title: Development of a reverse transcription-loop-mediated isothermal amplification (RT-LAMP) system for a highly sensitive detection of enterovirus in the stool samples of acute flaccid paralysis cases.
abstract: BACKGROUND
  In the global eradication program for poliomyelitis, the laboratory diagnosis plays a critical role by isolating poliovirus (PV) from the stool samples of acute flaccid paralysis (AFP) cases. In this study, we developed a reverse transcription-loop-mediated isothermal amplification (RT-LAMP) system for a rapid and highly sensitive detection of enterovirus including PV to identify stool samples positive for enterovirus including PV.
  
  
  METHODS
  A primer set was designed for RT-LAMP to detect enterovirus preferably those with PV-like 5'NTRs of the viral genome. The sensitivity of RT-LAMP system was evaluated with prototype strains of enterovirus. Detection of enterovirus from stool extracts was examined by using RT-LAMP system.
  
  
  RESULTS
  We detected at least 400 copies of the viral genomes of PV(Sabin) strains within 90 min by RT-LAMP with the primer set. This RT-LAMP system showed a preference for Human enterovirus species C (HEV-C) strains including PV, but exhibited less sensitivity to the prototype strains of HEV-A and HEV-B (detection limits of 7,400 to 28,000 copies). Stool extracts, from which PV, HEV-C, or HEV-A was isolated in the cell culture system, were mostly positive by RT-LAMP method (positive rates of 15/16 (= 94%), 13/14 (= 93%), and 4/4 (= 100%), respectively). The positive rate of this RT-LAMP system for stool extracts from which HEV-B was isolated was lower than that of HEV-C (positive rate of 11/21 (= 52%)). In the stool samples, which were negative for enterovirus isolation by the cell culture system, we found that two samples were positive for RT-LAMP (positive rates of 2/38 (= 5.3%)). In these samples, enterovirus 96 was identified by sequence analysis utilizing a seminested PCR system.
  
  
  CONCLUSIONS
  RT-LAMP system developed in this study showed a high sensitivity comparable to that of the cell culture system for the detection of PV, HEV-A, and HEV-C, but less sensitivity to HEV-B. This RT-LAMP system would be useful for the direct detection of enterovirus from the stool extracts.
authors.affiliation: Department of Virology II, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan. minetaro@nih.go.jp
authors.forename: Minetaro
authors.initials: M
authors.lastname: Arita
authors.forename: Hua
authors.initials: H
authors.lastname: Ling
authors.forename: Dongmei
authors.initials: D
authors.lastname: Yan
authors.forename: Yorihiro
authors.initials: Y
authors.lastname: Nishimura
authors.forename: Hiromu
authors.initials: H
authors.lastname: Yoshida
authors.forename: Takaji
authors.initials: T
authors.lastname: Wakita
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shimizu
mesh_terms: D020121:5' Untranslated Regions; D045744:Cell Line, Tumor; D017931:DNA Primers; D030015:Enterovirus C, Human / Q000302:isolation & purification; D005243:Feces / Q000821:virology; D006801:Humans; D011051:Poliomyelitis / Q000175:diagnosis*; D017955:Poliovirus / Q000302:isolation & purification*; D012367:RNA, Viral / Q000302:isolation & purification; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods*; D012680:Sensitivity and Specificity
chemical_list: D020121:5' Untranslated Regions; D017931:DNA Primers; D012367:RNA, Viral