Laboratory validation of an RNA/DNA hybrid tagmentation based mNGS workflow on SARS-CoV-2 and other respiratory RNA viruses detection

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Abstract

Background: Acute respiratory infection caused by RNA viruses is still one of the main diseases all over the world such as SARS CoV 2 and Influenza A virus. mNGS was a powerful tool for ethological diagnosis. But there were some challenges during mNGS implementation in clinical settings such as time consuming manipulation and lack of comprehensive analytical validation. Methods: We set up CATCH that was a mNGS method based on RNA and DNA hybrid tagmentation via Tn5 transposon. Seven respiratory RNA viruses and three subtypes of Influenza A virus had been used to test capabilities of CATCH on detection and quantification. Analytical performance of SARS CoV 2 and Influenza A virus had been determined with reference standards. We compared accuracy of CATCH with quantitative real time PCR by using clinical 98 samples from 64 COVID19 patients. Results: We minimized the library preparation process to 3 hours and handling time to 35 minutes. Duplicate filtered RPM of 7 respiratory viruses and 3 Influenza A virus subtypes were highly correlated with viral concentration. LOD of SARS CoV 2 was 39.2 copies/test and of Influenza A virus was 278.1 copies/mL. Comparing with quantitative real time PCR, the overall accuracy of CATCH was 91.4%. Sensitivity was 84.5% and specificity was 100%. Meanwhile, there were significant difference of microbial profile in oropharyngeal swabs among critical, moderate patients and healthy controls. Conclusion: Although further optimization is needed before CATCH can be rolled out as a routine diagnostic test, we highlight the potential impact of it advancing molecular diagnostics for respiratory pathogens.

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  1. SciScore for 10.1101/2020.05.12.20099754: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Ethics statement: This study was reviewed and approved by the Ethics Committee of Beijing Youan Hospital, Capital Medical University.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.
    Cell Line Authenticationnot detected.

    Table 2: Resources

    Experimental Models: Cell Lines
    SentencesResources
    LOD were calculated in R (version 3.5.1) using probit regression analysis23 following approved guidelines of clinical and laboratory standards institute with 3 to 20 replicates performed at each concentration. 2) Precision: External PC and NTC samples were analyzed over 5 independent mNGS runs (inter-run reproducibility) and as 3 independent sets over 1 run (intra-run reproducibility) and evaluated for quality control metrics and viral detection using established thresholds. 3) Interference: to evaluate the effect of human host background on mNGS assay performance, we spiked SARS-COV-2 and Influenza A virus (A/2009/H1N1) standards into low (1 × 104 cells/mL), medium (1×105 cells/mL), and high (1×106 cells/mL) titers of human A549 cell.
    A549
    suggested: NCI-DTP Cat# A549, RRID:CVCL_0023)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).


    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Second, our data showed that high host background was a fairly common limitation of mNGS. It inferred that negative findings of unbiased mNGS methods might be less useful for excluding infection in high host background samples11,16. We, third, explore accuracy of CATCH by clinical oropharyngeal swabs during COVID-19 pandemic. CATCH showed a well compatibility with concentration of input. Although there were 65.00% and 38.46% samples in qRT-PCR negative and positive samples cannot be measured a definite concentration (Figure S3), we still have a 100% success in library preparation (Data not shown). The overall accuracy of CATCH for SARS-CoV-2 detection relative to conventical qRT-PCR was 91.4%, with 84.5% sensitivity and 100% specificity. In dual-gene qRT-PCR positive samples, sensitivity increased to 93.7%. We suggest that integrity of viral RNA might impair pathogen detective efficiency of CATCH. Moreover, as we knew, CATCH or other RNA/DNA hybrid tagmentation method without optimization will have obvious 3’bias13. This feature might also decrease possibility to capture viral fragments in clinical samples. For further implementation, CATCH needs optimization for overcome this limitation. Last, we found that CATCH can detect enrichment of opportunistic pathogen in oropharyngeal swabs of COVID-19 patients comparing with healthy control. It indicated that we can expand application of CATCH in fungal or bacterial detection in the near future. We also found an interesting phenome...

    Results from TrialIdentifier: No clinical trial numbers were referenced.


    Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).


    Results from JetFighter: We did not find any issues relating to colormaps.


    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.