Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA.
Abbott Pandemic Defense Coalition, Abbott Park, IL, USA.
Nat Commun. 2024 Nov 12;15(1):9016. doi: 10.1038/s41467-024-51470-y.
Tools for rapid identification of novel and/or emerging viruses are urgently needed for clinical diagnosis of unexplained infections and pandemic preparedness. Here we developed and clinically validated a largely automated metagenomic next-generation sequencing (mNGS) assay for agnostic detection of respiratory viral pathogens from upper respiratory swab and bronchoalveolar lavage samples in <24 h. The mNGS assay achieved mean limits of detection of 543 copies/mL, viral load quantification with 100% linearity, and 93.6% sensitivity, 93.8% specificity, and 93.7% accuracy compared to gold-standard clinical multiplex RT-PCR testing. Performance increased to 97.9% overall predictive agreement after discrepancy testing and clinical adjudication, which was superior to that of RT-PCR (95.0% agreement). To enable discovery of novel, sequence-divergent human viruses with pandemic potential, de novo assembly and translated nucleotide algorithms were incorporated into the automated SURPI+ computational pipeline used by the mNGS assay for pathogen detection. Using in silico analysis, we showed that after removal of all human viral sequences from the reference database, 70 (100%) of 70 representative human viral pathogens could still be identified based on homology to related animal or plant viruses. Our assay, which was granted breakthrough device designation from the US Food and Drug Administration (FDA) in August of 2023, demonstrates the feasibility of routine mNGS testing in clinical and public health laboratories, thus facilitating a robust and rapid response to the next viral pandemic.
目前迫切需要用于临床不明原因感染的诊断和大流行防范的快速鉴定新型和/或新兴病毒的工具。在此,我们开发并临床验证了一种主要自动化的宏基因组下一代测序(mNGS)检测方法,可在 24 小时内从上呼吸道拭子和支气管肺泡灌洗液样本中对呼吸道病毒病原体进行无偏倚检测。mNGS 检测方法的平均检测限为 543 拷贝/ml,具有 100%线性的病毒载量定量,与金标准临床多重 RT-PCR 检测相比,灵敏度为 93.6%,特异性为 93.8%,准确性为 93.7%。经过差异测试和临床判断后,整体预测一致性提高到 97.9%,优于 RT-PCR(95.0%的一致性)。为了能够发现具有大流行潜力的新型、序列差异的人类病毒,新的组装和翻译核苷酸算法被纳入 mNGS 检测用于病原体检测的自动化 SURPI+计算管道。通过计算机模拟分析,我们表明,在从参考数据库中删除所有人类病毒序列后,仍然可以根据与相关动物或植物病毒的同源性鉴定 70 种(100%)代表的 70 种人类病毒病原体。我们的检测方法已于 2023 年 8 月获得美国食品和药物管理局(FDA)突破性设备认定,证明了常规 mNGS 检测在临床和公共卫生实验室中的可行性,从而为应对下一次病毒大流行提供了强大而快速的反应。
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