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      Amplification-free detection of SARS-CoV-2 with CRISPR-Cas13a and mobile phone microscopy

      research-article
      1 , 2 , 3 , 4 , 23 , 5 , 23 , 5 , 6 , 23 , 7 , 8 , 1 , 4 , 5 , 9 , 10 , 1 , 4 , 1 , 4 , 1 , 4 , 1 , 4 , 1 , 4 , 5 , 6 , 11 , 5 , 1 , 4 , 1 , 1 , 12 , 24 , 12 , 2 , 3 , 12 , 9 , 13 , 1 , 3 , 9 , 14 , 15 , 9 , 12 , 9 , 9 , 9 , 2 , 3 , 9 , 16 , 1 , 7 , 11 , 17 , 18 , 19 , 1 , 5 , 6 , 9 , 20 , 21 , 22 , , 1 , 2 , 3 , 4 , 25 , ∗∗
      Cell
      Elsevier Inc.
      CRISPR-Cas13, CRISPR Dx, SARS-CoV-2, COVID-19, point-of-care diagnostics, mobile phone microscopy

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          Abstract

          The December 2019 outbreak of a novel respiratory virus, SARS-CoV-2, has become an ongoing global pandemic due in part to the challenge of identifying symptomatic, asymptomatic, and pre-symptomatic carriers of the virus. CRISPR diagnostics can augment gold-standard PCR-based testing if they can be made rapid, portable, and accurate. Here, we report the development of an amplification-free CRISPR-Cas13a assay for direct detection of SARS-CoV-2 from nasal swab RNA that can be read with a mobile phone microscope. The assay achieved ∼100 copies/μL sensitivity in under 30 min of measurement time and accurately detected pre-extracted RNA from a set of positive clinical samples in under 5 min. We combined crRNAs targeting SARS-CoV-2 RNA to improve sensitivity and specificity and directly quantified viral load using enzyme kinetics. Integrated with a reader device based on a mobile phone, this assay has the potential to enable rapid, low-cost, point-of-care screening for SARS-CoV-2.

          Graphical Abstract

          Highlights

          • CRISPR-Cas13a can quantitatively detect SARS-CoV-2 RNA without pre-amplification

          • Combining crRNAs targeting multiple regions of the viral RNA enhances sensitivity

          • Cas13a can accurately and rapidly quantify SARS-CoV-2 RNA in patient samples

          • A mobile phone-based device allows for portable and sensitive readout of the assay

          Abstract

          Fozouni et al. devise a way to use CRISPR-Cas13a to detect and quantify SARS-CoV-2 RNA from patient samples without the need for a pre-amplification step. They then show how the assay’s signal can be efficiently detected with a portable, mobile phone-based device.

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          Most cited references64

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          A Novel Coronavirus from Patients with Pneumonia in China, 2019

          Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)
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            Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR

            Background The ongoing outbreak of the recently emerged novel coronavirus (2019-nCoV) poses a challenge for public health laboratories as virus isolates are unavailable while there is growing evidence that the outbreak is more widespread than initially thought, and international spread through travellers does already occur. Aim We aimed to develop and deploy robust diagnostic methodology for use in public health laboratory settings without having virus material available. Methods Here we present a validated diagnostic workflow for 2019-nCoV, its design relying on close genetic relatedness of 2019-nCoV with SARS coronavirus, making use of synthetic nucleic acid technology. Results The workflow reliably detects 2019-nCoV, and further discriminates 2019-nCoV from SARS-CoV. Through coordination between academic and public laboratories, we confirmed assay exclusivity based on 297 original clinical specimens containing a full spectrum of human respiratory viruses. Control material is made available through European Virus Archive – Global (EVAg), a European Union infrastructure project. Conclusion The present study demonstrates the enormous response capacity achieved through coordination of academic and public laboratories in national and European research networks.
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              Virological assessment of hospitalized patients with COVID-2019

              Coronavirus disease 2019 (COVID-19) is an acute infection of the respiratory tract that emerged in late 20191,2. Initial outbreaks in China involved 13.8% of cases with severe courses, and 6.1% of cases with critical courses3. This severe presentation may result from the virus using a virus receptor that is expressed predominantly in the lung2,4; the same receptor tropism is thought to have determined the pathogenicity-but also aided in the control-of severe acute respiratory syndrome (SARS) in 20035. However, there are reports of cases of COVID-19 in which the patient shows mild upper respiratory tract symptoms, which suggests the potential for pre- or oligosymptomatic transmission6-8. There is an urgent need for information on virus replication, immunity and infectivity in specific sites of the body. Here we report a detailed virological analysis of nine cases of COVID-19 that provides proof of active virus replication in tissues of the upper respiratory tract. Pharyngeal virus shedding was very high during the first week of symptoms, with a peak at 7.11 × 108 RNA copies per throat swab on day 4. Infectious virus was readily isolated from samples derived from the throat or lung, but not from stool samples-in spite of high concentrations of virus RNA. Blood and urine samples never yielded virus. Active replication in the throat was confirmed by the presence of viral replicative RNA intermediates in the throat samples. We consistently detected sequence-distinct virus populations in throat and lung samples from one patient, proving independent replication. The shedding of viral RNA from sputum outlasted the end of symptoms. Seroconversion occurred after 7 days in 50% of patients (and by day 14 in all patients), but was not followed by a rapid decline in viral load. COVID-19 can present as a mild illness of the upper respiratory tract. The confirmation of active virus replication in the upper respiratory tract has implications for the containment of COVID-19.
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                Author and article information

                Journal
                Cell
                Cell
                Cell
                Elsevier Inc.
                0092-8674
                1097-4172
                4 December 2020
                21 January 2021
                4 December 2020
                : 184
                : 2
                : 323-333.e9
                Affiliations
                [1 ]J. David Gladstone Institutes, San Francisco, CA 94158, USA
                [2 ]Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA 94143, USA
                [3 ]Biomedical Sciences Graduate Program, University of California, San Francisco, San Francisco, CA 94143, USA
                [4 ]Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
                [5 ]Department of Bioengineering, University of California, Berkeley, Berkeley, CA 94720, USA
                [6 ]UC Berkeley-UC San Francisco Graduate Program in Bioengineering, University of California, Berkeley, Berkeley, CA 94720, USA
                [7 ]Department of Molecular and Cell Biology, University of California, Berkeley, Berkeley, CA 94720, USA
                [8 ]Monash Biomedicine Discovery Institute, Department of Biochemistry & Molecular Biology, Monash University, VIC 3800, Australia
                [9 ]Chan Zuckerberg Biohub, San Francisco, CA 94158, USA
                [10 ]Department of Physics and Astronomy, San José State University, San Jose, CA 95192, USA
                [11 ]Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
                [12 ]Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA 94143, USA
                [13 ]Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA 94143, USA
                [14 ]Institute for Human Genetics, University of California, San Francisco, San Francisco, CA 94143, USA
                [15 ]Department of Epidemiology and Biostatistics and Institute of Computational Health Sciences, University of California, San Francisco, San Francisco, CA 94143, USA
                [16 ]Division of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA 94143, USA
                [17 ]Department of Chemistry, University of California, Berkeley, Berkeley, CA 94720, USA
                [18 ]Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA 94720, USA
                [19 ]Howard Hughes Medical Institute, University of California, Berkeley, Berkeley, CA 94720, USA
                [20 ]Biophysics Program, University of California, Berkeley, Berkeley, CA 94720, USA
                [21 ]California Institute for Quantitative Biosciences (QB3), University of California, Berkeley, Berkeley, CA 94720, USA
                [22 ]Division of Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
                Author notes
                []Corresponding author
                [∗∗ ]Corresponding author
                [23]

                These authors contributed equally

                [24]

                Present address: LegenDairy Foods GmbH, Rheinbach 53359, Germany

                [25]

                Lead contact

                Article
                S0092-8674(20)31623-8
                10.1016/j.cell.2020.12.001
                7834310
                33306959
                a1886707-88f5-43e0-89f3-19b3534884e2
                © 2020 Elsevier Inc.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 25 September 2020
                : 3 November 2020
                : 25 November 2020
                Categories
                Article

                Cell biology
                crispr-cas13,crispr dx,sars-cov-2,covid-19,point-of-care diagnostics,mobile phone microscopy

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