This work was supported by King Abdullah University of Science and Technology through core funding and the National Term Grand Challenge (NTGC) to S.M.H.

1. Taq polymerase expression and purification
<ol>
	<li>Construct a plasmid with a cleavable hexa-histidine tag at the C-terminus of the enzyme.</li>
	<li>Transform 50 ng of the expression vector into E. coli BL21-(DE3) strain following the standard protocol38.</li>
	<li>Inoculate the transformed cells in four 6 L flasks each containing 2 L of 2YT media broth at 37 &#176;C with shaking at 170 rpm until the OD 600 of 0.8 or cell number 6.4 x 108 is reached.</l...

Multiplex RT-qPCR Assay for Respiratory Virus Detection

There is a heavy economic burden on the healthcare system worldwide resulting from the high infection and mortality rates due to the spread of common respiratory viruses such as SARS-CoV-2, Influenza A/B and MERS-CoV variants12,19,20. Motivated by the sense of responsibility towards alleviating this burden, we realized the need for a quick, precise and accessible diagnostic assay such as RT-qPCR to distinguish between these comm...

The pandemic of the ongoing coronavirus disease 2019 (COVID-19) is caused by the novel coronavirus known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)1. Due to SAR-CoV-2&#39;s strong contagiousness and capacity for rapid transmission, the COVID-19 pandemic emerged in Wuhan City, China, and spread quickly throughout the world. This eventually led to the start of respiratory distress signs and even death2,3,4. COVID-19 has been declared a pandemic in more than 213 countries, expecting a steep increase in the number of confirmed cases, as evidenced by the papers published by different research studies3,5. COVID-19 is transmitted primarily by small respiratory droplets that infected individuals release into the environment and then get exposed to vulnerable individuals through inhalation or close contact with contaminated surfaces. When these droplets come into contact with the mucosa of the eyes, mouth, or nose, a person may become infected6. Statistics released by the World Health Organization (WHO) show that there have been more than 76 million confirmed cases of the pandemic worldwide, with a staggering 7 million deaths7. Thus, the United Nations classified the pandemic caused by COVID-19 disease as a disaster because of its direct impact on the lives of billions of people around the globe and had far-reaching economic, environmental, and social effects.
Public health initiatives including thorough testing, early detection, contact tracing, and case isolation have all been shown to be crucial in keeping this pandemic under control8,9,10,11. The winter months will increase the circulation of other respiratory viruses like Influenza A and B with COVID-19-like symptoms making it difficult to identify, track down, and isolate COVID-19 instances early on. Every year, Influenza A and B outbreak starts in the late fall or early January with a predictable seasonality12. Numerous epidemiological traits are shared by SARS-CoV-2 and Influenza viruses. Besides, sharing similarities in the susceptible populations which include children, the elderly, immunocompromised, and individuals with chronic comorbidities such as asthma, chronic obstructive pulmonary disease, cardiac and renal failure, or diabetes12,13. These viruses not only share vulnerable populations but also transmission routes of contact and respiratory droplets14. It is anticipated that patients may likely contract more than one of these respiratory viruses as flu season approaches14. For that, the screening of SARS-CoV-2 and the Influenza viruses needs to be done on symptomatic patients before they are isolated. Running separate tests for the three viruses (SARS-CoV-2, Influenza A, and Influenza B) is not possible due to the global lack of resources for nucleic acid extraction and diagnostics. In order to screen them all in one reaction, a method or test needs to be developed.
Middle East respiratory syndrome (MERS)-CoV is a human coronavirus (CoV) family member. The first MERS-CoV virus isolates came from a hospitalized patient in Saudi Arabia who had died in September 2012 due to acute respiratory issues15. There is evidence that suggests that a prominent reservoir host for MERS-CoV is dromedary camels. It has been proven that viruses from infected dromedary camels are zoonotic and thus can infect humans16,17. Humans infected with this virus can spread it to others through close contact18. As of January 26th,&#160;2018, there had been 2143 laboratory-confirmed cases of MERS-CoV infection including 750 deaths globally19. The most typical MERS-CoV symptoms are coughing, fever, and shortness of breath. MERS-CoV infections have also been reported to exhibit pneumonia, diarrhea and gastrointestinal sickness symptoms20. Currently, no commercial vaccine or specific treatment for MERS-CoV is available. Therefore, prompt and precise diagnosis is essential for preventing the widespread MERS-CoV outbreaks and differentiating MERS-CoV from SARS-CoV-2 disease.
To date, many approaches have been proposed to detect these viruses such as multiplex RT-PCR21,22,23,24,25, CRISPR/Cas1226,27, CRISPR/Cas928, and CRISPR/Cas329, lateral flow immunoassay30, paper-based biomolecular sensors31, SHERLOCK testing in one pot32, DNA aptamer33, loop-mediated isothermal amplification (LAMP)19,34, etc. Each of the aforementioned methods has unique benefits and drawbacks in terms of sensitivity and specificity. Among these methods, the nucleic acid amplification-based test: multiplex qRT-PCR, is the most common and is considered to be the gold standard for the diagnosis of SARS-CoV-2, Influenza A, Influenza B, and MERS-CoV.
In this study, we designed and assessed various primer combinations and probes for the effective, accurate, and simultaneous detection of SARS-CoV-2, Influenza A, Influenza B, and SARS-CoV-2, MERS-CoV utilizing standard twist synthetic viral RNAs. The multiplexed assays developed for either MERS-CoV or SARS-CoV-2 target genes are recommended by the World Health Organization (WHO). These genes generally encode proteins and complexes that contribute to the formation of a replication/transcription complex (RTC)35 such as the region within the open reading frame 1a (ORF1a) that is used for MERS-CoV assay. In addition, structural proteins are encoded by the genes utilized in diagnostic assays such as the upstream region of envelope gene (upE) and nucleocapsid gene (N) which are used for MERS-CoV and SARS-Cov-2 assays, respectively35,36. We used in-house R3T one-step RT-qPCR kit to establish the RT-qPCR for the detection of viruses37. Virus detection, sensitivity, specificity, and dynamic range of our R3T one-step RT-qPCR kit and primer sets were tested and evaluated using 10-fold serial dilutions of the standard twist synthetic RNAs. The lowest practical detection limit was approximately 10 transcripts copies per reaction. As a result, the in-house R3T one-step RT-qPCR kit and primer/probe sets can be successfully used and implemented for routine simultaneous diagnosis of SARS-CoV-2, Influenza A, Influenza B, and SARS-CoV-2, MERS-CoV.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>0.45 &#956;m filter cups</td>
			<td>Thermo Scientific</td>
			<td>291-4545</td>
			<td></td>
		</tr>
		<tr>
			<td>10X Tris-Glycine SDS running buffer</td>
			<td>Novex</td>
			<td>LC2675</td>
			<td></td>
		</tr>
		<tr>
			<td>6-well tissue culturing plates</td>
			<td>Corning</td>
			<td>353046</td>
			<td></td>
		</tr>
		<tr>
			<td>Ammonium sulfate</td>
			<td>Fisher Scientific</td>
			<td>A701-3</td>
			<td></td>
		</tr>
		<tr>
			<td>Ampicillin</td>
			<td>Corning</td>
			<td>61-238-RH</td>
			<td></td>
		</tr>
		<tr>
			<td>Cation exchange (HiTrap SP HP) 5 mL</td>
			<td>Cytiva</td>
			<td>17-1152-01</td>
			<td></td>
		</tr>
		<tr>
			<td>D-(+)-Biotin, 98+%</td>
			<td>Thermo Scientific</td>
			<td>A14207.60</td>
			<td></td>
		</tr>
		<tr>
			<td>DH10Bac competent cells</td>
			<td>Fisher Scientific</td>
			<td>10361012</td>
			<td></td>
		</tr>
		<tr>
			<td>Dialysis bag (Snakeskin 10,000 MWC)</td>
			<td>Thermo Scientific</td>
			<td>68100</td>
			<td></td>
		</tr>
		<tr>
			<td>Dithiothreitol (DTT)</td>
			<td>Thermo Scientific</td>
			<td>R0862</td>
			<td></td>
		</tr>
		<tr>
			<td>Dnase/Rnase Free Distilled Water</td>
			<td>Ambion</td>
			<td>AM9930</td>
			<td></td>
		</tr>
		<tr>
			<td>dNTPs</td>
			<td>Thermo Scientific</td>
			<td>R0192</td>
			<td></td>
		</tr>
		<tr>
			<td>E. coli BL21(DE3) competent cells</td>
			<td>Invitrogen</td>
			<td>C600003</td>
			<td></td>
		</tr>
		<tr>
			<td>EDTA</td>
			<td>Fisher Scientific</td>
			<td>BP120-1</td>
			<td></td>
		</tr>
		<tr>
			<td>Elution Buffer</td>
			<td>Qiagen</td>
			<td>19086</td>
			<td></td>
		</tr>
		<tr>
			<td>ESF 921 insect cell culture medium (Insect cells media)</td>
			<td>Expression Systems</td>
			<td>96-001-01</td>
			<td></td>
		</tr>
		<tr>
			<td>FBS Solution</td>
			<td>Gibco</td>
			<td>A38400-01</td>
			<td></td>
		</tr>
		<tr>
			<td>Fugene (transfection reagent)</td>
			<td>Promega</td>
			<td>E2311</td>
			<td></td>
		</tr>
		<tr>
			<td>Gentamicin</td>
			<td>Fisher Scientific</td>
			<td>15750060</td>
			<td></td>
		</tr>
		<tr>
			<td>Glycerol</td>
			<td>Sigma Aldrich</td>
			<td>G5516-500</td>
			<td></td>
		</tr>
		<tr>
			<td>IGEPAL CA-630</td>
			<td>Sigma Aldrich</td>
			<td>I8896-100ml</td>
			<td></td>
		</tr>
		<tr>
			<td>Imidazole</td>
			<td>Sigma Aldrich</td>
			<td>56750-1Kg</td>
			<td></td>
		</tr>
		<tr>
			<td>Influenza A (H1N1) synthetic RNA</td>
			<td>Twist Bioscience</td>
			<td>103001</td>
			<td></td>
		</tr>
		<tr>
			<td>Influenza A (H3N2)&#160; synthetic RNA</td>
			<td>Twist Bioscience</td>
			<td>103002</td>
			<td></td>
		</tr>
		<tr>
			<td>Influenza B synthetic RNA</td>
			<td>Twist Bioscience</td>
			<td>103003</td>
			<td></td>
		</tr>
		<tr>
			<td>IPTG</td>
			<td>Gold Biotechnology</td>
			<td>I3481C100</td>
			<td></td>
		</tr>
		<tr>
			<td>Kanamycin</td>
			<td>Gibco</td>
			<td>11815-032</td>
			<td></td>
		</tr>
		<tr>
			<td>LB Agar</td>
			<td>Fisher Scientific</td>
			<td>BP1425-500</td>
			<td></td>
		</tr>
		<tr>
			<td>LB Broth media</td>
			<td>Fisher Scientific</td>
			<td>BP1426-500</td>
			<td></td>
		</tr>
		<tr>
			<td>Lysozyme</td>
			<td>Sigma Aldrich</td>
			<td>L6876-10G</td>
			<td></td>
		</tr>
		<tr>
			<td>Magnesium Chloride</td>
			<td>Sigma Aldrich</td>
			<td>13152-1Kg</td>
			<td></td>
		</tr>
		<tr>
			<td>MERS-CoV synthetic RNA</td>
			<td>Twist Bioscience</td>
			<td>103015</td>
			<td></td>
		</tr>
		<tr>
			<td>MicroAmp Fast Optical 96-well Reaction plates with Barcode (0.1 mL)</td>
			<td>Applied Biosystems</td>
			<td>10310855</td>
			<td></td>
		</tr>
		<tr>
			<td>Mini- PROTEAN TGX Precast Gel</td>
			<td>Bio-Rad</td>
			<td>456-1093</td>
			<td></td>
		</tr>
		<tr>
			<td>Miniprep kit</td>
			<td>Qiagen</td>
			<td>27106</td>
			<td></td>
		</tr>
		<tr>
			<td>Ni-NTA Excel (HisTrap Excel) 5 mL</td>
			<td>Cytiva</td>
			<td>17-3712-06</td>
			<td></td>
		</tr>
		<tr>
			<td>Ni-NTA HP (HisTrap HP) 5 mL</td>
			<td>Cytiva</td>
			<td>17-5248-02</td>
			<td></td>
		</tr>
		<tr>
			<td>Optical Adhesice Covers (PCR Compatible,DNA/Rnase/PCR Inhibitors Free</td>
			<td>Applied Biosystems</td>
			<td>4311971</td>
			<td></td>
		</tr>
		<tr>
			<td>Potassium Chloride</td>
			<td>Fisher Bioreagents</td>
			<td>BP366-1</td>
			<td></td>
		</tr>
		<tr>
			<td>Primers and Probes</td>
			<td>Integrated DNA Technologies, Inc.</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Protease Inhibitor Mini tablets EDTA-Free</td>
			<td>Thermo Scientific</td>
			<td>A32955</td>
			<td></td>
		</tr>
		<tr>
			<td>Protein marker</td>
			<td>Fermentas</td>
			<td>26616</td>
			<td></td>
		</tr>
		<tr>
			<td>RT-qPCR machine (QuantStudio 7 Flex)</td>
			<td>Applied Biosystems</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>S.O.C medium</td>
			<td>Fisher Scientific</td>
			<td>15544034</td>
			<td></td>
		</tr>
		<tr>
			<td>SARS-CoV-+A2:C442 synthetic RNA</td>
			<td>Twist Bioscience</td>
			<td>102024</td>
			<td></td>
		</tr>
		<tr>
			<td>Sf9 insect cells</td>
			<td>Gibco</td>
			<td>A35243</td>
			<td></td>
		</tr>
		<tr>
			<td>Sodium Chloride</td>
			<td>Sigma Aldrich</td>
			<td>S3014-1Kg</td>
			<td></td>
		</tr>
		<tr>
			<td>StrepTrap XT 5 mL</td>
			<td>Cytiva</td>
			<td>29401323</td>
			<td></td>
		</tr>
		<tr>
			<td>Tetracycline</td>
			<td>IBI Scientific</td>
			<td>IB02200</td>
			<td></td>
		</tr>
		<tr>
			<td>Tris Base Molecular Biology Grade</td>
			<td>Promega</td>
			<td>H5135</td>
			<td></td>
		</tr>
		<tr>
			<td>Tris-HCl</td>
			<td>Affymetrix</td>
			<td>22676</td>
			<td></td>
		</tr>
		<tr>
			<td>Tween 20</td>
			<td>Sigma Aldrich</td>
			<td>P1379-100ml</td>
			<td></td>
		</tr>
		<tr>
			<td>X-Gal</td>
			<td>Invitrogen</td>
			<td>B1690</td>
			<td></td>
		</tr>
	</tbody>
</table>

development of multiplex real-time rt-qpcr assays for the detection of sars-cov-2, influenza a/b, and mers-cov

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes Coronavirus disease 2019 (COVID-19) is a serious threat to the general public&#39;s health. During influenza seasons, the spread of SARS-CoV-2 and other respiratory viruses may cause a population-wide burden of respiratory disease that is difficult to manage. For that, the respiratory viruses SARS-CoV-2, Influenza A, Influenza B, and Middle East respiratory syndrome (MERS-CoV) will need to be carefully watched over in the upcoming fall and winter seasons, particularly in the case of SARS-CoV-2, Influenza A, and Influenza B, which share similar epidemiological factors like susceptible populations, mode of transmission, and clinical syndromes. Without target-specific assays, it can be challenging to differentiate among cases of these viruses owing to their similarities. Accordingly, a sensitive and targeted multiplex assay that can easily differentiate between these viral targets will be useful for healthcare practitioners. In this study, we developed a real-time reverse transcriptase-PCR-based assay utilizing an in-house developed R3T one-step RT-qPCR kit for simultaneous detection of SARS-CoV-2, Influenza A, Influenza B, and SARS-CoV-2, MERS-CoV. With as few as 10 copies of their synthetic RNAs, we can successfully identify SARS-CoV-2, Influenza A, Influenza B, and MERS-CoV targets simultaneously with 100% specificity. This assay is found to be accurate, reliable, simple, sensitive, and specific. The developed method can be used as an optimized SARS-CoV-2, Influenza A, Influenza B, and SARS-CoV-2, MERS-CoV diagnostic assay in hospitals, medical centers, and diagnostic laboratories as well as for research purposes.

Author Spotlight: Advancements in Multiplex Detection of Respiratory Viruses 

Development of Multiplex Real-Time RT-qPCR Assays for the Detection of SARS-CoV-2, Influenza A/B, and MERS-CoV

In recent years, there have been significant advances in the diagnostic approach for detecting common respiratory viruses using PCR approaches21,22,23,24,25. However, despite these advancements, the multiplexed approach, which allows for detecting multiple viruses in a single test, has not been widely implemented, particularly in the RT-qPCR platform. This met...

Watch this Scientific Journal Video about Advancements in Multiplex Detection of Respiratory Viruses at JoVE.com

We present two probe-based in-house one-step RT-qPCR kits for common respiratory viruses. The first assay is for SARS-CoV-2 (N), Influenza A (H1N1 and H3N2), and Influenza B. The second is for SARS-Cov-2 (N) and MERS (UpE and ORF1a). These assays can be successfully implemented in any specialized laboratory.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes Coronavirus disease 2019 (COVID-19) is a serious threat to the general ...

development-multiplex-real-time-rt-qpcr-assays-for-detection-sars-cov