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2020-12

重磅文章|mNGS在快速病原體檢測(cè)中的應(yīng)用(Nat Med, IF:36.13)
發(fā)布時(shí)間:2020-12-11 17:04:16作者:精科醫(yī)學(xué) 來(lái)源:精科醫(yī)學(xué)

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2020年11月09日,NATURE MEDICINE 雜志(IF:36.13)發(fā)表《Rapid pathogen detection by metagenomic next - generation sequencing of infected body fluids》研究文章,探討新一代宏基因組測(cè)序?qū)Ω腥倔w液快速進(jìn)行病原檢測(cè)的應(yīng)用,該研究入組160名急性病患者,并收集了182種體液進(jìn)行mNGS檢測(cè),并與培養(yǎng)法、PCR、納米孔測(cè)序等方法進(jìn)行微生物學(xué)測(cè)試的對(duì)比。



We developed a metagenomic next-generation sequencing (mNGS) test using cell-free DNA from body fluids to identify pathogens. The performance of mNGS testing of 182 body fluids from 160 patients with acute illness was evaluated using two sequencing platforms in comparison to microbiological testing using culture, 16S bacterial PCR and/or 28S–internal transcribed ribosomal gene spacer (28S–ITS) fungal PCR. Test sensitivity and specificity of detection were 79 and 91% for bacteria and 91 and 89% for fungi, respectively, by Illumina sequencing; and 75 and 81% for bacteria and 91 and 100% for fungi, respec- tively, by nanopore sequencing. In a case series of 12 patients with culture/PCR-negative body fluids but for whom an infectious diagnosis was ultimately established, seven (58%) were mNGS positive. Real-time computational analysis enabled pathogen identification by nanopore sequencing in a median 50-min sequencing and 6-h sample-to-answer time. Rapid mNGS testing is a promising tool for diagnosis of unknown infections from body fluids. 

我們使用體液中的無(wú)細(xì)胞DNA進(jìn)行了mNGS測(cè)試,以鑒定病原體。使用兩種測(cè)序平臺(tái)對(duì)160名急性病患者的182種體液的mNGS測(cè)試性能進(jìn)行了評(píng)估,并與使用培養(yǎng)物、16S細(xì)菌PCR和/或28S-內(nèi)部轉(zhuǎn)錄核糖體基因間隔子(28S-ITS)真菌PCR的微生物學(xué)測(cè)試進(jìn)行對(duì)比。通過(guò)Illumina測(cè)序,細(xì)菌的檢測(cè)靈敏度和檢測(cè)特異性分別為79%和91%,真菌為91%和89%;通過(guò)納米孔測(cè)序,細(xì)菌分別為75%和81%,真菌為91%和100%。在12例培養(yǎng)/ PCR陰性體液但最終被確診為感染的患者中,有7例(58%)是mNGS陽(yáng)性。實(shí)時(shí)計(jì)算分析可通過(guò)中值50分鐘測(cè)序和6小時(shí)樣品到應(yīng)答時(shí)間的納米孔測(cè)序?qū)崿F(xiàn)病原體鑒定??焖俚膍NGS測(cè)試是診斷體液未知感染的潛在工具。


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圖a:mNGS體液分析工作流程示意圖

a, Schematic of mNGS body fluid analysis workflow. The clinical gold standard consisted of aggregated results from cultures, bacterial 16S PCR and/or fungal 28S–ITS PCR, while the composite standard also included confirmatory digital PCR with Sanger sequencing and clinical adjudication. For nanopore sequencing in <6?h, 40–60?min are needed for nucleic acid extraction, 2–2.5?h for mNGS library preparation, 1?h for nanopore 1D library preparation and 1?h for nanopore sequencing and analysis. 

臨床金標(biāo)準(zhǔn)由培養(yǎng)物、細(xì)菌16SPCR和/或真菌28S-ITSPCR的共同結(jié)果,而復(fù)核標(biāo)準(zhǔn)還包括與Sanger的驗(yàn)證性數(shù)字PCR測(cè)序和臨床診斷。 對(duì)于< 6? h的納米孔測(cè)序,核酸提取需40~60? min,mNGS文庫(kù)制備需2~ 2.5?h,納米孔1D 建庫(kù)需1?h,納米孔測(cè)序分析需1?h。)


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圖b:研究中包括的182例體液樣本的分析工作流程

b, Analysis workflow for the 182?body fluid samples included in the study170?samples were included in the accuracy assessment while 12?samples collected from patients with a clinical diagnosis of infection but negative microbiological testing were included for mNGS analysis. The pie chart displays the body fluid sample types analyzed in the study. 

(在準(zhǔn)確性評(píng)估中包括170個(gè)樣本,從臨床診斷感染的患者中收集的12個(gè)樣本,但對(duì)微生物樣本進(jìn)行了mNGS檢測(cè)。餅圖顯示研究中分析的體液樣本類型。)


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c:相對(duì)于培養(yǎng)的mNGS測(cè)試的時(shí)機(jī)

c, Timing for mNGS testing relative to culture. Whereas culture-based pathogen identification can take days to weeks, mNGS testing using nanopore or Illumina sequencing platforms has an overall turnaround time of 5–24?h.

(基于培養(yǎng)的病原體鑒定可能需要幾天到幾周,而使用納米孔或Illumina測(cè)序平臺(tái)進(jìn)行mNGS測(cè)試的總體運(yùn)行時(shí)間為5-24小時(shí)。)


參考文獻(xiàn):[1]. Rapid pathogen detection by metagenomic next-generation sequencing of infected body fluids.[J]. Nature medicine,2020.





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