Abstract
In the past few years, interest in the development of digital PCR (dPCR) as a direct nucleic acid amplification technique for clinical viral diagnostics has grown. The main advantages of dPCR over qPCR include: quantification of nucleic acid concentrations without a calibration curve, comparable sensitivity, superior quantitative precision, greater resistance to perturbations by inhibitors, and increased robustness to the variability of the target sequence. In this review, we address the application of dPCR to viral nucleic acid quantification in clinical applications and for nucleic acid quantification standardization. Further development is required to overcome the current limitations of dPCR in order to realize its widespread use for viral load measurements in clinical diagnostic applications.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: This work was supported by the National High Technology Research and Development Program (863 Program) (2011AA02A116) and the National Natural Science Foundation of China (81201347).
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet 2012;379:1245–55.10.1016/S0140-6736(11)61347-0Search in Google Scholar
2. Mukaide M, Sugiyama M, Korenaga M, Murata K, Kanto T, Masaki N, et al. High-throughput and sensitive next-generation droplet digital PCR assay for the quantitation of the hepatitis C virus mutation at core amino acid 70. J Virol Methods 2014;207:169–77.10.1016/j.jviromet.2014.07.006Search in Google Scholar PubMed
3. Pavšič J, Devonshire AS, Parkes H, Schimmel H, Foy CA, Karczmarczyk M, et al. Standardization of nucleic acid tests for clinical measurements of bacteria and viruses. J Clin Microbiol 2015;53:2008–14.10.1128/JCM.02136-14Search in Google Scholar PubMed PubMed Central
4. Proietti FA, Carneiro-Proietti AB, Catalan-Soares BC, Murphy EL. Global epidemiology of HTLV-I infection and associated diseases. Oncogene 2005;24:6058–68.10.1038/sj.onc.1208968Search in Google Scholar PubMed
5. Gullett JC, Nolte FS. Quantitative nucleic acid amplification methods for viral infections. Clin Chem 2015;61:72–8.10.1373/clinchem.2014.223289Search in Google Scholar PubMed
6. Sidransky D, Tokino T, Hamilton SR, Kinzler KW, Levin B, Frost P, et al. Identification of ras oncogene mutations in the stool of patients with curable colorectal tumors. Science 1992;256:102–5.10.1126/science.1566048Search in Google Scholar PubMed
7. Hall Sedlak R, Jerome KR. The potential advantages of digital PCR for clinical virology diagnostics. Expert Rev Mol Diagn 2014;14:501–7.10.1586/14737159.2014.910456Search in Google Scholar PubMed
8. Hayden RT, Gu Z, Ingersoll J, Abdul-Ali D, Shi L, Pounds S, et al. Comparison of droplet digital PCR to real-time PCR for quantitative detection of cytomegalovirus. J Clin Microbiol 2013;51:540–6.10.1128/JCM.02620-12Search in Google Scholar PubMed PubMed Central
9. Dong L, Meng Y, Sui Z, Wang J, Wu L, Fu B. Comparison of four digital PCR platforms for accurate quantification of DNA copy number of a certified plasmid DNA reference material. Sci Rep 2015,25;5:13174.10.1038/srep13174Search in Google Scholar PubMed PubMed Central
10. Shen F, Sun B, Kreutz JE, Davydova EK, Du W, Reddy PL, et al. Multiplexed quantification of nucleic acids with large dynamic range using multivolume digital RT-PCR on a rotational SlipChip tested with HIV and hepatitis C viral load. J Am Chem Soc 2011;133:17705–12.10.1021/ja2060116Search in Google Scholar PubMed PubMed Central
11. Sedlak RH, Cook L, Cheng A, Magaret A, Jerome KR. Clinical utility of droplet digital PCR for human cytomegalovirus. J Clin Microbiol 2014;52:2844–8.10.1128/JCM.00803-14Search in Google Scholar PubMed PubMed Central
12. Huggett JF, Cowen S, Foy CA. Considerations for digital PCR as an accurate molecular diagnostic tool. Clin Chem 2015;61:79–88.10.1373/clinchem.2014.221366Search in Google Scholar PubMed
13. Huggett JF, Foy CA, Benes V, Emslie K, Garson JA, Haynes R, et al. The digital MIQE guidelines: minimum Information for Publication of Quantitative Digital PCR Experiments. Clin Chem 2013;59:892–902.10.1373/clinchem.2013.206375Search in Google Scholar PubMed
14. Nixon G, Garson JA, Grant P, Nastouli E, Foy CA, Huggett JF. Comparative study of sensitivity, linearity,and resistance to inhibition of digital and nondigital polymerase chainreaction and loop mediated isothermal amplification assays for quantification of human cytomegalovirus. Anal Chem 2014:6;86:4387–94.10.1021/ac500208wSearch in Google Scholar PubMed
15. Dingle TC, Sedlak RH, Cook L, Jerome KR. Tolerance of droplet-digital PCR vs real-time quantitative PCR to inhibitory substances. Clin Chem 2013;59:1670–2.10.1373/clinchem.2013.211045Search in Google Scholar PubMed PubMed Central
16. Huang JT, Liu YJ, Wang J, Xu ZG, Yang Y, Shen F, et al. Next generation digital PCR measurement of hepatitis B virus copy number in formalin-fixed paraffin-embedded hepatocellular carcinoma tissue. Clin Chem 2015;61:290–6.10.1373/clinchem.2014.230227Search in Google Scholar PubMed
17. Mu D, Yan L, Tang H, Liao Y. A sensitive and accurate quantification method for the detection of hepatitis B virus covalently closed circular DNA by the application of a droplet digital polymerase chain reaction amplification system. Biotechnol Lett 2015;37:2063–73.10.1007/s10529-015-1890-5Search in Google Scholar PubMed
18. Boizeau L, Laperche S, Désiré N, Jourdain C, Thibault V, Servant-Delmas A. Could droplet digital PCR be used instead of real-time PCR for quantitative detection of the hepatitis B virus genome in plasma? J Clin Microbiol 2014 52:3497–8.10.1128/JCM.01306-14Search in Google Scholar PubMed PubMed Central
19. Alidjinou EK, Bocket L, Hober D. Quantification of viral DNA during HIV-1 infection: A review of relevant clinical uses and laboratory methods. Pathol Biol (Paris) 2015;63:53–9.10.1016/j.patbio.2014.07.007Search in Google Scholar PubMed
20. Strain MC, Richman DD. New assays for monitoring residual HIV burden in effectively treated individuals. Curr Opin HIV AIDS 2013;8:106–10.10.1097/COH.0b013e32835d811bSearch in Google Scholar PubMed PubMed Central
21. Henrich TJ, Gallien S, Li JZ, Pereyra F, Kuritzkes DR. Low-level detection and quantitation of cellular HIV-1 DNA and 2-LTR circles using droplet digital PCR. J Virol Methods 2012;186:68–72.10.1016/j.jviromet.2012.08.019Search in Google Scholar PubMed PubMed Central
22. Strain MC, Lada SM, Luong T, Rought SE, Gianella S, Terry VH, et al. Highly precise measurement of HIV DNA by droplet digital PCR. PLoS One 2013;8:e55943.10.1371/journal.pone.0055943Search in Google Scholar PubMed PubMed Central
23. De Spiegelaere W, Malatinkova E, Kiselinova M, Bonczkowski P, Verhofstede C, Vogelaers D, et al. Touchdown digital polymerase chain reaction for quantification of highly conserved sequences in the HIV-1 genome. Anal Biochem 2013 15;439:201–3.10.1016/j.ab.2013.04.024Search in Google Scholar PubMed
24. Kiselinova M, Pasternak AO, De Spiegelaere W, Vogelaers D, Berkhout B, Vandekerckhove L. Comparison of droplet digital PCR and seminested real-time PCR for quantification of cell-associated HIV-1 RNA. PLoS One 2014;21:9:e85999.10.1371/journal.pone.0085999Search in Google Scholar PubMed PubMed Central
25. Sanders R, Mason DJ, Foy CA, Huggett JF. Evaluation of digital PCR for absolute RNA quantification. PLoS One 2013;20:8:e75296.10.1371/journal.pone.0075296Search in Google Scholar PubMed PubMed Central
26. Rački N, Morisset D, Gutierrez-Aguirre I, Ravnikar M. One-step RT-droplet digital PCR: a breakthrough in the quantification of waterborne RNA viruses. Anal Bioanal Chem 2014;406:661–7.10.1007/s00216-013-7476-ySearch in Google Scholar PubMed PubMed Central
27. Sedlak RH, Jerome KR. Viral diagnostics in the era of digital polymerase chain reaction. Diagn Microbiol Infect Dis 2013;75:1–4.10.1016/j.diagmicrobio.2012.10.009Search in Google Scholar PubMed PubMed Central
28. Sedlak RH, Cook L, Huang ML, Magaret A, Zerr DM, Boeckh M, et al. Identification of chromosomally integrated human herpesvirus 6 by droplet digital PCR. Clin Chem 2014;60:765–72.10.1373/clinchem.2013.217240Search in Google Scholar PubMed PubMed Central
29. Leibovitch EC, Brunetto GS, Caruso B, Fenton K, Ohayon J, Reich DS, et al. Coinfection of human herpesviruses 6A (HHV-6A) and HHV-6B as demonstrated by novel digital droplet PCR assay. PLoS One 2014;24:9:e9232.10.1371/journal.pone.0092328Search in Google Scholar PubMed PubMed Central
30. Brunetto GS, Massoud R, Leibovitch EC, Caruso B, Johnson K, Ohayon J, et al. Digital droplet PCR (ddPCR) for the precise quantification of human T-lymphotropic virus 1 proviral loads in peripheral blood and cerebrospinal fluid of HAM/TSP patients and identification of viral mutations. J Neurovirol 2014;20:341–51.10.1007/s13365-014-0249-3Search in Google Scholar PubMed PubMed Central
31. Haynes RJ, Kline MC, Toman B, Scott C, Wallace P, Butler JM, et al. Standard reference material 2366 for measurement of human cytomegalovirus DNA. J Mol Diagn 2013;15:177–85.10.1016/j.jmoldx.2012.09.007Search in Google Scholar PubMed
32. White H, Deprez L, Corbisier P, Hall V, Lin F, Mazoua S, et al. A certified plasmid reference material for the standardization of BCR-ABL1 mRNA quantification by real-time quantitative PCR. Leukemia 2015;29:369–76.10.1038/leu.2014.217Search in Google Scholar PubMed PubMed Central
©2016 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Editorials
- The Theranos phenomenon, scientific transparency and freedom of speech
- Holotranscobalamin: in the middle of difficultly lies opportunity
- Review
- Laboratory and clinical risk assessment to treat myelodysplatic syndromes
- Mini Review
- Quantitative nucleic acid amplification by digital PCR for clinical viral diagnostics
- Genetics and Molecular Diagnostics
- Hybrid minigene splicing assay verified the pathogenicity of a novel splice site variant in the dystrophin gene of a Chinese patient with typical Duchenne muscular dystrophy phenotype
- General Clinical Chemistry and Laboratory Medicine
- Prospective validation of an automated chemiluminescence-based assay of renin and aldosterone for the work-up of arterial hypertension
- Sex steroid hormone stability in serum tubes with and without separator gels
- Reduced absorption and enhanced synthesis of cholesterol in patients with cystic fibrosis: a preliminary study of plasma sterols
- An International Standard for holotranscobalamin (holoTC): international collaborative study to assign a holoTC value to the International Standard for vitamin B12 and serum folate
- A technical and clinical evaluation of a new assay for inhibin A and its use in second trimester Down syndrome screening
- Investigation on the ability of first trimester glycodelin and angiopoietin-2 to predict small-for-gestational age pregnancies at delivery
- Plasma total C-terminal agrin fragment (tCAF) as a marker for kidney function in patients with chronic kidney disease
- Hematology and Coagulation
- Thirty-minutes’ exposure to smartphone call triggers neutrophil activation in vitro
- Performance of the XN-2000 WPC channel-flagging to differentiate reactive and neoplastic leukocytosis
- Differences in lupus anticoagulant final conclusion through clotting time or Rosner index for mixing test interpretation
- Reference Values and Biological Variations
- Derivation of level-specific reference change values (RCV) from a health screening database and optimization of their thresholds based on clinical utility
- Cancer Diagnosis
- BRAF analysis before surgery for papillary thyroid carcinoma: correlation with clinicopathological features and prognosis in a single-institution prospective experience
- Letters to the Editor
- Significant increase of serum prostate-specific antigen after exercise
- Serum delipidation but not high-speed centrifugation is effective in clearing lipemia interference in serum lipase activity measurement
- A relationship between absolute monocyte count and C-reactive protein in patients with migraine undergoing no pharmacological therapy
- Validation of the “Vacutainer® urinalysis preservative plus urine tube” for the determination of albumin and protein
- Performance evaluation of a novel automated HIV Ag/Ab chemiluminescence immunoassay
- SLC26A4 genotypes associated with enlarged vestibular aqueduct malformation in south Italian children with sensorineural hearing loss
- Is cystatin C level altered in women with polycystic ovary syndrome?
- Venous thromboembolism in a patient with persistent inhibitor to coagulation factor V – a case report
- Free light chains nephelometric assay: human urine stability in different storage conditions
- Comparing the viscoelastomeric fibrin polymerization assays FIBTEM® (ROTEM) vs. Functional Fibrinogen® (TEG): or why is a higher threshold for fibrinogen substitution better than a lower one?
- Reply to: Comparing the visco-elastomeric fibrin polymerization assays FIBTEM® (ROTEM) vs. Functional Fibrinogen® (TEG): or why is a higher threshold for fibrinogen substitution better than a lower one? By Schöchl et al.
- Congress Abstracts
- 5th Slovenian Congress of Clinical Chemistry and Laboratory Medicine
Articles in the same Issue
- Frontmatter
- Editorials
- The Theranos phenomenon, scientific transparency and freedom of speech
- Holotranscobalamin: in the middle of difficultly lies opportunity
- Review
- Laboratory and clinical risk assessment to treat myelodysplatic syndromes
- Mini Review
- Quantitative nucleic acid amplification by digital PCR for clinical viral diagnostics
- Genetics and Molecular Diagnostics
- Hybrid minigene splicing assay verified the pathogenicity of a novel splice site variant in the dystrophin gene of a Chinese patient with typical Duchenne muscular dystrophy phenotype
- General Clinical Chemistry and Laboratory Medicine
- Prospective validation of an automated chemiluminescence-based assay of renin and aldosterone for the work-up of arterial hypertension
- Sex steroid hormone stability in serum tubes with and without separator gels
- Reduced absorption and enhanced synthesis of cholesterol in patients with cystic fibrosis: a preliminary study of plasma sterols
- An International Standard for holotranscobalamin (holoTC): international collaborative study to assign a holoTC value to the International Standard for vitamin B12 and serum folate
- A technical and clinical evaluation of a new assay for inhibin A and its use in second trimester Down syndrome screening
- Investigation on the ability of first trimester glycodelin and angiopoietin-2 to predict small-for-gestational age pregnancies at delivery
- Plasma total C-terminal agrin fragment (tCAF) as a marker for kidney function in patients with chronic kidney disease
- Hematology and Coagulation
- Thirty-minutes’ exposure to smartphone call triggers neutrophil activation in vitro
- Performance of the XN-2000 WPC channel-flagging to differentiate reactive and neoplastic leukocytosis
- Differences in lupus anticoagulant final conclusion through clotting time or Rosner index for mixing test interpretation
- Reference Values and Biological Variations
- Derivation of level-specific reference change values (RCV) from a health screening database and optimization of their thresholds based on clinical utility
- Cancer Diagnosis
- BRAF analysis before surgery for papillary thyroid carcinoma: correlation with clinicopathological features and prognosis in a single-institution prospective experience
- Letters to the Editor
- Significant increase of serum prostate-specific antigen after exercise
- Serum delipidation but not high-speed centrifugation is effective in clearing lipemia interference in serum lipase activity measurement
- A relationship between absolute monocyte count and C-reactive protein in patients with migraine undergoing no pharmacological therapy
- Validation of the “Vacutainer® urinalysis preservative plus urine tube” for the determination of albumin and protein
- Performance evaluation of a novel automated HIV Ag/Ab chemiluminescence immunoassay
- SLC26A4 genotypes associated with enlarged vestibular aqueduct malformation in south Italian children with sensorineural hearing loss
- Is cystatin C level altered in women with polycystic ovary syndrome?
- Venous thromboembolism in a patient with persistent inhibitor to coagulation factor V – a case report
- Free light chains nephelometric assay: human urine stability in different storage conditions
- Comparing the viscoelastomeric fibrin polymerization assays FIBTEM® (ROTEM) vs. Functional Fibrinogen® (TEG): or why is a higher threshold for fibrinogen substitution better than a lower one?
- Reply to: Comparing the visco-elastomeric fibrin polymerization assays FIBTEM® (ROTEM) vs. Functional Fibrinogen® (TEG): or why is a higher threshold for fibrinogen substitution better than a lower one? By Schöchl et al.
- Congress Abstracts
- 5th Slovenian Congress of Clinical Chemistry and Laboratory Medicine