McFarlandJournal of Medicaland
nephelometer andPCR
Biological Research (1999) 32: 1073-1076 1073
ISSN 0100-879X Short Communication
Abstract
Correspondence Polymerase chain reaction (PCR) has been widely investigated for the Key words
B.A.L. Fonseca diagnosis of tuberculosis. However, before this technique is applied Tuberculosis
Departamento de Clnica Mdica on clinical samples, it needs to be well standardized. We describe the PCR
FMRP, USP
use of McFarland nephelometer, a very simple approach to determine
Av. dos Bandeirantes, 3900
14049-900 Ribeiro Preto, SP
microorganism concentration in solution, for PCR standardization
Brasil and DNA quantitation, using Mycobacterium tuberculosis as a model.
Fax: +55-16-633-6695 Tuberculosis is an extremely important disease for the public health
system in developing countries and, with the advent of AIDS, it has
V.R. Bollela was the recipient also become an important public health problem in developed coun-
of a CNPq fellowship. tries. Using Mycobacterium tuberculosis as a research model, we were
Publication supported by FAPESP.
able to detect 3 M. tuberculosis genomes using the McFarland
nephelometer to assess micobacterial concentration. We have shown
here that McFarland nephelometer is an easy and reliable procedure to
Received August 24, 1998 determine PCR sensitivity at lower costs.
Accepted June 2, 1999
Tuberculosis (TB) is a worldwide disease screening test but with a low sensitivity,
that has never lost its importance in develop- detecting acid-fast bacilli only when there
ing countries, and after the 80s it has also are more than 104 mycobacteria per ml. Even
become a problem in developed countries. though culture on solid media is the gold
There are almost 20 million cases of active standard diagnostic test for tuberculosis, it is
tuberculosis in the world with almost 5,000 laborious and slow for clinical use, requiring
deaths every day (1). The laboratory diagno- at least 4 weeks to detect the M. tuberculosis
sis of TB is currently based on the demon- (2).
stration of Mycobacterium tuberculosis in PCR (3) is a remarkably specific and
acid-fast stained (Ziehl-Neelsen) or fluoro- sensitive method of DNA amplification ca-
chrome-stained smears, and on culture growth pable of amplifying as little as 1 copy of a
on solid or liquid media. Staining is a rapid given DNA. While this technique has been
widely used for the diagnosis of viral infec- acid. The tube was sealed and kept in the
tions, bacterial infections still rely on culture refrigerator until a fine white precipitate of
methods. Assuming that PCR may play a barium sulfate became visible after vigorous
role in the diagnosis of bacterial infections, shaking. At that time the tube had a density
we devised a method for assaying concentra- corresponding to approximately 3 x 108 my-
tion of microorganisms detected by PCR cobacteria/ml of suspension. We prepared a
using M. tuberculosis as a tool. solution of the M. tuberculosis reference
Tuberculosis diagnosis by PCR has been strain (HRa37) corresponding to McFarland
possible since the identification of singular No. 1 standard. By sequentially diluting the
DNA sequences present in the genome of sample ten-fold, we ended up with concen-
organisms of the M. tuberculosis complex trations of M. tuberculosis from 108 to 10-1
(4). A PCR assay can be run in a few hours bacilli/ml.
with high rates of specificity and for this DNA extraction was performed by boil-
reason it has become an excellent option for ing 1 ml of each HRa37 M. tuberculosis
rapid diagnosis of pulmonary tuberculosis. dilution for 10 min and centrifuging the
Proper standardization is the first step for the samples for 10 min at 13,500 rpm. The re-
use of PCR in the clinical diagnosis of tuber- sulting supernatant was used for PCR.
culosis. The PCR was based on the amplification
In this study, we describe the use of the of the insertion sequence IS6110 with prim-
McFarland nephelometer procedure to de- ers described by Eisenach et al. (6). The
termine the concentration of tubercle bacilli primers were TB1 5'-CCTGCGAGCGTAG
in solution and its use for PCR standardiza- GCGTCGG-3' and TB2 5'-CTCGTCC
tion and quantitation of M. tuberculosis in AGCGCCGCTTCGG-3' (Gibco-BRL,
solution. Even though several quantitation Gaithersburg, MD, USA) and amplified a
methods have been described for PCR, in- 123-bp fragment of the repetitive IS6110
cluding methods for the M. tuberculosis ge- sequence. The DNA amplification protocol
nome, they are not always feasible in devel- used the GeneAmp PCR reagent kit with
oping countries. We have used a simple native Taq DNA polymerase (Perkin Elmer
procedure to estimate M. tuberculosis con- Corporation, Branchburg, NJ, USA). Five
centration, which should be useful to stan- microliters of the extracted DNA solution
dardize PCR protocols. The McFarland was added to 45 l of PCR reaction mixture
nephelometer approach offers the advantage containing AmpliTaq DNA polymerase (1.25
of being less expensive when compared to U), deoxynucleotides (200 M each), PCR
ordinary methods of DNA quantitation by buffer (10 mM Tris-HCl, pH 8.3, 50 mM
PCR. KCl, 0.15 mM MgCl2, 0.01% gelatin), and
The McFarland nephelometer was de- 20 pmol of DNA primers. Thermal cycling
scribed in 1907 by J. McFarland as an instru- was performed on a Perkin-Elmer DNA ther-
ment for estimating the number of bacteria mal cycler 480, with an initial cycle of 5 min
in suspensions used for calculating the bac- at 94oC followed by 35 cycles consisting of 1
terial opsonic index and for vaccine prepara- min at 94oC, 2 min at 65oC and 1 min at
tion. The McFarland nephelometer No. 1 72oC. The procedure was stopped after a 10-
standard procedure was performed as de- min final extension step at 72oC to allow
scribed by McFarland (5). In a large test polymerization of incomplete strands.
tube, 0.1 ml of a 1% solution of anhydrous One-tenth of the amplification reaction
barium chloride was mixed with 9.9 ml of a mixture was analyzed electrophoretically on
cold solution of 1% chemically pure sulfuric 3% agarose gel. The gel was then stained
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