Multiplexed Reverse Transcription Loop-Mediated Isothermal Amplification Coupled with a Nucleic Acid-Based Lateral Flow Dipstick as a Rapid Diagnostic Method to Detect SARS-CoV-2.

Due to the high reproduction rate of COVID-19, it is important to identify and isolate infected patients at the early stages of infection. The limitations of current diagnostic methods are speed, cost, and accuracy. Furthermore, new viral variants have emerged with higher rates of infectivity and mortality, many with mutations at various primer binding sites, which may evade detection via conventional PCR kits. Therefore, a rapid method that is sensitive, specific, and cost-effective is needed for a point-of-care molecular test. Accordingly, we developed a rapid molecular SARS-CoV-2 detection kit with high specificity and sensitivity, RT-PCR, taking advantage of the loop-mediated isothermal amplification (LAMP) technique. Four sets of six primers were designed based on conserved regions of the SARS-CoV-2 genome: two outer, two inner and two loop primers. Using the optimized protocol, SARS-CoV-2 genes were detected as quickly as 10 min but were most sensitive at 30 min, detecting as little as 100 copies of template DNA. We then coupled the RT-LAMP with a lateral flow dipstick (LFD) for multiplex detection. The LFD could detect two genic amplifications on a single strip, making it suitable for multiplexed detection. The development of a multiplexed RT-LAMP-LFD reaction on crude VTM samples would be suitable for the point-of-care diagnosis of COVID-19 in diagnostic laboratories as well as in private homes.

Potential of Reverse Transcription Loop-Mediated Isothermal Amplification (RT-LAMP) as a Simple Rapid Molecular Diagnostic Tool to Detect SARS-CoV-2 Nucleocapsid Gene

Introduction: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), identified in December of 2019, is the cause of the coronavirus disease 2019 (COVID-19). Due to the high reproductive rate of the virus, the best way to slow down the spread is to identify and isolate patients at the early stage of infections. The current diagnostic methods are either too expensive, slow or have low accuracy. Variants of SARS-CoV-2 with mutations at the primer binding sites may cause evasion of polymerase chain reaction (PCR) detection using current primers. Reverse transcription loop-mediated isothermal amplification (RT-LAMP) has potential as a rapid molecular test that is easy to conduct. Methods: LAMP primers were design based on the highly conserved regions of the SARS-CoV-2 Nucleocapsid (N) gene. RT-LAMP assays were conducted using an optimized Bst 3.0 polymerase protocol on T7 RNA polymerase synthesized RNA template. The LAMP sensitivity assay was tested on 1:10 serial diluted pJET1.2 vector with SARSCoV2 N gene inserts. A specificity test was conducted by running the test on plasmids containing SARS-CoV and MERS-CoV N genes. The results were visualised via gel electrophoresis, SYBR Green staining and Lateral Flow Dipstick (LFD). Results: The optimized protocol is sensitive enough to detect SARS-CoV-2 genetic material within 10 minutes but is most sensitive at 30 minutes. Additionally, it is specific to only the genetic materials of SARS-CoV-2. Furthermore, an LFD with multiple test lines was successful for multiplexed LAMP reactions with different genic regions of the virus. Conclusion: The multiplexed LFD-LAMP is potentially a simple yet specific and sensitive method of rapid molecular diagnostics of COVID-19.