How should a DEXA scan be used to evaluate bisphosphonate therapy for osteoporosis?

If bone density is evaluated after initiating bisphosphonate drug therapy, it should be tested no earlier than 2 years (strength of recommendation [SOR]: B, based on case series of dual energy x-ray absorptiometry [DEXA] scanning precision and bisphosphonate efficacy). Currently no prospective, randomized trials investigate the impact of bone density follow-up testing on osteoporotic patients receiving bisphosphonate therapy

Melt analysis of mismatch amplification mutation assays (melt-MAMA): a functional study of a cost-effective SNP genotyping assay in bacterial models.

Single nucleotide polymorphisms (SNPs) are abundant in genomes of all species and biologically informative markers extensively used across broad scientific disciplines. Newly identified SNP markers are publicly available at an ever-increasing rate due to advancements in sequencing technologies. Efficient, cost-effective SNP genotyping methods to screen sample populations are in great demand in well-equipped laboratories, but also in developing world situations. Dual Probe TaqMan assays are robust but can be cost-prohibitive and require specialized equipment. The Mismatch Amplification Mutation Assay, coupled with melt analysis (Melt-MAMA), is flexible, efficient and cost-effective. However, Melt-MAMA traditionally suffers from high rates of assay design failures and knowledge gaps on assay robustness and sensitivity. In this study, we identified strategies that improved the success of Melt-MAMA. We examined the performance of 185 Melt-MAMAs across eight different pathogens using various optimization parameters. We evaluated the effects of genome size and %GC content on assay development. When used collectively, specific strategies markedly improved the rate of successful assays at the first design attempt from ~50% to ~80%. We observed that Melt-MAMA accurately genotypes across a broad DNA range (~100 ng to ~0.1 pg). Genomic size and %GC content influence the rate of successful assay design in an independent manner. Finally, we demonstrated the versatility of these assays by the creation of a duplex Melt-MAMA real-time PCR (two SNPs) and conversion to a size-based genotyping system, which uses agarose gel electrophoresis. Melt-MAMA is comparable to Dual Probe TaqMan assays in terms of design success rate and accuracy. Although sensitivity is less robust than Dual Probe TaqMan assays, Melt-MAMA is superior in terms of cost-effectiveness, speed of development and versatility. We detail the parameters most important for the successful application of Melt-MAMA, which should prove useful to the wider scientific community

Phylogeography of Francisella tularensis subspecies holarctica from the country of Georgia

<p>Abstract</p> <p>Background</p> <p><it>Francisella tularensis</it>, the causative agent of tularemia, displays subspecies-specific differences in virulence, geographic distribution, and genetic diversity. <it>F. tularensis </it>subsp. <it>holarctica </it>is widely distributed throughout the Northern Hemisphere. In Europe, <it>F. tularensis </it>subsp. <it>holarctica </it>isolates have largely been assigned to two phylogenetic groups that have specific geographic distributions. Most isolates from Western Europe are assigned to the B.Br.FTNF002-00 group, whereas most isolates from Eastern Europe are assigned to numerous lineages within the B.Br.013 group. The eastern geographic extent of the B.Br.013 group is currently unknown due to a lack of phylogenetic knowledge about populations at the European/Asian juncture and in Asia. In this study, we address this knowledge gap by describing the phylogenetic structure of <it>F. tularensis </it>subsp. <it>holarctica </it>isolates from the country of Georgia, and by placing these isolates into a global phylogeographic context.</p> <p>Results</p> <p>We identified a new genetic lineage of <it>F. tularensis </it>subsp. <it>holarctica </it>from Georgia that belongs to the B.Br.013 group. This new lineage is genetically and geographically distinct from lineages previously described from the B.Br.013 group from Central-Eastern Europe. Importantly, this new lineage is basal within the B.Br.013 group, indicating the Georgian lineage diverged before the diversification of the other known B.Br.013 lineages. Although two isolates from the Georgian lineage were collected nearby in the Ukrainian region of Crimea, all other global isolates assigned to this lineage were collected in Georgia. This restricted geographic distribution, as well as the high levels of genetic diversity within the lineage, is consistent with a relatively older origin and localized differentiation.</p> <p>Conclusions</p> <p>We identified a new lineage of <it>F. tularensis </it>subsp. <it>holarctica </it>from Georgia that appears to have an older origin than any other diversified lineages previously described from the B.Br.013 group. This finding suggests that additional phylogenetic studies of <it>F. tularensis </it>subsp. <it>holarctica </it>populations in Eastern Europe and Asia have the potential to yield important new insights into the evolutionary history and phylogeography of this broadly dispersed <it>F. tularensis </it>subspecies.</p

Real-time PCR amplification and dissociation (melt) curve plots.

<p><i>B. anthracis</i> Melt-MAMA SYBR® Green assay targeting the A.Br.004 genetic clade. (A & C) The amplification of two alleles are illustrated for haploid template (<i>Bacillus anthracis</i>) possessing an ‘A’ polymorphic SNP-state or ‘G’ state. Each amplification plot represents a single PCR reaction containing a reverse “common” primer and two allele-specific MAMA primers. The AS-MAMA primers anneal to the same template target and then compete for extension across the SNP position. The polymerase-mediated extension rate of the 3′match AS-MAMA primer (perfect primer-template complex) exceeds that of the 3′mismatched MAMA primer (mismatched primer-template complex), thus the perfect match primer-template complex outcompetes the mismatched primer-template complex and dominates the PCR amplification. (B & D) Plots of the temperature-dissociation (melt) curve of the final PCR products for the two allele templates are shown next to their respective amplification plots (green arrows). Allele-specific PCR products are easily differentiated through temperature-dissociation (melt) curve analysis, which is conferred by the GC-clamp engineered on one of the AS-MAMA primer.</p

Two-Locus (duplexed) Melt-MAMA development.

<p>(A) A phylogenetic topology of the three subspecies of <i>F. tularensis</i> rooted with <i>F. novicida</i>. The SNP-signatures specific for the two pathogenic subspecies of <i>F. tularensis</i> (indicated by black bars) were incorporated into Melt-MAMAs. The table (right) indicates expected allele states (derived and ancestral) for strains from each <i>F. tularensis</i> subspecies represented on the topology; <i>F. novicida</i> would have the same allelic states as <i>F. tularensis</i> subsp. <i>mediasiatica</i>. (Bi–iv) Temperature-dissociation (melt) curves (derivative) of allele-specific PCR products from <i>F. tularensis</i> strains amplified in the duplexed assay (Type A and Type B). Each profile show two melt-curve peaks generated from a single <i>F. tularensis</i> strain. Each peak corresponds to the allele-specific PCR product for a single SNP-locus in the duplexed assay.</p

Genotyping over a broad range of DNA amounts.

<p>Melt-MAMA genotyping accuracy is not diminished at lower amounts of DNA, even at near-single copy for some assays. The sensitivity of individual melt-MAMAs varies greatly. This <i>B. anthracis</i> melt-MAMA (A.Br.003 clade) <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0032866#pone.0032866-VanErt1" target="_blank">[4]</a> accurately genotyped DNA regardless of starting amounts as long as it was sufficient to support amplification. (A & B) The respective amplification plots of genomic DNA of ‘G’ allele and ‘A’ SNP allele templates show the amplification curves of templates titrated in ten-fold serial dilutions and in replicates of eight. The number assigned to each amplification curve (1–8) denotes the DNA amount for the starting template. (C) The temperature-dissociation (melt) curve derivatives for all initial template amounts are shown (numbers denote DNA amount shown). This panel illustrates that genotyping accuracy was not affected by DNA amounts, even at near-single copy levels. Similar to TaqMan assays, the detection of low levels of DNA template by Melt-MAMA is also subject to stochastic sampling effects (<i>B. anthracis</i> single copy ∼6 fg), which is predictable using a Poisson distribution <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0032866#pone.0032866-VanErt1" target="_blank">[4]</a>.</p

Genotyping over a broad range of DNA amounts.

<p>Melt-MAMA sensitivity to low level DNA amounts varies greatly among different assays. <i>B. anthracis</i> melt-MAMA targeting the A.Br.006 clade <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0032866#pone.0032866-VanErt1" target="_blank">[4]</a> accurately genotyped DNA at amount ∼19 copies. (A & B) The respective amplification plots of genomic DNA of ‘G’ and ‘A’ SNP allele templates show the amplification curves of templates titrated in ten-fold serial dilutions and in replicates of eight. The number assigned to each amplification curve (1–7) denotes the DNA amount for the starting template. (C & D) The temperature-dissociation (melt) curve derivatives for all initial template amounts are shown (numbers denote DNA amount shown). Panels C and D illustrates that genotyping accuracy is obtained across a broad range of DNA template amounts of ∼115 ng to 115 fg. Assay sensitivity to template is limited to ∼19 copies and above. An inherent characteristic of this assay is the occurrence of spurious amplification at extended cycle times (>35) in the absence of template as indicated by the NTCs. Melt-MAMAs detecting low level DNA are subject to stochastic sampling effects (<i>B. anthracis</i> single genome copy ∼6 fg), which is predictable using a Poisson distribution <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0032866#pone.0032866-VanErt1" target="_blank">[4]</a>.</p

Competition between specific and non-specific amplification at extremely low level DNA amounts.

<p>With extremely low-level DNA amounts (<∼2 copies), stochastic, spurious, non-specific amplification could outcompete allele-specific amplification. The <i>Bacillus anthracis</i> melt-MAMA targeting the A.Br.003 clade <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0032866#pone.0032866-VanErt1" target="_blank">[4]</a> stochastically amplified allele-specific product and non-specific spurious products at amounts of less than a single copy (∼0.19 copies). (A and B) The respective amplification plots of genomic DNA of ‘G’ allele and ‘A’ SNP allele templates show the amplification curves of templates at 1.15 ng and at two low level ten-fold dilution series (near-single copy and less than a single copy) in replicates of eight. The number assigned to each amplification curve (3, 8–9) denotes the DNA amount for the starting template. (C & D) The temperature-dissociation (melt) curve derivatives for the 1.15 ng and lowest template amounts are shown. This panel illustrates that genotyping accuracy was not compromised at DNA template amounts near single copy level, but spurious amplification was observed in dilution points below this level. This spurious amplification had a unique melt-profile that did not match the profile of either allele types (red arrow).</p

Melt-MAMAs targeting specific groups within eight pathogen species.

a<p>First design attempt and altered primer ratio optimization.</p>b<p>Success after combining first or second design attempts and altered primer ratio optimization.</p>c<p>Failed after first design attempt.</p>d<p>Assays that required altered primer concentration ratios.</p