Background
Members of the
Anopheles gambiae complex are the major vectors of malaria in sub-Saharan Africa. One of the most effective vector-directed malaria control strategies involves the use of insecticide-treated bednets (ITNs) [
1‐
4]. The only class of insecticides presently licensed for this purpose are the pyrethroids which show low mammalian toxicity and fast knockdown activity. Unfortunately, the intensive use of pyrethroids, including their indirect use in agriculture, has led to reports of reduced efficacy [
5,
6].
Pyrethroids act on the insect nervous system by altering the normal function of the
para-type sodium channel, resulting in prolonged channel opening that causes increased nerve impulse transmission, leading to paralysis and death [
7,
8]. Resistance to pyrethroids is often associated with alterations (point mutations) in the
para-type sodium channel gene, that cause reduced neuronal sensitivity. This resistance mechanism was first identified in the house fly
Musca domestica and was termed knockdown resistance or
kdr [
9]. Subsequent analyses demonstrated that
kdr was caused by a leucine to phenylalanine (L1014F) replacement in transmembrane segment 6 of domain II of the sodium channel [
10]. Two amino acid substitutions at the same position (L1014F and L1014S) have been reported in pyrethroid resistant
An. gambiae initially in
An. gambiae s.s. [
11,
12] and more recently in
Anopheles arabiensis [
13,
14]. In several West African countries the predominant
kdr mutation in
An. gambiae populations is the leucine to phenyalanine substitution (L1014F) termed
kdr west (
kdr- w), whilst in East African populations the leucine to serine (L1014S) termed
kdr east (
kdr-e) is more common [
14‐
19]. Recently, individuals heterozygous for both the
kdr-w and
kdr-e alleles have been reported [
20,
21].
Sensitive detection of the mutations associated with resistance is a prerequisite for resistance management strategies aimed at prolonging insecticide life while maintaining sufficient insect control. This type of monitoring requires rapid high-throughput assays and there are currently several different methods available for detecting the DNA changes responsible for
kdr in
An. gambiae. The most widely used method is based on Allele Specific PCR (AS-PCR) [
11,
12], but more recently a number of other assays have been described including Heated Oligonucleotide Ligation Assay (HOLA) [
22], Sequence Specific Oligonucleotide Probe Enzyme-Linked ImmunoSorbent Assay (SSOP-ELISA) [
23], PCR-Dot Blot [
24], Fluorescence Resonance Energy Transfer (FRET)/Melt Curve analysis [
20] and PCR elongation with fluorescence [
25]. However, to date there are few reports comparing the performance and relative advantages and disadvantages (safety, cost, speed, simplicity etc.) of these assays under comparable conditions. Here a single blind comparison of the performance of four of these assays with two newly developed fluorescence-based high-throughput assays (TaqMan and High Resolution Melt – HRM) was carried out using a 96 sample reference plate containing DNAs from a variety of field-collected
Anopheles individuals representing all the known
kdr genotypes.
Methods
Mosquito collections and preparation of 96 sample reference plate
For the initial optimisation of each assay mosquitoes were either obtained from two laboratory colonies, Kisumu (susceptible line from Kenya) and RSP (homozygous for the East African
kdr mutation), or were field-caught samples from Burkina Faso, Ghana, Kenya and Cameroon. Genotypes of individuals were confirmed by sequencing of the relevant region of the
para-type sodium channel gene as described previously [
12].
All detection assays were performed on a standard 96 well test plate. The 96 sample test plate was comprised of genomic DNA of representative mosquito individuals of all the known
kdr genotypes including three individuals heterozygous for both the east and west
kdr alleles. The plate included DNA from
An. gambiae s.s (both S and M forms)
An. arabiensis, Anopheles quadriannulatus, Anopheles melas, Anopheles merus and
Anopheles funestus. The amount of DNA was variable between samples to test the sensitivity of each assay. DNA concentration was determined by absorption at 260 nm using a NanoDrop spectrophotometer (NanoDrop Technologies). The plate also included a number of
Plasmodium falciparum DNA samples and water blanks as negative controls. The details of each of the 96 samples (including species, molecular form, collection location, DNA concentration and
kdr genotype) is given in Additional file
1. This information was withheld from the persons who carried out the testing of each assay to ensure no bias occurred in the scoring of results. For all samples DNA was extracted from single mosquitoes using either the Livak or Ballinger Crabtree methods [
26,
27] or DNAzol reagent (Molecular Research Center, Inc) at one-fifth the recommended reagent volume for each extraction. The DNAs were resuspended in either TE buffer or sterile water at volumes between 100 and 200 μl. Species identification was carried out using an established PCR assay [
28] and specimens had been assigned a putative
kdr genotype by AS-PCR [
11,
12], HOLA [
22] or DNA sequencing. After the blind genotyping trials any samples of ambiguous
kdr genotype were sequenced.
AS-PCR
AS-PCR was carried out following the methods in the original descriptions of AS-PCR for
kdr detection in
Anopheles [
11,
12]. Two reported methods of modifications to these assays were also investigated [
20,
29]. All four protocols were performed using three different DNA polymerases/master mixes, Dynazyme II (Finzymes), PCR master mix (Promega) HotStarTaq Plus Master Mix Kit (Qiagen) and three different PCR machines a GeneAmp™ PCR System 2700 a Techne Genius and a Techne Progene. In all cases amplifications were performed in 25 μl reactions using 1 μl template. After comparison of all protocols/polymerase kits the protocol of Verhaeghen
et al [
20] using the 2 × PCR master mix (Promega) was selected to genotype the 96 sample reference plate.
TaqMan
Previous work characterizing the para gene region encoding domain II S4–S6 of the sodium channel from a range of insect species has shown that this region contains an intron very close to the kdr mutation site. In many insect species this intron shows a degree of variation (nucleotide substitutions or insertions/deletions) between different stains/isolates which would affect the performance of any assay that uses primer binding sites within this region. Therefore, nucleotide alignments of all the An. gambiae and An. arabiensis domain II sodium channel gene sequences available in the National Center for Biotechnology Information (NCBI) database were compared and a region around the kdr site which was conserved in all isolates/species was selected for primer/probe design.
Forward and reverse primers and three minor groove binding (MGB) probes (Applied Biosystems) were designed using the Primer Express™ Software Version 2.0. Primers
kdr-Forward (5'-CATTTTTCTTGGCCACTGTAGTGAT-3'), and
kdr-Reverse (5'-CGATCTTGGTCCATGTTAATTTGCA-3') were standard oligonucleotides with no modification. The probe WT (5'-CTTACGACTAAATTTC-3') was labelled with VIC at the 5' end for the detection of the wildtype allele, the probes
kdr W (5'-ACGACAAAATTTC-3') and
kdr E (5'-ACGACTGAATTTC-3') were labelled with 6-FAM for detection of the
kdr-w and
kdr-e alleles respectively. Each probe also carried a 3' non-fluorescent quencher and a minor groove binder at the 3' end. The minor groove binder provides more accurate allelic discrimination by increasing the T
M between matched and mis-matched probes [
30]. The primers
kdr-Forward and
kdr-Reverse and the WT probe were used in one assay with probe
kdr W for
kdr-w detection and in a second assay with probe
kdr E for
kdr-e detection.
PCR reactions (25 μl) contained 1 μl of genomic DNA, 12.5 μl of SensiMix DNA kit (Quantace), 900 nM of each primer and 200 nM of each probe. Samples were run on a Rotor-Gene 6000™ (Corbett Research) using the temperature cycling conditions of: 10 minutes at 95°C followed by 40 cycles of 95°C for 10 seconds and 60°C for 45 seconds. The increase in VIC and FAM fluorescence was monitored in real time by acquiring each cycle on the yellow (530 nm excitation and 555 nm emission) and green channel (470 nm excitation and 510 emission) of the Rotor-Gene respectively.
The TaqMan assays were also performed using a standard PCR machine followed by endpoint measurements using a fluorimeter. For this the PCR reactions were set up as described above and run on a GeneAmp™ PCR System 2700 (Applied Biosystems) using temperature cycling conditions of: 10 minutes at 95°C followed by 40 cycles of 92°C for 15 seconds and 60°C for 1 minute. Reactions were then transferred to black half-area microtitre plates (Costar) and read in a FLx800 fluorimeter (Biotek) using 485/20 excitation and 528/20 emission filters for FAM detection and 530/25 excitation and 560/10 emission filters for VIC detection. The sensitivity of the FLx800 was adjusted for FAM and VIC fluorescence to achieve the maximum dynamic range without exceeding the maximum threshold. To determine the background level of fluorescence of the assay three or more no template controls were included in each run and the fluorescence values of these reactions averaged and subtracted from all values. To aid in genotype scoring a cut-off threshold was established by subtracting a further percentage of the averaged negative control value to create only positive or negative values. Percentages varied for the different probe fluorophore measurements. For the east and west assay susceptible probes labelled with VIC, an additional 15% was subtracted. For the kdr-w allele specific probe (VIC), an additional 20% was subtracted and for the kdr-e specific probe, an additional 60% was subtracted. The cut-off values given here were found to work well with the master mix and conditions described above. However, when using different master mixes or fluorimeters the cut-off thresholds were found to vary, so if alternative conditions are to be used optimization with templates of known genotype may be required.
HRM
The design of a HRM assay for
kdr detection followed the recommendations in previous reports of this technique [
31‐
33]. The same forward and reverse primers (
kdr-Forward and
kdr-Reverse) that were used in the TaqMan assay were also used for HRM as they efficiently amplified a small product of 71 bp. PCR reactions contained 1 μl of genomic DNA, 12.5 μl of SensiMix DNA kit (Quantace), 300 nM of each primer and 1.5 μM of SYTO 9 (Invitrogen) made up to 25 μl with filter sterilized water. Samples were run on a Rotor-Gene 6000 (HRM)™ (Corbett Research) using temperature cycling conditions of: 10 minutes at 95°C followed by 40 cycles of 95°C for 5 seconds and 60°C for 10 seconds. This was followed by a melt step of 65–75°C in 0.1°C increments pausing for 2 seconds per step. The increase in SYTO 9 fluorescence was monitored in real time during the PCR and the subsequent decrease during the melt phase by acquiring each cycle/step to the green channel (470 nm excitation and 510 nm emission) of the Rotor-Gene. Genotypes were scored by examining normalized and difference melt plots using the Rotor-Gene Software.
HOLA
HOLA was carried out following the protocol of Lynd
et al [
22] with no modification.
SSOP-ELISA
SSOP-ELISA followed the protocol of Kulkarni
et al [
23] with slight modifications. Primers AgD1 and AgD2 primers [
23] were used to PCR amplify a 293 bp fragment from domain II of the sodium channel gene. The primer AgD2 carries a biotin modification at the 5' end. PCR was carried out in a 25 μl volume with a final concentration of 1 × Buffer, 2 mM MgCl
2, 0.2 mM dNTPs, 0.1 μM each primer, 0.034 U/μl Taq DNA polymerase (Qiagen). Reaction conditions were 94°C for 5 min followed by 35 cycles of 94°C for 30 sec, 48°C for 40 sec, 72°C for 40 sec and a final extension step of 72°C for 10 min. PCR products were diluted 1:1 in water, denatured at 95°C for five minutes and cooled to 4°C. The 3' end digoxigenin-conjugated SSOPs (104F, 104S, 104L) [
22] were added together with the diluted PCR products to the streptavidin-coated ELISA plates (Sigma) as described previously [
22]. Washes were performed [
22] and 100 μl of TMB substrate (Roche, 11 484 281 001) was added. After five minutes, the reaction was stopped with the addition of 0.5 M H
2SO
4 and the optical density at 450 nm was measured in an ELISA reader.
PCR-Dot Blot
PCR was carried out as for the SSOP-ELISA method (although in this case the AgD2 primer is unmodified). Amplified DNA products were denatured for 2 min at 94°C and then cooled to 4°C. One and a half μl of PCR products were spotted onto nylon membranes (Roche) and fixed to them by cross-linking with ultraviolet radiation. Membranes were probed with the 104L, 104F and 104S probes [
22] at 42°C for 1.5 hours and then washed twice with 2 × SSC 0.1% SDS for 5 min at room temperature, followed by two washings with 0.2 × SSC 0.1% SDS at 42°C for the three
kdr alleles (15 minutes per wash). Membranes were then placed in blocking buffer (Roche) for 30 minutes. Probes were detected using a non-radioactive CSPD substrate (Roche) based approach. Alkaline phosphatase-conjugated anti-digoxigenin Fab fragments and CSPD substrate were added to the membranes following manufacturer's instructions. Membranes were finally exposed to Hyperfilm ECL for approximately 6 hours.
Discussion
The development of pyrethroid resistance in
Anopheles populations has the potential to seriously compromise malaria control efforts. A recent report examining the effectiveness of using ITNs at two sites in Benin has given clear evidence of pyrethroids failing to control an
An. gambiae population that contains
kdr resistance at high levels [
6]. This highlights the need to monitor the spread of resistance conferring alleles and to use this information to devise management strategies to prolong the effective life of the insecticide and to help make decisions on which insecticide class to best use for effective control. There are a number of assays available for genotyping
kdr alleles. The most widely used of these in malaria endemic countries is the AS-PCR method, probably due to its relatively low cost (both capital expenditure and running costs) (Table
2); however, a number of recent reports have questioned the reliability of this technique [
20,
29]. In this study, a number of protocol variations on the basic AS-PCR method were followed and the method which gave optimal results is described. The blind genotyping trial showed the AS-PCR method gave a relatively low misscore rate but compared to the TaqMan method it lacked sensitivity with a higher rate of failed reactions. The comparisons given in Table
2 also show other disadvantages of this technique; for example, the potential safety hazard presented by the use of ethidium bromide and the relatively low-throughput compared to TaqMan and HRM.
Table 2
Comparison of seven assays for kdr genotyping based on specialist equipment required, cost, safety, simplicity of protocol and speed of method. Capital cost was calculated for all assays and is correct at the time of submission. Consumable/running cost was calculated for all assays except for the HOLA and SSOP-ELISA where the running cost listed was obtained from the original report of the method.
Specialist equipment required
| Real-time PCR machine | PCR thermocyler Fluorimeter | High-spec real time PCR machine | PCR thermocycler Gel electrophoresis and imaging equipment | PCR thermocycler Shaking incubator Multichannel pipette *optional ELISA plate reader | PCR thermocycler Shaking incubator Multichannel pipette | PCR thermocycler Multichannel pipette *optional ELISA plate reader |
Capital outlay cost (for equipment above given in US$) | 96 well $25 000 48 well $19 000 | $17 800 | $50 000 | $10 000 | $7600 *optional ELISA plate reader add $5000 | $7600 | $5500 *optional ELISA plate reader add $5000 |
Hazardous chemicals
| - | - | - | Ethidium bromide | TMAC, H2SO4, SDS | SDS | SDS |
Protocol run time
| 1 hr 45 mins | 2 hrs | 1 hr 35 mins | ~4 hrs 30 mins | ~5 hrs 30 mins | ~16–18 hrs | ~6 hrs 30 mins |
Number of steps
| 1 | 2 | 1 | 2 | 17 | 16 | 15 |
Primers/Probes required (for detection of 3 kdr alleles) | 2 PCR primers 3 fluorescently labelled probes | 2 PCR primers 3 fluorescently labelled probes | 2 PCR primers | 5 PCR primers | 2 PCR primers (one biotin labelled) 3 SSOPs (digoxigenin labelled) | 2 PCR primers 3 SSOPs (digoxigenin labelled) | 2 PCR primers 2 reporter primers (5'phosphorylation and 3'fluorescein labelled) 4 detector primers (biotin labelled) |
Number of tubes/wells/membranes required per sample
| 2 | 2 | 1 | 2 | 3 | 3 | 4 |
Running cost (per sample for three alleles) | $1.72 | $1.72 | $0.62 | $0.92 | sim $1 | $1.6 | $1.74 |
Other methods with a low initial set-up cost that were investigated in this study were SSOP-ELISA, PCR DOT-BLOT and HOLA with all three giving comparable results in the blind genotyping trial. As shown in Table
2 all three assays require only basic equipment (a PCR machine, shaking incubator (ELISA) and, for the ELISA and HOLA methods, an optional ELISA reader). In addition, all dispense with the need for gel electrophoresis making them safer than AS-PCR. On the basis of cost and throughput the SSOP-ELISA method is the front-runner of the three assays. It requires approximately five and a half hours to run (17 steps) and more than 150 samples can be screened for the three
kdr alleles in one day. The HOLA method takes approximately six and a half hours (16 steps) and 96 samples can be screened per day if four PCR machines/blocks are used. The PCR dot-blot assay can be completed in approximately 16 hours (16 steps) and more than 150 samples can be screened per day. Analysis of one sample (for the three
kdr alleles) costs approximately US $1 using the SSOP-ELISA method, US$ 1.74 using the HOLA method and US$ 1.6 using the PCR dot-blot assay. Overall, the SSOP-ELISA, HOLA and PCR dot-blot assays require the use of basic equipment, are relatively cheap and provide acceptable sensitivity/specificity. They are thus amenable to researchers on a limited budget or without access to expensive equipment and are good options for laboratories in developing countries. The limitation of these assays lies in the requirement for a high number of post-PCR steps making them lengthier and of limited throughput capacity compared to the TaqMan and HRM assays. This is also an important consideration where operator time is included as part of the assay cost.
In this study, the performance of the four lower throughput assays was compared with two newly developed assays, TaqMan and HRM. The two high-throughput platforms both represent true closed-tube approaches requiring a single step to achieve results. This is in contrast to two recently developed high-throughput assays for
kdr detection, FRET/MCA which requires two rounds of PCR [
20] and PCR elongation with fluorescence which requires PCR followed by capillary electrophoresis [
25]. HRM is a relatively new technique that has been used very successfully in a number of previous genotyping studies [
32,
33]. Because this method uses standard oligonucleotide primers and has no requirement for fluorescently-labelled oligonucleotides, the running costs are very low (Table
2). In addition HRM has the potential to identify novel mutations in the region of DNA encompassed by the PCR primers as any alternative base change will alter the melt profile of the amplicon. The HRM method showed initial promise during optimization with templates of known genotype (where DNA concentration was adjusted to be consistent for all samples) but subsequently performed less well in the blind genotyping trial. This is likely explained by variable DNA quality and quantity in the 96 samples in the reference plate, leading to many samples amplifying after ~35 cycles or failing to reach full plateau phase. For HRM it is recommended that the amount of DNA template used in PCR be consistent between samples as large differences in starting template will affect the observed Tm. It is, therefore, possible that this assay could be improved if DNA concentration was adjusted. However this constitutes an additional step in the protocol and would require DNA quantification using a spectrophotometer or gel electrophoresis. A comparison of HRM with the other methods (Table
2) highlights the greatest disadvantage which is the capital outlay required. Although HRM has low consumable costs it requires real-time PCR machines of high thermal and optical precision that are significantly more expensive than those that lack this specification. This high initial cost may give this assay limited application for use in resource poor malaria endemic countries.
In contrast to HRM, the TaqMan approach performed very well in the genotyping trial showing the highest level of specificity and sensitivity (as determined by the low number of failed reactions and incorrect scores) of all the assays trialled. This is likely due to both a higher degree of sensitivity and a higher tolerance to variation in DNA quality and quantity than the other assays. The TaqMan method was quick to optimise and along with HRM shows the highest throughput of the assays being simple and quick to setup (Table
2). Results can be scored easily, both manually or autoscored. The running cost of the TaqMan assay is slightly higher than the AS-PCR and HRM assays but comparable to the other methods (Table
2). Currently this method uses two separate assays to detect the
kdr-w and
kdr-e mutations, in future consumable costs could be further reduced by multiplexing the assay so that the wildtype,
kdr-e and
kdr-w alleles are detected in a single tube using probes with three fluorophores with distinct emission and excitation spectra. The other significant disadvantage of this assay is the capital outlay required, for a 96 well real-time PCR machine which costs in the region of US$ 25,000–50,000. One way to bring this cost down is through the purchase of a 48 well machine (these can be purchased for US$ 19,000–21,000) although this entails a reduction in possible throughput. An alternative cost-saving option is to carry out the TaqMan assays using a standard thermocycler for PCR and then measure endpoint fluorescence with a fluorimeter. The results described here show this is a viable approach and although a slight increase in failed reactions and incorrect scores was seen in the blind genotyping trial compared to the real-time assay, this method was still more sensitive and more specific than the AS-PCR, SSOP-ELISA, HOLA, and PCR Dot-Blots assays. A disadvantage of the endpoint method is the requirement for a small degree of data analysis before scoring (subtraction of blank and cut-off values).
Monitoring of resistance alleles such as kdr often involves the processing of thousands of individual insects per site. In this study the performance of these methods was examined on individual mosquitoes, future work could investigate the feasibility of using these assays on pooled insects to further increase throughput. A potential caveat of this approach is that it may not efficiently identify resistance alleles at low levels in mosquito populations particularly if they are present in the heterozygous state.
Authors' contributions
CB developed the TaqMan and HRM techniques, optimized and ran the AS-PCR method and drafted the manuscript. DN optimized and ran the SSOP-ELISA and PCR-Dot Blot methods and helped draft the manuscript. MJD helped design the study, organized and designed the reference plate of samples and helped draft the manuscript. MSW, HR and JV helped design the study and draft the manuscript. AB genotyped the reference plate using the HOLA method. LMF helped design the study and helped draft the manuscript. All authors read and approved the final manuscript.