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Applied and Environmental Microbiology, March 2007, p. 1457-1466, Vol. 73, No. 5
0099-2240/07/$08.00+0 doi:10.1128/AEM.01635-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Norwegian Defence Research Establishment, P.O. Box 25, N-2027 Kjeller, Norway,1 Department of Molecular Biosciences, Oslo University, P.O. Box 1050, N-0316 Oslo, Norway2
Received 14 July 2006/ Accepted 20 December 2006
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The pathogenesis of cholera is a complex process, and the major virulence factors of V. cholerae are the cholera toxin (CT) encoded by the ctxAB genes and the toxin-coregulated pilus (TCP) encoded by the tcpA gene (30). CT leads to increased intestinal secretion of electrolytes and water into the lumen. TCP is a type IV pilus that is essential for intestinal colonization in humans and in animal models of cholera (26, 50). The ctxAB genes are located in the genome of the CTX
filamentous prophage, and tcpA is located in the large Vibrio pathogenicity island, which functions as a receptor for the CTX
prophage (31, 33, 53). The toxR gene encodes a transcription factor that directly regulates the expression of CT, among others (37). Most toxigenic strains and non-O1and non-O139 strains of V. cholerae possess the toxR gene (48). Another genetic target is the virulence factor hemolysin, which is proposed to cause diarrhea (29). The hemolysin produced by V. cholerae non-O1and non-O139 strains is identical to the hemolysin product of the V. cholerae El Tor strains (54). However, some El Tor strains do not express the hly gene. Still, the hlyA gene is detected in several nonhemolytic strains by PCR (48).
PCR has now become a frequently used detection method, and several PCR protocols have been developed for V. cholerae (24, 25, 35, 36, 48, 49). PCR detection confirms the presence of specific genetic regions in a target organism. However, RNA-based methods such as the nucleic acid sequence-based amplification (NASBA) method and reverse transcription-PCR may reveal the expression of various genes. Viable but nonculturable (VBNC) forms of bacterial cells are now recognized as a common phenomenon in many bacterial species, and these organisms may escape detection if only culture methods are used (28). It has been demonstrated that the viability of VBNC cells may be monitored by reverse transcription-PCR analysis (17).
The NASBA assay, initially introduced by Compton (14), is a sensitive, transcription-based amplification system specifically designed for detecting RNA. The technology relies on the simultaneous activity of three different enzymes: RNaseH, avian myeloblastosis virus reverse transcriptase, and T7 RNA polymerase. The presence of a T7 promoter sequence at the 5' end of the forward primer is essential and is used by the T7 RNA polymerase during the synthesis of new RNA amplicons. In contrast to PCR and reverse transcription-PCR, the NASBA method is isothermal (41°C). At 41°C, genomic DNA remains double-stranded, and it is therefore not a substrate in NASBA. Although NASBA is specifically designed for the detection of RNA targets, in some NASBA systems DNA may be amplified (19, 42). However, the DNA amplification is ineffective and occurs only in the absence of RNA targets or in the case of a 1,000-fold excess of target DNA. Successful reverse transcription-PCR requires residual DNA to be eliminated in order to provide accurate detection of specific bacterial RNA sequences. Such extensive extraction of the nucleic acids may be time-consuming and may reduce the recovery of target RNA.
In NASBA, single-stranded RNA amplicons are produced, and these can easily be detected by hybridization with a sequence-specific probe such as a molecular beacon. Molecular beacons are single-stranded oligonucleotide hybridization probes designed such that they can form a stem-loop structure (51). The loop sequence is complementary to the target sequence to be detected, and the stem sequences are complementary to each other. A fluorescent label is linked to the end of one arm and a quencher to the other. Therefore, the molecular beacon is not fluorescent when it is free in a solution. A molecular beacon is designed so that its probe sequence is just long enough for a perfect complementary probe-target hybrid to be more stable than the stem hybrid. Consequently, the molecular beacon spontaneously forms probe-target hybrids in which the effect of the quencher is eliminated (19). Molecular beacon probes are designed according to specific rules (19), and the design is critical for the specificity and sensitivity of real-time NASBA (34).
NASBA has been extensively applied in clinical microbiology in detecting RNA viruses (19). However, NASBA is also used successfully for detection of microbial pathogens in food and environmental samples (16). Descriptions of such methods for the detection of Campylobacter spp. (52), Listeria monocytogenes (7), Salmonella enterica in various foods (15), Cryptosporidium parvum (3), and Escherichia coli in water (38) have been published. It has been shown that as few as 10 viable spores of Bacillus anthracis can be detected by NASBA (4).
In the present study, a real-time multitarget NASBA assay for the specific detection of V. cholerae cells has been developed. Primers and molecular beacons were targeted to five different genomic regions. These were the constitutively expressed housekeeping gene groEL, the hemolysin A virulence gene hlyA, the CT gene ctxA, the TCP gene tcpA, and the regulator for the expression of CT, the toxR gene. Serial dilutions of V. cholerae RNA were used to determine the detection limits of the single assays (50 CFU/ml), and RNA extraction and NASBA were performed within 3 h. The specificity of the assay was tested against several isolates of V. cholerae, Vibrio spp., and strains of Bacillus cereus, S. enterica, and E. coli. Furthermore, V. cholerae was detected in spiked environmental water samples (5 x 103 CFU/ml). This is to our knowledge the first report describing the use of NASBA for the specific detection of V. cholerae. Our results indicate that the ctxA and tcpA markers may be used to monitor the environmental population of V. cholerae strains expressing the virulence factors.
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TABLE 1. Bacterial strains used for NASBA
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TABLE 2. Primers and molecular beacon probes for the V. cholerae real-time NASBA assay
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NASBA.
The NASBA reaction was carried out by using the NucliSens basic NASBA kit according to the guidelines of the manufacturer (BioMèrieux Ltd., Boxtel, The Netherlands) and the personnel at NorChip AS (personal communication). The NASBA assays were carried out with a total of 25 µl containing the reagent mix, primers (0.2 µM [each]), the molecular beacon (0.25 µM), KCl (70 mM), and the template (5 µl). Samples were incubated at 65°C for 4 min before the enzymes were added. The samples were then incubated at 41°C for 90 min. Each NASBA assay included a deionized H2O blank as a negative control. The RNA amplicons were identified in real-time and online by using specific fluorescent molecular beacon probes (Table 2). Real-time measurements with these probes were made with a SmartCycler thermocycler (Cepheid). The amplification of a specific NASBA product is indicated by the detection time in minutes (the t value). The t value represents the time point at which the fluorescence value crosses a fixed threshold that is 10 times the standard deviation of the baseline intensity. In some experiments, the RNA amplicons were analyzed by electrophoresis on a Bioanalyzer (Agilent Technology, Germany). The predicted sizes of the amplicons were between 102 and 151 nucleotides (Table 2). The expression of the selected target genes was tested at different time points during the logarithmic growth phase and in the late stationary growth phase. These results provided a basis for further experiments in which cells were grown to mid-logarithmic phase (about 4 x 107 CFU/ml) before harvesting. A variety of primers were tested, but only the optimal primer pair is shown in this report. Several isolates of Vibrio spp. and non-Vibrio spp. were used to test the specificities of the primers and the molecular beacons in NASBA (Tables 1 and 2).
Isolated nucleic acids were subjected to DNase or RNase treatment. Aliquots (100 µl) of nucleic acids were incubated with 10 U of RNase (EC 3.1.27.5; Sigma chemical Co.) in Tris (10 mM)-EDTA (1 mM) buffer, pH 7.5, at 37°C for 2 h or 120 U of DNase (EC 232-667-0; Sigma Chemical Co.) in sodium acetate (100 mM) buffer, pH 5.25, containing MgCl2 (5 mM) for 2 h at 25°C. These treatments were followed by phenol-chloroform extraction and NASBA.
Sensitivity.
The detection limit and the reproducibility were determined by amplifying samples from 10-fold serial dilutions of V. cholerae RNA. Each dilution, which corresponded to cell concentrations ranging from 5 to 5 x 105 CFU/ml, was tested in triplicate, and two separate experiments were performed. RNA was also isolated from a 10-fold-dilution series of V. cholerae cells ranging from 5 to 5 x 105 CFU/ml, and isolated nucleic acids were amplified by NASBA.
Analysis of spiked environmental water samples.
Environmental samples were collected from the Oslo fjord (marine) and from two different freshwater lakes. These samples were spiked with V. cholerae cells (Cip 106855 O1 Inaba El Tor), and RNA was isolated using the NucliSens basic kit. Briefly, 100 µl of V. cholerae cells was added to 0.9 ml of the environmental samples to final concentrations of 5 x 103 or 5 x 105 CFU/ml. The cell suspensions were centrifuged at 2,000 x g for 10 min, the pellets were suspended in 900 µl of lysis buffer, and RNA was isolated as described above. RNA isolated from one of the freshwater lake samples spiked with 5 x 105 CFU/ml was amplified using all five primer sets and molecular beacons. RNA from the other freshwater lake sample and from the seawater sample (spiked with 5 x 105 and 5 x 103 CFU/ml) was amplified using primers and molecular beacons targeting the groEL and tcpA genes. Spiked samples of PBS were used as positive controls for RNA isolation and amplification. Environmental water samples not spiked with V. cholerae cells were used as negative controls, and neither of the targets was amplified.
Viability testing.
Viable V. cholerae cells were investigated in comparison with nonviable cells. Samples of V. cholerae cells (5 x 105 CFU/ml) were subjected to the following treatments: autoclaving (121°C) for 20 min and further incubation at room temperature for 4 or 24 h and heating at 98°C for 20 min and further incubation at room temperature for 4 or 24 h. As controls, cells were kept on ice but otherwise treated similarly. The treatments were followed by the isolation of nucleic acids and subsequent analysis with all NASBA primers and beacons immediately after the treatment and after 4 h and 24 h. The viability was tested by plating samples onto TSB agar and incubating at 37°C for 24 h. Nucleic acids isolated from cells heated at 98°C were subjected to DNase and RNase treatment (as described above) to confirm that RNA and not DNA was amplified.
Real-time PCR.
Real-time PCR was performed using a LightCycler (Roche, Germany) real-time PCR instrument. The NASBA primers and molecular beacons were used for PCR. The real-time PCR assays were carried out as described previously (22) using a Lithos qPCR kit (Eurogentec, Belgium). Briefly, the reaction mixture contained deoxynucleoside triphosphates, Taq DNA polymerase and reaction buffer, MgCl2 (4.5 mM), primers (1 µM [each]), and the probe (0.75 µM) in a final volume of 20 µl. The PCR program was as follows: initial denaturation at 95°C for 3 min and then 40 cycles at 95°C for 5 s, 58°C for 10 s, and 72°C for 15 s.
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The five different molecular beacons were evaluated using serial dilutions of nucleic acids isolated from V. cholerae cells. All target sequences were amplified by the corresponding primers, and the amplicons were detected by molecular beacons as a significant increase in fluorescence (Fig. 1). The results were confirmed by the amplification of an RNA sample, containing no DNA, that had been isolated by using the RNeasy kit (results not shown). The sensitivity of the single-target NASBA assays was evaluated using 10-fold dilutions of nucleic acids extracted from V. cholerae cells. Two separate assays were performed, and each assay was run in triplicate. Consistent detection (Table 3) was obtained at 50 CFU/ml for groEL and tcpA, 500 CFU/ml for toxR and ctxA, and 5 x 105 CFU/ml for hlyA. As shown in Fig. 1 and Table 3, lower concentrations were occasionally detected, but these levels of detection could not be reproduced in all NASBA experiments (Table 3).
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FIG. 1. Real-time NASBA of V. cholerae RNA. The five different molecular beacons were evaluated by using a 10-fold dilution series of RNA isolated from V. cholerae cells (Cip 106855 O1 Inaba El Tor). Data shown are representative of results from multiple experiments. Fluorescence is measured in relative units.
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TABLE 3. Sensitivity and reproducibility of the single-target NASBA assaysa
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NASBA is specifically designed to amplify RNA. However, it has been shown that DNA can also be amplified (19, 42). To confirm that the origin of the NASBA signal was RNA, the nucleic acids were subjected to RNase and DNase treatment as described in Materials and Methods. In the presence of RNase, no targets were amplified, whereas DNase treatment did not affect NASBA. This result was further confirmed with the electrophoresis of all amplicons (Bioanalyzer). These results are illustrated for the hlyA and tcpA targets in Fig. 2. Similar results were obtained for all other targets. However, for toxR, a slight decrease in the level of RNA amplicons was observed after DNase treatment. The decrease in RNA did not affect the t value, but a small decrease in the fluorescence intensity was observed for toxR after DNase treatment. These results show that V. cholerae RNA was detected by NASBA in a DNA-contaminated background.
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FIG. 2. Detection of RNA isolated from V. cholerae cells (Cip 106855 O1 Inaba El Tor) after RNase and DNase treatment of the nucleic acids isolated with the NucliSens basic kit. Fluorescence is measured in relative units. (A) Real-time NASBA of the hlyA and tcpA gene targets. (B) Electrophoresis (Bioanalyzer) of the hlyA and tcpA real-time NASBA products. Lanes: L, molecular weight standard; 1, hlyA negative control; 2, hlyA control; 3, hlyA DNase; 4, hlyA RNase; 5, tcpA negative control; 6, tcpA control; 7, tcpA DNase; 8, tcpA RNase.
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Spiked environmental water samples.
Highly sensitive detection of V. cholerae from environmental samples is dependent on efficient RNA extraction and the removal of potential NASBA inhibitors, as well as other factors. RNA was extracted and amplified from three different water samples, one from seawater and two from different freshwater lakes, spiked with V. cholerae cells. The genetic targets were specifically detected in V. cholerae, and no inhibition was observed. The results are illustrated by the amplification of the groEL target from seawater, freshwater, and a positive control sample (PBS) (Fig. 3). Similar results were obtained with all environmental samples and for all genetic targets (Table 4).
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FIG. 3. Real-time NASBA detection (groEL) of V. cholerae RNA isolated from environmental water samples spiked with V. cholerae cells (Cip 106855 O1 Inaba El Tor). Seawater, freshwater, and a positive control (PBS) were spiked with 5 x 103 and 5 x 105 CFU/ml, and RNA was isolated using the NucliSens basic kit. Fluorescence is measured in relative units.
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TABLE 4. Detection of V. cholerae cells in spiked water samplesa
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FIG. 4. Real-time NASBA of RNA isolated from heat-treated nonviable V. cholerae cells (Cip 106855 O1 Inaba El Tor). (A) NASBA of the toxR and groEL genes in cells treated at 121°C and further incubated for 4 and 24 h at room temperature. (B) NASBA of the groEL gene target in cells treated at 98°C and further incubated for 24 h at room temperature. To confirm that RNA and not DNA was amplified, the nucleic acids were treated with RNase and DNase as described in Materials and Methods. No amplification was detected after RNase treatment. Fluorescence is measured in relative units.
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In general, NASBA is a sensitive method, and more than 109 copies of RNA can be amplified in the assay in 90 min (14). In the present study, as little as 50 CFU/ml was detected using the groEL or tcpA primers and molecular beacons. The groEL marker is a general marker for detecting all V. cholerae strains. The tcpA marker is specific for the detection of toxigenic strains. The sensitivity of the presented method was in agreement with previous NASBA results for other bacterial species. Min and Baeumner (38) were able to detect 40 E. coli cells/ml of water, and as few as 10 spores of B. anthracis could be detected (4). In the latter case, the spores were inoculated into a culture medium for 30 min in order to germinate the spores and express target RNA. In a recent study, the levels of toxigenic V. cholerae cells in water in Mathbaria, Bangladesh, were monitored. Seasonal variation was observed, and the concentration of V. cholerae cells varied from <10 to 3.4 x 107 cells/liter (1). In the NASBA assay in the present study, 5 x 104 CFU/liter was detected. Preliminary studies in our laboratory indicate that 5 x 104 CFU/ml corresponds to 1 x 106 cells/liter. The sensitivity might be further increased by the filtration of large volumes of water, which has not been done in this study. The infectious dose of V. cholerae from water is assumed to be 103 to 106 bacteria (44). Thus, such doses may be detected using the present NASBA method either directly or after filtration of the water.
A report of the use of molecular beacons for the multiplex real-time PCR detection of V. cholerae cells has recently been published, stating a detection limit of 5 x 103 CFU/ml (25). The sensitivity of our assay proved to be 100-fold higher (50 CFU/ml). Previous reports revealed that real-time PCR using TaqMan probes or SYBR green can detect 10 to 106 CFU of V. cholerae/ml (24, 36). It is well known that the nucleotide sequences and the binding efficiencies of primers and probes for the target strand are of importance in obtaining high sensitivity and specificity for real-time PCR and NASBA assays. The kinetics of the NASBA reaction are mainly determined by the efficiency of primer binding and the extent of nonspecific product synthesis due to mispriming events (20). In this study, the sensitivity of the amplification of hlyA was lower than that of the other targets. This might be due to primer or probe construction or a lower level of expression of the hlyA marker compared to the other targets.
Theoretically, the possibility that the groEL primers and molecular beacon can amplify and detect nontarget strains is low, confirmed by BLAST analysis. Surprisingly, the amplification of RNA isolated from the S. enterica ATCC 13076 strain occurred in two out of three separate experiments. Sequence alignments of the groEL target gene of V. cholerae (>gi15640032:2832629-2834254) and the groEL gene of S. enterica (gi7527386) showed approximately 45% similarity at the DNA level, but the sequence of the groEL molecular beacon probe appeared to be unique (BLASTN analysis). Therefore, the detection of groEL in S. enterica was not expected. Furthermore, the amplification of S. enterica was not reproducible. Also, in a few experiments a background signal in the negative control was achieved with the groEL molecular beacon probe. These two observations might be due to the binding of the molecular beacon to primers (19). However, S. enterica ATCC 13076 was not detected at all using real-time PCR and molecular beacon probe detection.
Pathogenicity is dependent on the expression of virulence genes in a microorganism. The ctxA and tcpA genes are known to play a crucial role in maintaining the virulence of V. cholerae. These genes are usually associated with clinical strains of the O1 and O139 serogroups. However, outbreaks of cholera caused by non-O1 and non-O139 have also been reported (18, 45), and some of these strains produce CT or CT-like toxins (10). Interestingly, the ctxA and tcpA genes were detected by NASBA in a strain belonging to the O2 serogroup (VC 5/47). However, the t value was high and the fluorescence low. This result was most likely due to mispriming or a low yield of RNA. PCR studies have also revealed the presence of the ctxA and tcpA genes in various non-O1 and non-O139 serogroups of environmental V. cholerae strains (10). An environmental O1 isolate (VC 4/57) was also detected in this study. As said, the t value was high and the increase in the fluorescence signal was low and most likely due to mispriming or the level of expression. Furthermore, isolates of V. mimicus that express the two main virulence factors (CT and TCP) of V. cholerae have been identified (9), and this finding might explain why the V. mimicus (VM034) strain was detected using the ctxA primers and a molecular beacon. Thus, CT or CT-like proteins are associated with non-O1 and non-O139 serogroups of V. cholerae and strains of V. mimicus as well. Amplification of the ctxA gene target in environmental samples by NASBA indicates the detection of a potential pathogen. The potential nonspecific detection in environmental samples of, e.g., ctxA in V. mimicus or toxR in S. marcescens, found in water, soil, insects, plants, and vegetables (23), is not a problem since the specificity of the presented NASBA assay is based on the use of several genetic targets. Using a combination of groEL and tcpA, the presented multitarget NASBA assay is specific for the detection of V. cholerae cells. For the monitoring of strains expressing virulence factors, the ctxA and tcpA targets can be used. A direct comparison of the specificity of NASBA and real-time PCR using molecular beacons is difficult since different targets and different strains of bacteria were used. A real-time PCR assay using molecular beacons used four different genetic targets in a multiplex assay (rtxA, epsM, ompW, and tcpA) in order to detect V. cholerae cells; in this assay, V. mimicus was detected nonspecifically through ompW (25). The tcpA marker used in PCR was designed to detect the toxigenic El Tor strains. However, in one of these strains no amplification was detected (25). To our knowledge, these two studies are the only studies describing the use of molecular beacon probes for the detection of V. cholerae.
Using NASBA for analyzing environmental samples requires efficient methods for sample preparation since the samples generally contain substances that inhibit NASBA (16). V. cholerae was detected by NASBA in spiked environmental seawater and freshwater samples. Potential inhibitors were effectively removed, and the whole analysis including RNA extraction and NASBA was completed within 3 h. If the samples contain large amounts of inhibitory substances, the extraction methods might require modifications. In contrast, conventional culture methods and subsequent bacterial identification are time-consuming and require several days to complete (21). Vibrio spp. in the environment are known to be in a VBNC state, a state that is described as a survival mechanism of bacteria facing environmental stress conditions (28). Preliminary results show that V. cholerae cells in the VBNC state could be detected by NASBA.
In principle, the presence of RNA in bacterial cells may serve as an indicator for viable cells (32), and mRNA species are supposed to have an average half-life of only minutes in metabolizing cells (2). However, in several studies it has been shown that mRNA species may persist in a detectable form for many hours after cell death (6, 46, 47). The persistence of mRNA species may vary depending on the method of cell death (46, 47) and the physiological state of the cell population before killing. In another study, only viable cells of E. coli were detected using NASBA (38). Other studies have also demonstrated that the selection of the genetic target is important for providing good correlations with cell viability (40, 55). This was also the case in this study. A correlation between cell viability and NASBA was demonstrated for the ctxA, hlyA, and toxR targets, whereas such correlation was not demonstrated for the groEL and tcpA targets. Our results therefore indicate that care must be taken in using NASBA for viability studies. This finding also highlights the need for increased knowledge of the persistence and decay characteristics of the potential mRNA targets. False-positive results due to the amplification of RNA from dead cells can be eliminated by preenrichment in a selective medium, and the analysis time might be shortened from days (culture methods) to hours (52). This strategy also solves the problems with NASBA inhibitors contained in environmental samples.
In conclusion, the described multitarget NASBA assay for the detection of V. cholerae is a novel, sensitive, specific, and rapid method in which nucleic acid extraction and NASBA can be completed in less than 3 h. The NASBA assay is run at a single temperature, and a thermocycler is not required. The advantages, including the use of a crude RNA extract, have a potential for being further improved for field applications. Environmental water samples spiked with V. cholerae cells were used to demonstrate that the combination of a rapid method for the extraction of nucleic acids (DNA and RNA) and NASBA could be a promising strategy for the rapid and sensitive detection of V. cholerae. The monitoring of particular strains expressing virulence factors known to cause human disease is of great value for hazard evaluation of water. Preliminary studies also show that the NASBA method has potential as a detection tool for VBNC cells isolated from water samples.
The groEL and toxR targets are general markers and detected all V. cholerae strains. The sensitivity of the groEL assay was 10-fold higher than that of the toxR assay. In order to detect toxigenic strains, we suggest that the tcpA and ctxA markers be used. However, the sensitivity of the tcpA assay was 10-fold higher than that of the ctxA assay. A combination of the groEL, toxR, tcpA, and ctxA markers provides maximum specificity for the detection of all V. cholerae strains.
Published ahead of print on 12 January 2007. ![]()
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