Multiplex Polymerase Chain Reaction

多重聚合酶链反应
  • 文章类型: Journal Article
    镰刀菌冠腐病(FCR),由镰刀菌引起。,是小麦种植区的毁灭性疾病。以前的研究表明,FCR是由同时感染禾谷镰刀菌引起的,F.假赤霉,湖北省F.proliferatum和F.writicillioides,中国。在这项研究中,开发了一种同时检测F.graminearumDNA的方法,F.假赤霉,可以有效区分它们的F.proliferatum和F.roticillioides。这四个镰刀菌的全基因组序列比较。进行,并设计了20bp序列作为通用上游引物。还设计了每种病原体的特异性下游引物,每个病原体产生206、482、680和963bp的扩增子,分别。多重PCR专门鉴定了禾谷镰刀菌,F.假赤霉,F.增殖和轮虫,但不来自其他46种病原体,目标病原体的检测限约为100pg/μl。此外,我们使用优化的多重PCR方法准确地确定了小麦样品中的FCR病原体种类。这些结果表明,本研究建立的多重PCR方法可以高效、快速地鉴定禾谷菌株。F.假赤霉,F.增殖,和F.verticillioides,为及时、有针对性地预防和控制FCR提供技术支持。
    Fusarium crown rot (FCR), caused by Fusarium spp., is a devastating disease in wheat growing areas. Previous studies have shown that FCR is caused by co-infection of F. graminearum, F. pseudograminearum, F. proliferatum and F. verticillioides in Hubei Province, China. In this study, a method was developed to simultaneously detected DNAs of F. graminearum, F. pseudograminearum, F. proliferatum and F. verticillioides that can efficiently differentiate them. Whole genome sequence comparison of these four Fusarium spp. was performed and a 20 bp sequence was designed as an universal upstream primer. Specific downstream primers of each pathogen was also designed, which resulted in a 206, 482, 680, and 963 bp amplicon for each pathogen, respectively. Multiplex PCR specifically identified F. graminearum, F. pseudograminearum, F. proliferatum and F. verticillioides but not from other 46 pathogens, and the detection limit of target pathogens is about 100 pg/μl. Moreover, we accurately determined the FCR pathogen species in wheat samples using the optimized multiplex PCR method. These results demonstrate that the multiplex PCR method established in this study can efficiently and rapidly identify F. graminearum, F. pseudograminearum, F. proliferatum, and F. verticillioides, which should provide technical support for timely and targeted prevention and control of FCR.
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  • 文章类型: Journal Article
    准确识别骨科感染的病因对于正确及时的临床管理非常重要,但是研究很少。在当前的研究中,我们探索了多种细菌病原体与骨科感染的关联。
    住院的骨科患者在青岛的一家乡村医院登记,中国。收集伤口或渗出物拭子样品,并通过培养和多重实时PCR测试十二种细菌病原体。
    共纳入349例骨科住院患者,其中193例入院时出现感染表现,156例无感染迹象。骨科感染患者主要为男性(72.5%),住院时间较长(中位数为15天)。在42.5%(82/193)的感染患者中至少检测到一种病原体,在没有感染的患者中至少检测到一种病原体(P<0.001)。金黄色葡萄球菌是最常见的病原体(15.5%)。观察到数量依赖性病原体与感染的关联,特别是铜绿假单胞菌和肺炎克雷伯菌,可能提示亚临床感染.大多数检测到病原体的患者都有骨科手术史(比值比2.8,P=0.038)。有病原体特异性临床表现。多重qPCR,因为它的高灵敏度,优越的特异性,强大的定量可以与培养结合使用,以指导抗菌治疗并跟踪治疗期间骨科感染的进展。
    UNASSIGNED: Accurate identification of the etiology of orthopedic infection is very important for correct and timely clinical management, but it has been poorly studied. In the current study we explored the association of multiple bacterial pathogens with orthopedic infection.
    UNASSIGNED: Hospitalized orthopedic patients were enrolled in a rural hospital in Qingdao, China. Wound or exudate swab samples were collected and tested for twelve bacterial pathogens with both culture and multiplex real time PCR.
    UNASSIGNED: A total of 349 hospitalized orthopedic patients were enrolled including 193 cases presenting infection manifestations upon admission and 156 with no sign of infection. Orthopedic infection patients were mainly male (72.5%) with more lengthy hospital stay (median 15 days). At least one pathogen was detected in 42.5% (82/193) of patients with infection while 7.1% (11/156) in the patients without infection (P < 0.001). S. aureus was the most prevalent causative pathogen (15.5%). Quantity dependent pathogen association with infection was observed, particularly for P. aeruginosa and K. pneumoniae, possibly indicating subclinical infection. Most of the patients with detected pathogens had a previous history of orthopedic surgery (odds ratio 2.8, P = 0.038). Pathogen specific clinical manifestations were characterized. Multiplex qPCR, because of its high sensitivity, superior specificity, and powerful quantification could be utilized in combination with culture to guide antimicrobial therapy and track the progression of orthopedic infection during treatment.
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  • 文章类型: Journal Article
    最近,开发了一种基于多重PCR的滴定(MPBT)测定法,用于同时测定口服脊髓灰质炎病毒疫苗(OPV)的所有三种萨宾菌株的感染滴度,以取代常规的CCID50测定法,这既费时费力。MPBT分析被证明是可重复的,健壮和敏感。常规和MPBT测定显示相似的结果和灵敏度。MPBT检测可以在两到三天内完成,而不是常规检测的十天。为了防止脊髓灰质炎病毒减毒疫苗株逆转为毒力,一本小说,遗传稳定的OPV(nOPV)是通过修饰OPV中使用的常规Sabin菌株的基因组而开发的。在这项工作中,我们评估了MPBT测定作为一种快速筛选工具,通过同时滴定三种nOPV菌株来支持三价nOPV(tnOPV)制剂开发,以确认所需的稳定性,用于选择主要的tnOPV配方候选。我们首先通过在同一板上滴定两个tnOPV样品(未稀释和三倍稀释)来评估MPBT测定区分0.5log10滴度差异的能力。一旦分析被证明是有区别的,然后,我们测试了在37°C下经历不同暴露时间的tnOPV药物产品(DP)的不同配方(未处理组和处理组:在37°C下2天和7天),和三个冻融(FT)循环。通过进行常规CCID50测定,最终确认了向下选择的候选制剂。比较未治疗组和治疗组的稳定性,并对前三名候选人进行FT稳定性测试。结果显示MPBT测定产生与常规测定相似的滴度。通过在同一板上测试两个三价样品,该测定可以区分测试的nOPV样品的滴度之间的0.5log10差异。此外,该测定能够检测具有不同制剂组成和在不同时间/温度条件和冷冻/解冻循环下的nOPV病毒的逐渐降解。我们发现,有三种tnOPV制剂在暴露于37℃2天后和三个FT循环后,满足小于0.5log10损失的稳定性标准,维持这些制剂中所有三种血清型的效力。MPBT测定在同一平板中滴定两个tnOPV批次(六个病毒)的能力使其更便宜,并为快速筛选提供了更高的通量。该测定检测到tnOPV的逐渐降解,并且成功地选择了tnOPV的最佳制剂。结果表明,MPBT方法可用作稳定性指示测定法,以评估nOPV的热稳定性。可用于疫苗生产过程中病毒滴度的快速测定,在临床试验中。MPBT测定可以自动化并应用于其他病毒,包括那些没有细胞病变效应的。
    Recently, a multiplex PCR-based titration (MPBT) assay was developed for simultaneous determination of infectious titers of all three Sabin strains of the oral poliovirus vaccine (OPV) to replace the conventional CCID50 assay, which is both time-consuming and laborious. The MPBT assay was shown to be reproducible, robust and sensitive. The conventional and MPBT assays showed similar results and sensitivity. The MPBT assay can be completed in two to three days, instead of ten days for the conventional assay. To prevent attenuated vaccine strains of poliovirus from reversion to virulence, a novel, genetically stable OPV (nOPV) was developed by modifying the genomes of conventional Sabin strains used in OPV. In this work, we evaluated the MPBT assay as a rapid screening tool to support trivalent nOPV (tnOPV) formulation development by simultaneous titration of the three nOPV strains to confirm stability as needed, for the selection of the lead tnOPV formulation candidate. We first assessed the ability of the MPBT assay to discriminate a 0.5 log10 titer difference by titrating the two tnOPV samples (undiluted and threefold-diluted) on the same plate. Once the assay was shown to be discriminating, we then tested different formulations of tnOPV drug products (DPs) that were subjected to different exposure times at 37 °C (untreated group and treated groups: 2 and 7 days at 37 °C), and to three freeze and thaw (FT) cycles. Final confirmation of the down selected formulation candidates was achieved by performing the conventional CCID50 assay, comparing the stability of untreated and treated groups and FT stability testing on the top three candidates. The results showed that the MPBT assay generates similar titers as the conventional assay. By testing two trivalent samples in the same plate, the assay can differentiate a 0.5 log10 difference between the titers of the tested nOPV samples. Also, the assay was able to detect the gradual degradation of nOPV viruses with different formulation compositions and under different time/temperature conditions and freeze/thaw cycles. We found that there were three tnOPV formulations which met the stability criteria of less than 0.5 log10 loss after 2 days\' exposure to 37 ℃ and after three FT cycles, maintaining the potency of all three serotypes in these formulations. The ability of the MPBT assay to titrate two tnOPV lots (six viruses) in the same plate makes it cheaper and gives it a higher throughput for rapid screening. The assay detected the gradual degradation of the tnOPV and was successful in the selection of optimal formulations for the tnOPV. The results demonstrated that the MPBT method can be used as a stability indicating assay to assess the thermal stability of the nOPV. It can be used for rapid virus titer determination during the vaccine manufacturing process, and in clinical trials. The MPBT assay can be automated and applied for other viruses, including those with no cytopathic effect.
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  • 文章类型: Journal Article
    胸膜脓胸是小儿肺炎的严重并发症。细菌培养阴性通常会阻碍最佳抗生素治疗。为了提高细菌鉴定,我们开发了一种分子检测方法,并与细菌培养进行了比较。我们的多重定量PCR检测肺炎链球菌,化脓性链球菌,使用细菌基因组DNA和实验室制备的样品(n=267)评估了金黄色葡萄球菌和流感嗜血杆菌。为了评估临床表现,我们进行了胸部脓胸分子评估(MATE)观察性研究,登记患有脓胸住院的儿童。通过细菌培养和多重qPCR检测胸膜液,和使用研究黄金标准确定的性能。我们确定了临床敏感性和时间到生物体的鉴定,以评估多重qPCR减少经验性非靶向抗生素治疗持续时间的潜力。使用加标样品,多重qPCR对所有生物体均表现出213/215(99.1%)的敏感性和52/52(100%)的特异性.在2019年5月至2023年3月期间,有100名儿童参加了MATE研究;平均年龄为3.9岁(IQR2-5.6)。通过多重qPCR在90/100(90%)标本中鉴定出细菌病原体,细菌培养24/100(24%)(P<0.001)。多重qPCR在68/76(90%)培养阴性标本中鉴定出细菌原因。肺炎链球菌是最常见的病原体,在67/100(67%)标本中鉴定。我们估计我们的多重qPCR将减少61%病例中非靶向抗生素治疗的持续时间,中位数为20天(IQR17.5-23,范围1-55)。与培养物相比,多重qPCR显着增加了病原体检测,并且可以减少非靶向抗生素治疗的持续时间。
    Pleural empyema is a serious complication of pneumonia in children. Negative bacterial cultures commonly impede optimal antibiotic therapy. To improve bacterial identification, we developed a molecular assay and evaluated its performance compared with bacterial culture. Our multiplex-quantitative PCR to detect Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus and Haemophilus influenzae was assessed using bacterial genomic DNA and laboratory-prepared samples (n = 267). To evaluate clinical performance, we conducted the Molecular Assessment of Thoracic Empyema (MATE) observational study, enrolling children hospitalised with empyema. Pleural fluids were tested by bacterial culture and multiplex-qPCR, and performance determined using a study gold standard. We determined clinical sensitivity and time-to-organism-identification to assess the potential of the multiplex-qPCR to reduce the duration of empiric untargeted antibiotic therapy. Using spiked samples, the multiplex-qPCR demonstrated 213/215 (99.1%) sensitivity and 52/52 (100%) specificity for all organisms. During May 2019-March 2023, 100 children were enrolled in the MATE study; median age was 3.9 years (IQR 2-5.6). A bacterial pathogen was identified in 90/100 (90%) specimens by multiplex-qPCR, and 24/100 (24%) by bacterial culture (P <0.001). Multiplex-qPCR identified a bacterial cause in 68/76 (90%) culture-negative specimens. S. pneumoniae was the most common pathogen, identified in 67/100 (67%) specimens. We estimate our multiplex-qPCR would have reduced the duration of untargeted antibiotic therapy in 61% of cases by a median 20 days (IQR 17.5-23, range 1-55). Multiplex-qPCR significantly increased pathogen detection compared with culture and may allow for reducing the duration of untargeted antibiotic therapy.
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  • 文章类型: Journal Article
    视网膜色素变性(RP)是最常见的遗传性视网膜营养不良和失明的主要原因。RP是由多个基因的几种变异引起的,通过识别这些变异进行基因诊断对于优化治疗和估计患者预后很重要。下一代测序(NGS),目前广泛用于诊断,被认为是有用的,但已知在检测拷贝数变异(CNV)方面具有局限性。在这项研究中,我们在EYS中重新评估了CNVs,RP的主要致病基因,使用多重连接依赖性探针扩增(MLPA)通过NGS鉴定。在8名患者的NGS样品中鉴定了CNV。为了识别潜在的CNVs,还对来自42名患者的样本进行了MLPA,这些患者未被NGS诊断,但携带了日本EYS-RP病例中报道的五种主要致病变异之一。通过MLPA确认了8名患者中基于NGS数据的所有疑似CNV。在42例未诊断的NGSRP病例中,有2例发现了CNV。此外,结果显示,661例RP患者中有121例以EYS为致病基因,8.3%(10/121例EYS-RP患者)有CNVs。尽管NGS使用本研究中使用的CNV调用标准未能在两种情况下识别CNV,未检测到假阳性结果.总的来说,这些发现表明NGS在RP的临床诊断中对CNV的检测是有用的。
    Retinitis pigmentosa (RP) is the most common inherited retinal dystrophy and a major cause of blindness. RP is caused by several variants of multiple genes, and genetic diagnosis by identifying these variants is important for optimizing treatment and estimating patient prognosis. Next-generation sequencing (NGS), which is currently widely used for diagnosis, is considered useful but is known to have limitations in detecting copy number variations (CNVs). In this study, we re-evaluated CNVs in EYS, the main causative gene of RP, identified via NGS using multiplex ligation-dependent probe amplification (MLPA). CNVs were identified in NGS samples of eight patients. To identify potential CNVs, MLPA was also performed on samples from 42 patients who were undiagnosed by NGS but carried one of the five major pathogenic variants reported in Japanese EYS-RP cases. All suspected CNVs based on NGS data in the eight patients were confirmed via MLPA. CNVs were found in 2 of the 42 NGS-undiagnosed RP cases. Furthermore, results showed that 121 of the 661 patients with RP had EYS as the causative gene, and 8.3% (10/121 patients with EYS-RP) had CNVs. Although NGS using the CNV calling criteria utilized in this study failed to identify CNVs in two cases, no false-positive results were detected. Collectively, these findings suggest that NGS is useful for CNV detection during clinical diagnosis of RP.
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  • 文章类型: Case Reports
    孢子丝菌病是由土壤中常见的双形孢子丝菌引起的全球分布的皮下真菌病,苔藓,和腐烂的植物物质。淋巴皮肤表现,历史上与职业活动和皂虫传播有关,最近观察到也通过动物接触发生,尤其是在巴西。我们描述了一例罕见的淋巴皮肤孢子丝菌病,同时伴有肺部并发症,这是由于刮伤了南部的三带状Armadillo引起的。Tolypeutesmatacus,主要居住在南美洲中部地区的干旱森林中。使用多重定量聚合酶链反应(qPCR)的形态确定了病原为S.schenckiis.str。,而扩增片段长度多态性(AFLP)分析揭示了一种在巴西中西部流行的新型基因型。患者接受伊曲康唑(200毫克/天)治疗两个月,导致皮肤和肺部症状的实质性临床改善。这个案例强调了动物介导的传播在孢子丝菌病流行病学中的关键作用。特别是在有不同物种的区域内。该病例的异常流行病学和遗传特征强调了在非典型孢子丝菌病表现中需要增强意识和诊断警惕。
    Sporotrichosis is a globally distributed subcutaneous mycosis caused by dimorphic Sporothrix species commonly found in soil, mosses, and decaying plant matter. The lymphocutaneous manifestation, historically associated with occupational activities and sapronotic transmission, has recently been observed to also occur through animal contact, particularly notable in Brazil. We describe a rare case of lymphocutaneous sporotrichosis with simultaneous pulmonary complications resulting from the scratching of a southern three-banded armadillo, Tolypeutes matacus, primarily inhabiting the arid forests of South America\'s central region. Speciation using multiplex quantitative polymerase chain reaction (qPCR) established the etiological agent as S. schenckii s. str., while amplified fragment length polymorphism (AFLP) analysis unveiled a novel genotype circulating in the Midwest of Brazil. The patient received treatment with itraconazole (200 mg/day) for two months, leading to substantial clinical improvement of cutaneous and pulmonary symptoms. This case highlights the critical role of animal-mediated transmission in sporotrichosis epidemiology, particularly within regions with diverse armadillo species. The unusual epidemiology and genetic characteristics of this case emphasize the need for enhanced awareness and diagnostic vigilance in atypical sporotrichosis presentations.
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  • 文章类型: Journal Article
    肉囊虫属包括具有间接生命周期的原生动物寄生虫。结节虫。可以感染各种动物和人类,导致肌囊炎,具有经济重要性和人畜共患关注的寄生虫病。野猪可以作为肉孢子虫和人畜共患的猪孢子虫的中间宿主,它们通过食用生的或未煮熟的感染猪肉来感染人类。在本研究中,检查了在希腊猎杀的123头野猪的the肌组织,以确定肉孢子虫的频率。通过组织压缩和分子技术检查样品。在光学显微镜下,123只野猪中有34只(27.6%)的肉囊虫属试验呈阳性。,而在100个样本中进行的多重PCR显示出更高的感染率(75%)。通过多重PCR扩增并测序了20个样品的mtDNAcox1基因(〜1100bp)。被确定为与这些感染有关的唯一物种。这是有关结节虫的患病率的第一项研究。在希腊的野生动物。Further,需要进行大规模调查,以评估希腊这种寄生虫的患病率和种类,并从“一个健康”的角度设计有效的控制和预防措施。
    The genus Sarcocystis includes protozoan parasites with an indirect life cycle. Sarcocystis spp. can infect various animal species and humans, causing sarcocystosis, a parasitosis of economic importance and zoonotic concern. Wild boars can act as intermediate hosts for Sarcocystis miescheriana and the zoonotic Sarcocystis suihominis that infects humans by consumption of raw or undercooked infected swine meat. In the present study, the diaphragmatic muscle tissue of 123 wild boars hunted in Greece was examined to determine the frequency of Sarcocystis spp. The samples were examined by tissue compression and molecular techniques. Under light microscopy, 34 out of 123 (27.6%) wild boars tested positive for Sarcocystis spp., while a higher infection prevalence (75%) was revealed by multiplex PCR performed in 100 of the samples. The partial mtDNA cox1 gene (~ 1100 bp) of 20 samples tested positive for S. miescheriana by multiplex PCR was amplified and sequenced. Sarcocystis miescheriana was identified as the only species involved in these infections. This is the first study on the prevalence of Sarcocystis spp. in wild animals in Greece. Further, large-scale surveys are needed to assess the prevalence and species of this parasite in Greece and to design efficient control and preventive measures in a One Health perspective.
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  • 文章类型: Case Reports
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  • 文章类型: Journal Article
    犬传染性呼吸道疾病综合征(CIRDC)是一种高度传染性疾病。犬呼吸道冠状病毒(CRCoV),犬流感病毒(CIV),犬瘟热病毒(CDV),犬副流感病毒(CPiV)是引起CIRDC的关键病原体。由于这些病毒引起的类似临床症状,仅基于症状的鉴别诊断可能具有挑战性。在这项研究中,开发了一种多重实时PCR检测方法,用于检测CIRDC的四种RNA病毒。设计针对CRCoVM基因的特异性引物和探针,CIV的M基因,CDV的N基因和CPiV的NP基因。CIV或CRCoV的检测限为10拷贝/μL,CDV或CPiV的检测限为100拷贝/μL。组内和组间重复性变异系数(CV)均小于2%。共分析了341个临床犬样本,结果表明,与常规逆转录PCR方法相比,本研究建立的方法具有良好的一致性和更好的特异性。这项研究提供了一种新的方法,能够在单一反应中同时检测所有四种病原体,提高CIRDC中四种病毒流行率的监测效率,这有利于CIRDC的控制。
    Canine Infectious Respiratory Disease Complex (CIRDC) is a highly infectious diseases. Canine respiratory coronavirus (CRCoV), Canine influenza virus (CIV), Canine distemper virus (CDV), and Canine parainfluenza virus (CPiV) are crucial pathogens causing CIRDC. Due to the similar clinical symptoms induced by these viruses, differential diagnosis based solely on symptoms can be challenging. In this study, a multiplex real-time PCR assay was developed for detecting the four RNA viruses of CIRDC. Specific primers and probes were designed to target M gene of CRCoV, M gene of CIV, N gene of CDV and NP gene of CPiV. The detection limit is 10 copies/μL for CIV or CRCoV, while the detection limit of CDV or CPiV is 100 copies/μL. Intra-group and inter-group repeatability coefficient of variation (CV) were both less than 2 %. A total of 341 clinical canine samples were analyzed, and the results indicated that the method developed in our study owns a good consistency and better specificity compared with the conventional reverse transcription PCR. This study provides a new method to enable the simultaneous detection of all four pathogens in a single reaction, improving the efficiency for monitoring the prevalence of four viruses in CIRDC, which benefits the control of CIRDC.
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  • 文章类型: Journal Article
    已知非脊髓灰质炎肠道病毒感染会引起多种疾病和神经系统并发症。还已知这些疾病的严重程度在具有不同基因型和等位基因的个体之间有很大差异。特定基因内的单核苷酸多态性(SNP)对肠道病毒的免疫反应和疾病的结果有相当大的影响,导致并发症和感染易感性的变化。了解此类SNP的分布对于个体病例管理和研究肠道病毒感染的流行病学参数可能是有价值的。在这个可行性研究中,已经开发了一种称为SNaPshot测定的多重形式的基于引物延伸的技术,用于检测各种相关基因中的SNP,以预测肠道病毒感染的临床严重程度.已经确定这种技术是精确的,一致,可扩展,并可能表现出高通量。多重SNaPshot可以同时研究多个遗传易感标记,该测定法可用于识别脆弱人群,了解感染的流行病学,管理肠道病毒的爆发。根据文献,鉴定了怀疑在肠道病毒感染后对最坏结果具有较高易感性的15个SNP,并开发了该测定。收集100名健康志愿者的血液样品并测试测定可行性以及了解15种选择的SNP的比例。经过分析,已经鉴定了七个SNP,并建议考虑用于未来的测定。根据试验结果,看来,在确定的七个SNP中,任何三个SNP的阳性都可能表明风险较高,未来的研究与有和没有严重疾病的患者的临床研究相关,利用该测定将提供可靠的参数,以更准确地确定有风险的个体。
    Non-polio enterovirus infections are known to cause a variety of diseases and neurological complications. It is also known that the severity of these diseases largely differs among individuals with different genotypes and alleles. The Single Nucleotide Polymorphisms (SNPs) within specific genes have a considerable effect on the immune response to enteroviruses and on the outcome of disease, leading to variations in complications and infection susceptibility. Knowing the distribution of such SNPs can be valuable for individual case management and studying epidemiological parameters of enterovirus infections. In this feasibility study, a multiplex version of the primer extension-based technique called the SNaPshot Assay has been developed to examine SNPs in various relevant genes for predicting the clinical severity of enterovirus infections. It is already established that this technique is precise, consistent, scalable, and likely to exhibit high throughput. The multiplex SNaPshot can investigate multiple genetic susceptibility markers simultaneously, and the assay can be used to identify vulnerable populations, understand the epidemiology of infections, and manage the outbreaks of enteroviruses. Based on the literature, 15 SNPs were identified which are suspected for higher susceptibility to the worst outcomes after enterovirus infection and the assay was developed. Blood samples of 100 healthy volunteers were collected and tested for assay feasibility as well as to know the proportions of 15 selected SNPs. After the analysis, seven SNPs have been identified and suggested to be considered for future assays. Based on the pilot test results, it appears that positivity for any three out of the identified seven SNPs might indicate a higher risk, and future studies correlated with clinical studies among patients with and without severe diseases utilizing this assay will provide robust parameters to determine at-risk individuals more accurately.
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