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Rapid, Loop-Mediated Isothermal Amplification Detection of Celiac Disease Risk Alleles

https://doi.org/10.1016/j.jmoldx.2018.01.005Get rights and content
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Human leukocyte antigen (HLA) genotyping has become a useful investigation in the diagnostic work-up of celiac disease (CD), with utility in risk stratification and screening. However, broad application of this technology has been hindered by the cost and time burden of conventional laboratory-based assays. We have developed and validated CD–loop-mediated isothermal amplification (CD-LAMP), a LAMP assay, which enables rapid identification of the signature CD risk genotypes, HLA-DQ2.5, HLA-DQ8, HLA-DQ2.2, and HLA-DQA1*05. Sample-to-answer is achieved in approximately 65 minutes without DNA purification, thermal cycling, or specialized analytical equipment. CD-LAMP genotyping of samples was 100% concordant with accredited pathology genotyping on a panel of 40 blood and 20 saliva samples. In a panel of 100 purified DNA samples, genotyping of the high-risk DQ2.5 genotype was 100% concordant with accredited pathology genotyping, with slightly reduced sensitivity for the DQ8 genotype (97.1%) and reduced specificity for the DQ8 (93.9%) and DQ2.2 (95.1%) genotypes. CD-LAMP results are easily visualized and instrument free through the addition of a DNA intercalating dye after amplification. Combined with point-of-care antibody testing, CD-LAMP may enable immediate, confident CD diagnosis at a low cost in the clinical setting.

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Supported by an Australian Postgraduate Award scholarship (M.E.), a Melbourne Neuroscience Institute postgraduate award (M.E.), the Mathison Centenary Fellowship from the University of Melbourne (J.A.T.-D.), and Coeliac Australia (J.A.T.-D.).

Disclosures: J.A.T.-D. is a co-inventor of patents pertaining to the use of gluten peptides in therapeutics, diagnostics, and nontoxic gluten, is a shareholder of Nexpep Pty Ltd, and is a consultant to ImmusanT, Inc.