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6 protocols using lightmix sarbecov e gene

1

SARS-CoV-2 Detection Protocols Comparison

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(Assay I) Nucleic acid extraction was performed using the MagNAPure® 96 DNA and Viral NA Kit, followed by amplification on LightCycler® 480II (Roche Diagnostics, Mannheim, Germany) according to the manufacturer's instructions. Detection of SARS-CoV-2 was conducted using the RealStar® SARS-CoV-2 RT-PCR Kit1.0 (altona Diagnostics, Hamburg, Germany) or LightMix®SarbecoV E-gene plus equine arteritis virus (EAV) control (TibMolBiol, Berlin, Germany). (Assay II) Processing of swabs was implemented with Panther Fusion® Hologic® and SARS-CoV-2 was detected using 5 μl of total RNA in 20 μl of LightMix®SarbecoV E-gene plus β-globin as internal control (TibMolBiol, Berlin, Germany). As second target the N-gene was amplified (inhouse primer sets in multiplex PCR, data unpublished). (Assay III) Detection of SARS-CoV-2 was performed on a Roche cobas®6800 using the cobas® SARS-CoV-2 kit targeting the E-gene/ORF-1a/b regions according to manufacturer's protocol.
SARS-CoV-2 was quantified using dilution series of cell culture supernatant extrapolated to approved standards (INSTAND e.V., Düsseldorf, Germany), measured in all assays, and Ct-values adjusted to Assay III (Cta).
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2

SARS-CoV-2 RT-qPCR Detection Protocol

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The 5 μl of the extracted RNA elute/sample was subjected to RT-qPCR for the qualitative detection of SARS-CoV-2 RNA utilizing with AgPath-IDTM One-Step RT-PCR Reagents (Thermo Fisher Scientific) using a Applied biosystem (ABI) 7500 Real Time PCR system (Thermo Fisher Scientific) and LightMix® SarbecoV E-gene (TIB MOLBIOL). Reactions were heated to 55°C for 5 minutes for reverse transcription, denatured in 95°C for 5 minutes and then 45 cycles of amplification were carried out for 95°C for 5 seconds and 60°C for 15 seconds using FAM parameter for E gene. This assay targets the detection of E gene for SARS as well as nCoV-2. The primer details are given in Table 1. All samples that were screened positive for E gene were confirmed by performance of RT-qPCR for the detection of specific RdRP gene of SARS-CoV-2 using LightMix® Modular SARS-CoV-2 RdRP (TIB MOLBIOL) using similar PCR conditions as described above.
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3

SARS-CoV-2 RT-PCR Detection Protocol

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Reverse transcriptase-polymerase chain reaction (RT-PCR) was used as the reference test. The RT-PCR samples were collected by health-care workers using nasopharyngeal swabs. At the study laboratory, the samples were initially lysed to inactivate any viral agent, followed by extraction of the viral RNA in separate biosafety class 2 cabinets. The next step involved the mastermix preparation and template addition in separate hoods. The final stage was amplification using AriaMx real-time PCR thermocycler. The reagent used was LightMix SarbecoV E-gene (manufacturer TIB MOLBIOL) which is the standard assay used in the Public Health Reference Laboratory. The assay targets only the E-gene of SARS-CoV-2. Further details and test properties can be found in the instructions for use [16 ]. A Ct value of <40 is interpreted as a positive and Ct values ≥40 as a negative test result for SARS-CoV-2.
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4

Quantifying SARS-CoV-2 Viral Load by qPCR

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Cycle threshold values for quantifying viral load in naso/oro-pharyngeal swabs was done by qPCR using LightMix® SarbecoV E-gene(Corman et al., 2020 (link)) plus EAV control (TIB Molbiol, Berlin, Germany) in combination with the N-gene (inhouse primer sets in multiplex PCR) on LightCycler® 480 (Roche Diagnostics).
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5

Multimodal Approach for SARS-CoV-2 Identification

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SARS-CoV-2 infections were identified using a multimodal approach in which biomaterial was collected at baseline and follow-up. To identify acute infection, throat swabs were analyzed by quantitative reverse transcription polymerase chain reaction (RT-qPCR) using the Light Mix SarbecoV E-gene (plus EAV control) and RdRP-gene (TIB Molbiol, Germany). The methods used for RT-qPCR have been described elsewhere (laboratory 2) [17 (link)]. EDTA plasma samples were analyzed for circulating antibodies to the SARS-CoV-2 nucleocapsid with a qualitative microparticle chemiluminescent immunoassay (Architect SARS-CoV-2 IgG, Abbott, Germany) with a threshold of 1.4 relative light units and second, a qualitative microparticle electro-chemiluminescence immunoassay (Elecsys Anti-SARS-CoV-2 Pan-Ig, Roche, Germany) with a cutoff index of 0.8. Any self-reported PCR results were additionally included which were collected retrospectively via a computer-assisted personal interview and continuously via a weekly smartphone-app survey. Individuals were considered infected if any of these measurements were positive. Detailed information on sample preprocessing and storage is provided in the Supplementary Appendix.
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6

Comparative SARS-CoV-2 RT-qPCR Detection

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Different SARS-CoV-2 RT-qPCR protocols were used for detection of SARS-CoV-2. In brief, the following methods were used: (i) cobas® SARS-CoV-2 test kit running on the cobas 6800® (Roche Diagnostics, Mannheim, Germany) was used for 385 (55.32%) samples according to the manufacturer's instructions. (ii) SARS-CoV-2 AMP kit on the Alinity m (Abbott, Illinois, USA) was used for 62 (8.91%) samples. (iii) Multiplex RT-qPCR with LightMix® SarbecoV E-gene (TIB Molbiol, Berlin, Germany) running on the Panther Fusion® (Hologic, Wiesbaden, Germany) was used for 2 (0.29%) samples. (iv) For 244 (35.06%) specimens, samples from up to ten asymptomatic employees were pooled and tested for SARS-CoV-2 infection using the methods (i) and (ii). All samples within a negative pool were considered negative. For positive pools all samples were retested individually using the methods (i) and (ii). (v) Xpert® Xpress SARS-CoV-2 (Cepheid, Sunnyvale, USA) test kit was used for 3 (0.43%) samples according to the manufacturer's instructions. To enable comparison of Cycle threshold (Ct) values between different RT-qPCR protocols, Ct values were translated into copies/ml and converted to a cobas 6800®-adjusted Ct value. Detailed descriptions of the RT-qPCR protocols and Ct value conversion can be found in previous publications [10 , 27 ].
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