (H.D.W.).

FOOTNOTES
* Corresponding author. Mailing address: Division of Geographic Medicine and Infectious Diseases, Tufts-New England Medical Center, Box 041, 750 Washington Street, Boston, MA 02111. Phone: (617) 636-2869. Fax: (617) 636-5292. E-mail:
bleav{at}tufts-nemc.org.


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Applied and Environmental Microbiology, June 2006, p. 4484-4488, Vol. 72, No. 6
0099-2240/06/$08.00+0 doi:10.1128/AEM.00189-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.
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