The development and validation of a reverse transcription recombinase polymerase amplification assay for detection of flaviviruses

Flaviviruses have been of clinical importance since ancient times. Five flaviviruses are known to occur or have been identified historically in South Africa (SA) namely, West Nile virus (WNV), Usutu virus (USUV), Wesselsbron virus (WSLV), Spondweni virus (SPOV) and Banzi virus (BANV). Medically significant flaviviruses, WNV and WSLV, are known to occur annually in SA. Development of isothermal assays, such as recombinase polymerase amplification (RPA), plays an important role in performing surveillance studies and increasing diagnostic capacity for emerging viral pathogens in limited resource settings. In their native form, WNV and WSLV can only be handled in a biosafety laboratory level 3 and this restricts laboratories that lack such resources, hence transcribed RNA controls were successfully prepared for WNV, USUV and WSLV to develop and validate a RT-RPA for the detection of flaviviruses. A lateral-flow RT-RPA was developed by identifying theoretical cross reactivity between the probe and primer candidates by sequence alignments of the conserved NS5 protein of WNV, USUV and WSLV. It was determined that a few mismatches were present between WNV and USUV in the probe binding region and in the reverse primer, as well as between WNV and WSLV, hence different probe and reverse primer regions were identified for WNV/USUV and WSLV. A limitation of the study was the selection of a reference strain of WNV belonging to lineage 1 as a lineage 2 isolate would have been a more suitable representative of SA lineages. Nonetheless, RNA from SA isolate 93/01 was amplified using the RT-RPA. The sensitivity of the assay was determined by diluting RNA control ten-fold, and was found that the WNV RT-RPA could detect WNV and USUV transcribed RNA diluted 109 fold, whereas the WSLV RT-RPA detected WSLV transcribed RNA diluted 1010 fold. Testing RNA from other arboviruses suggested that despite the binding tolerability of the assay there was good specificity as no other arboviruses were
National Research Foundation (NRF)
Poliomyelitis Research Foundation (PRF)