Sensitive tracking of circulating viral RNA through all stages of SARS-CoV-2 infection.

TitleSensitive tracking of circulating viral RNA through all stages of SARS-CoV-2 infection.
Publication TypeJournal Article
Year of Publication2021
AuthorsHuang Z, Ning B, Yang HS, Youngquist BM, Niu A, Lyon CJ, Beddingfield BJ, Fears AC, Monk CH, Murrell AE, Bilton SJ, Linhuber JP, Norton EB, Dietrich ML, Yee J, Lai W, Scott JW, Yin X-M, Rappaport J, Robinson JE, Saba NS, Roy CJ, Zwezdaryk KJ, Zhao Z, Hu TY
JournalJ Clin Invest
Date Published2021 04 01
KeywordsAdolescent, Adult, Aged, Animals, Cell-Free Nucleic Acids, Child, Child, Preschool, COVID-19, COVID-19 Nucleic Acid Testing, CRISPR-Cas Systems, Disease Models, Animal, Female, Humans, Infant, Longitudinal Studies, Macaca mulatta, Male, Middle Aged, Pandemics, RNA, Viral, SARS-CoV-2, Sensitivity and Specificity, Time Factors

BACKGROUNDCirculating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA may represent a more reliable indicator of infection than nasal RNA, but quantitative reverse transcription PCR (RT-qPCR) lacks diagnostic sensitivity for blood samples.METHODSA CRISPR-augmented RT-PCR assay that sensitively detects SARS-CoV-2 RNA was employed to analyze viral RNA kinetics in longitudinal plasma samples from nonhuman primates (NHPs) after virus exposure; to evaluate the utility of blood SARS-CoV-2 RNA detection for coronavirus disease 2019 (COVID-19) diagnosis in adults cases confirmed by nasal/nasopharyngeal swab RT-PCR results; and to identify suspected COVID-19 cases in pediatric and at-risk adult populations with negative nasal swab RT-qPCR results. All blood samples were analyzed by RT-qPCR to allow direct comparisons.RESULTSCRISPR-augmented RT-PCR consistently detected SARS-CoV-2 RNA in the plasma of experimentally infected NHPs from 1 to 28 days after infection, and these increases preceded and correlated with rectal swab viral RNA increases. In a patient cohort (n = 159), this blood-based assay demonstrated 91.2% diagnostic sensitivity and 99.2% diagnostic specificity versus a comparator RT-qPCR nasal/nasopharyngeal test, whereas RT-qPCR exhibited 44.1% diagnostic sensitivity and 100% specificity for the same blood samples. This CRISPR-augmented RT-PCR assay also accurately identified patients with COVID-19 using one or more negative nasal swab RT-qPCR results.CONCLUSIONResults of this study indicate that sensitive detection of SARS-CoV-2 RNA in blood by CRISPR-augmented RT-PCR permits accurate COVID-19 diagnosis, and can detect COVID-19 cases with transient or negative nasal swab RT-qPCR results, suggesting that this approach could improve COVID-19 diagnosis and the evaluation of SARS-CoV-2 infection clearance, and predict the severity of infection.TRIAL NCT04358211.FUNDINGDepartment of Defense, National Institute of Allergy and Infectious Diseases, National Institute of Child Health and Human Development, and the National Center for Research Resources.

Alternate JournalJ Clin Invest
PubMed ID33561010
PubMed Central IDPMC8011898
Grant ListP51 OD011104 / OD / NIH HHS / United States
R01 HD090927 / HD / NICHD NIH HHS / United States
U54 GM104940 / GM / NIGMS NIH HHS / United States
Related Faculty: 
He Sarina Yang, M.D., Ph.D. Zhen Zhao, Ph.D.


Pathology & Laboratory Medicine 1300 York Avenue New York, NY 10065 Phone: (212) 746-6464
Surgical Pathology: (212) 746-2700