RT-PCR based SARS-CoV-2 variant screening assays require careful quality control

https://doi.org/10.1016/j.jcv.2021.104905Get rights and content

Highlights

  • We observed robust performance of commercial and in-house SARS-CoV-2 variant-detection RT-qPCR-based assays

  • Laboratories utilizing assays to identify four key nucleotide substitutions could adequately identify and classify a sample as a variant of concern (VOC)

  • Low template copy number and variation in regions targeted by RT-qPCR-based assays resulted in loss of confidence to classify a sample as a VOC

Abstract

Background

Distinctive genotypes of SARS-CoV-2 have emerged that are or may be associated with increased transmission, pathogenicity, and/or antibody escape. In many countries, clinical and diagnostic laboratories are under mandate to identify and report these so-called variants of concern (VOC).

Objectives

We used an external quality assessment scheme to determine the scope, accuracy, and reliability of laboratories using various molecular diagnostic assays to identify current VOC (03 March 2021).

Study design

Participant laboratories were sent the same five patient-derived samples and were asked to provide their variant detection methods, variant detection results and interpretation of results.

Results

Twenty-five laboratories reported a range of RT-qPCR-based assays to identify specific variations in the SARS-CoV-2 spike protein that are characteristic of three VOC lineages. Laboratories that detected VOC-associated nucleotide mutations at four specific sites had the highest ratio of correct classification. Low template copy number and additional variation in target regions resulted in loss of confidence and accuracy in sample classification.

Conclusions

Melting-curve-based assays to identify genomic variants are less time-consuming and require less bioinformatic analysis compared to partial or whole genome sequencing. However, our results suggest that correct classification of a given genotype/lineage (e.g., a VOC) relies on the ability to detect more than one variant site, adequate template in the sample (i.e., relatively high viral load/copy number) and results may be unclear in certain samples with additional genetic variations. These initial results suggest that some diagnostic laboratories may require additional training to interpret and report complex genetic information about a dynamic emerging virus.

Keywords

SARS-CoV-2
variant of concern
melting curve analysis
external quality assessment

Cited by (0)

View Abstract