A streamlined clinical metagenomic sequencing protocol for rapid pathogen identification
Abstract Metagenomic next generation sequencing (mNGS) holds promise as a diagnostic tool for unbiased pathogen identification and precision medicine. However, its medical utility depends largely on the assay simplicity and reproducibility. In the current study, we aimed to develop a streamlined Illumina and Oxford Nanopore-based DNA/RNA library preparation protocol and rapid data analysis pipeline. The Illumina sequencing based mNGS method was first developed and evaluated using a set of samples with known etiology. Its sensitivity for RNA virus (Influenza A, H1N1) was <6.4×102 EID50/mL, and a good correlation between viral loads and mapped reads was observed. Then the rapid turnaround time of Nanopore sequencing was testified by sequencing of an Influenza A virus and Adenoviruses. Further, 11 respiratory swabs or sputum samples pre-tested for a panel of pathogens were analyzed and the pathogens identified by illumina sequencing showed 81.8% concordance with qPCR-based results. Additional sequencing of cerebrospinal fluid (CSF) samples from HIV-1 positive patients with meningitis/encephalitis detected HIV-1 RNA and toxoplasma gondii sequences. In conclusion, we have developed a simplified protocol which realized facile metagenomic sequencing of a variety of clinical samples and pathogen identification in a clinically meaningful time frame.