Research ArticleInfectious Disease

Rapid antigen tests for dengue virus serotypes and Zika virus in patient serum

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Science Translational Medicine  27 Sep 2017:
Vol. 9, Issue 409, eaan1589
DOI: 10.1126/scitranslmed.aan1589
  • Fig. 1. NS1 protein alignment and linear epitope mapping of the 10 antibodies used to run the DENV serotype–specific NS1 rapid tests, pan-DENV NS1 test, and ZIKV NS1 test.

    (A) Table listing mAb names, mAb immunochromatography applications, mAb linear epitope sequences and starting amino acid positions, and NS1 domain positions. (B) Comparison of amino acid similarity based on analysis of NS1 protein sequences from the following viruses: DENV1 (strain Singapore/S275/1990), accession number P33478; DENV2 (strain New Guinea C), accession number AAA42941; DENV3 (strain Philippines/H87/1956), accession number AAA99437; DENV4 (strain Singapore/8976/1995), accession number AAV31422; ZIKV, accession number KU497555.1. Amino acid sequences were compared using Color Align Conservation www.bioinformatics.org/sms2/color_align_cons.html to enhance the output of sequence alignment program. Residues that are identical among the sequences are boxed. Linear peptide epitopes (B) are italicized and indicated in color in the figure, with the key to the right of the figure.

  • Fig. 2. Rapid immunochromatography for specific detection of DENV NS1 proteins (serotypes 1 to 4) and ZIKV NS1 protein.

    (A and B) Images of rapid test strips. Strip numbers refer to the DENV serotype NS1 (1 to 4), pan-DENV (P; all four DENV serotype NS1 proteins), or ZIKV NS1 (Z) detected. rNS1 proteins, indicated with an “r” preceding the virus name, were prepared at 500 ng/ml, and the strips were run using 50 μl of solution. Strip #1 (detects DENV1), mAb pair 912/271; strip #2 (detects DENV2), mAb pair 243/1; strip #3 (detects DENV3), mAb pair 411/55; strip #4 (detects DENV4), mAb pair 626/55; strip P (“pan-DENV”; detects all four DENV serotypes), mAb pair 271-243-411-626/323; strip Z (detects ZIKV), mAb pair 130/110. The test proteins run on the strips are recombinant DENV NS1 serotypes 1 to 4 (rDENV1 to rDENV4), as well as rNS1 proteins from ZIKV (rZIKV), rWNV, rYFV, rJEV, and rTBEV. C, control; NS1, detection site for specific NS1 protein. (C to E) Limits of detection for viral NS1 proteins using the serotype-specific (SSp) DENV strips 1 to 4 (C), the pan-DENV strip (D), and the ZIKV strip (E). The limits of detection, representing three independent determinations, are recorded in the figures. Each point (C to E) is presented as the means and SD. (F) NS1-containing supernatants from Vero cells infected with DENV1–4 (Vs DENV1–4) or ZIKV [Vs ZIKV-U (Uganda) or ZIKV-B (Brazil)] were chromatographed on strips 1 to 4, pan-DENV (P), or ZIKV (Z) NS1 strips. The arrows indicate the strips with positive NS1 signals. Horizontal test lines (F) result from applying antibodies to the nitrocellulose using a mechanical striper device; the circular dot signals result from applying antibodies to the nitrocellulose using a standard pipettor.

  • Fig. 3. Applying the rapid test to analyze human patient sera.

    (A) Map showing the endemic virus regions where the rapid tests were deployed to analyze patient serum samples. The areas of the circles correlate with the numbers of samples analyzed. The blue colors, faint to dark, represent DENV1–4. ZIKV is indicated in orange color. (B) ELISA results showing the amounts of DENV NS1 (left) and ZIKV NS1 (right) found in patient serum and supernatants from infected cell cultures. Lanes 1 and 6 are supernatants from Vero cells infected with DENV; lanes 2 and 7 are supernatants from Vero cells infected with ZIKV. Lanes 3 and 8 are PCR-negative sera; lanes 4 and 9 are sera from PCR-positive DENV patients. Lanes 5 and 10 are sera from PCR-positive ZIKV patients. (C) Images of rapid test analysis of DENV NS1 serotypes 1 to 4 and ZIKV NS1 on serotype-specific strips 1 to 4, as well as pan-DENV (P) and ZIKV (Z); the upward arrows mark positive tests, and θ is serum from an uninfected patient. (D to G) Quantification of rapid test results. Dipstick tests were run with PCR-confirmed DENV sera or ELISA-validated ZIKV serum (C), and the resulting signals were quantified and expressed as box plots. Statistical significance, based on one-way analysis of variance (ANOVA), is indicated as ***P < 0.001. (H) Statistical significance, based on an unpaired t test, is presented as *P < 0.05. In the box-and-whisker plots, the black × represents the maximum and minimum measured normalized intensity values, whereas the small square box (□☐) represents the mean value, and the larger box represents the 25 to 75% range of the data. Individual colored points represented individual patient samples measured. (I and J) Images of rapid tests showing that DENV and ZIKV NS1 tests do not cross-react. (I) Supernatants from Vero cells infected with DENV4 were chromatographed on DENV serotype strips 1 to 4 on the pan-DENV strip (P) and on the ZIKV NS1 strip (Z). (J) Supernatants from Vero cells infected with ZIKV were chromatographed on DENV serotype strips 1 to 4, on the pan-DENV strip (P), and on the ZIKV NS1 strip (Z). (K) Images of rapid tests showing ZIKV NS1 are detected in serum samples concentrated five times, but ZIKV NS1 is not detected in concentrated urine. Three sets of paired serum and urine samples were concentrated five times by filter centrifugation and chromatographed on the ZIKV dipsticks. S, serum; U, urine. (I to K) The red boxes and vertical black lines serve as fiducial markers for image recognition and processing. Upward arrows indicate positive tests using the serum samples. (L to N) Quantification of NS1 protein in supernatants of Vero cells infected separately with three DENV4 patient isolates (L) or three ZIKV patient isolates (M) or five paired serum/urine patient samples (N). (L to N) One-way ANOVA was used to calculate statistical significance of the dengue and Zika tests: ***P < 0.001. In the box-and-whisker plots, the black × represents the maximum and minimum measured normalized intensity values, whereas the black box (□) represents the mean value, and the larger box represents the 25 to 75% range of the data. Individual colored points represented individual patient samples measured.

  • Fig. 4. ROC analysis, sensitivity/specificity analysis, and 95% confidence intervals of the dengue and Zika tests.

    (A) ROC curve analysis of the patient sample data collected for DENV1–4, pan-DENV, and ZIKV. TPR, true-positive rate (sensitivity); FPR, false-positive rate (1 − specificity). (B) Table listing numerical values of the sensitivity and specificity results. AUC, area under the curve; Conf. int., confidence interval.

Supplementary Materials

  • www.sciencetranslationalmedicine.org/cgi/content/full/9/409/eaan1589/DC1

    Materials and Methods

    Fig. S1. Stepwise strategy for identifying mAbs that differentiate the closely related NS1 proteins of DENV1–4 and ZIKV.

    Fig. S2. Repertoire of antigen-specific antibodies among DENV and ZIKV mAbs.

    Fig. S3. Limit of detection comparison.

    Fig. S4. The Standard Diagnostics DENV NS1 test cross-reacts with ZIKV NS1 protein.

    Fig. S5. DENV NS1 and ZIKV NS1 detection expressed as days after onset of fever symptoms.

    Fig. S6. Laboratory-made gold nanoparticles for detecting DENV NS1 in rapid test format.

    Fig. S7. NS1 detection by rapid tests in secondary infections.

    Table S1. Stepwise description of the approaches used to define antibodies that detect and distinguish DENV1–4 NS1 and the ZIKV NS1 proteins.

    Table S2. Amino acid homology and identity among DENV NS1 and ZIKV NS1 proteins.

    Table S3. Matrix of mAb pair trials.

    Table S4. List of mAbs used in the rapid tests, relative binding values, and summary of final use in the DENV and ZIKV immunochromatography tests.

    Table S5. Individual subject-level data.

    References (47, 48)

  • Supplementary Material for:

    Rapid antigen tests for dengue virus serotypes and Zika virus in patient serum

    Irene Bosch, Helena de Puig, Megan Hiley, Marc Carré-Camps, Federico Perdomo-Celis, Carlos F. Narváez, Doris M. Salgado, Dewahar Senthoor, Madeline O'Grady, Elizabeth Phillips, Ann Durbin, Diana Fandos, Hikaru Miyazaki, Chun-Wan Yen, Margarita Gélvez-Ramírez, Rajas V. Warke, Lucas S. Ribeiro, Mauro M. Teixeira, Roque P. Almeida, José E. Muñóz-Medina, Juan E. Ludert, Mauricio L. Nogueira, Tatiana E. Colombo, Ana C. B. Terzian, Patricia T. Bozza, Andrea S. Calheiros, Yasmine R. Vieira, Giselle Barbosa-Lima, Alexandre Vizzoni, José Cerbino-Neto, Fernando A. Bozza, Thiago M. L. Souza, Monique R. O. Trugilho, Ana M. B. de Filippis, Patricia C. de Sequeira, Ernesto T. A. Marques, Tereza Magalhaes, Francisco J. Díaz, Berta N. Restrepo, Katerine Marín, Salim Mattar, Daniel Olson, Edwin J. Asturias, Mark Lucera, Mohit Singla, Guruprasad R. Medigeshi, Norma de Bosch, Justina Tam, Jose Gómez-Márquez, Charles Clavet, Luis Villar, Kimberly Hamad-Schifferli,* Lee Gehrke*

    *Corresponding author. Email: kim.hamad{at}umb.edu (K.H.-S.); lgehrke{at}mit.edu (L.G.)

    Published 27 September 2017, Sci. Transl. Med. 9, eaan1589 (2017)
    DOI: 10.1126/scitranslmed.aan1589

    This PDF file includes:

    • Materials and Methods
    • Fig. S1. Stepwise strategy for identifying mAbs that differentiate the closely related NS1 proteins of DENV1–4 and ZIKV.
    • Fig. S2. Repertoire of antigen-specific antibodies among DENV and ZIKV mAbs.
    • Fig. S3. Limit of detection comparison.
    • Fig. S4. The Standard Diagnostics DENV NS1 test cross-reacts with ZIKV NS1 protein.
    • Fig. S5. DENV NS1 and ZIKV NS1 detection expressed as days after onset of fever symptoms.
    • Fig. S6. Laboratory-made gold nanoparticles for detecting DENV NS1 in rapid test format.
    • Fig. S7. NS1 detection by rapid tests in secondary infections.
    • Table S1. Stepwise description of the approaches used to define antibodies that detect and distinguish DENV1–4 NS1 and the ZIKV NS1 proteins.
    • Table S2. Amino acid homology and identity among DENV NS1 and ZIKV NS1 proteins.
    • Table S3. Matrix of mAb pair trials.
    • Table S4. List of mAbs used in the rapid tests, relative binding values, and summary of final use in the DENV and ZIKV immunochromatography tests.
    • References (47, 48)

    [Download PDF]

    Other Supplementary Material for this manuscript includes the following:

    • Table S5 (Microsoft Excel format). Individual subject-level data.

    [Download Table S5]

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