Abstract
BackgroundThe development of easy-to-perform diagnostic methods is highly important for detecting current coronavirus disease (COVID-19). This pilot study aimed at developing a lateral flow assay (LFA)-based test prototype to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus in saliva samples.MethodsMice were immunized using the recombinant receptor-binding domain (rRBD) of SARS-CoV-2 virus spike protein. The combinations of the obtained mouse anti-receptor-binding domain (RBD) polyclonal antibodies (PAbs) and several commercial antibodies directed against the SARS-CoV-2 spike protein were used for enzyme-linked immunosorbent assay (ELISA) to select antibody pairs for LFA. The antibody pairs were tested in a LFA format using saliva samples from individuals with early SARS-CoV-2 infection (n = 9). The diagnostic performance of the developed LFA was evaluated using saliva samples from hospitalized COVID-19 patients (n = 111); the median time from the onset of symptoms to sample collection was 10 days (0–24 days, interquartile range (IQR): 7–13). The reverse transcription-polymerase chain reaction (rRT-PCR) was used as a reference method.ResultsBased on ELISA and preliminary LFA results, a combination of mouse anti-RBD PAbs (capture antibody) and rabbit anti-spike PAbs (detection antibody) was chosen for clinical analysis of sample. When compared with rRT-PCR results, LFA exhibited 26.5% sensitivity, 58.1% specificity, 50.0% positive prediction value (PPV), 33.3% negative prediction value (NPV), and 38.7% diagnostic accuracy. However, there was a reasonable improvement in assay specificity (85.7%) and PPV (91.7%) when samples were stratified based on the sampling time.ConclusionThe developed LFA assay demonstrated a potential of SARS-CoV-2 detection in saliva samples. Further technical assay improvements should be made to enhance diagnostic performance followed by a validation study in a larger cohort of both asymptomatic and symptomatic patients in the early stage of infection.
Highlights
Severe acute respiratory syndrome coronavirus-2, namely SARSCoV-2, is a novel strain of coronavirus belonging to the genus Betacoronavirus, which primarily causes interstitial pneumonia; in severe cases it may affect other organ systems [1, 2]
This study aimed to develop a lateral flow assay (LFA)-based test prototype directed against SARS-CoV-2 antigens in saliva samples
The antibody A obtained in this study by mouse immunization with receptor-binding domain (rRBD) and commercial antibodies showed comparable reactivity toward the rS1/S2 antigen
Summary
Severe acute respiratory syndrome coronavirus-2, namely SARSCoV-2, is a novel strain of coronavirus belonging to the genus Betacoronavirus, which primarily causes interstitial pneumonia; in severe cases it may affect other organ systems [1, 2]. The real-time reverse transcription-polymerase chain reaction (rRT-PCR) is the primary diagnostic method to detect viral ribonucleic acid (RNA) in nasopharyngeal and oropharyngeal swabs [5]. The development of easy-to-perform diagnostic methods is highly important for detecting current coronavirus disease (COVID-19). This pilot study aimed at developing a lateral flow assay (LFA)based test prototype to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus in saliva samples. The combinations of the obtained mouse anti-receptor-binding domain (RBD) polyclonal antibodies (PAbs) and several commercial antibodies directed against the SARS-CoV-2 spike protein were used for enzyme-linked immunosorbent assay (ELISA) to select antibody pairs for LFA. The antibody pairs were tested in a LFA format using saliva samples from individuals with early SARS-CoV-2 infection (n = 9). Further technical assay improvements should be made to enhance diagnostic performance followed by a validation study in a larger cohort of both asymptomatic and symptomatic patients in the early stage of infection
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