Description

The invention relates to a control preparation comprising target sequences for fluorescence in situ hybridization (FISH) probes encased in a polymer body, and to methods for use of these control preparations in microbiological pathology.

Background

Bacterial infections are among the ten most frequent causes of death. A fast diagnosis and initiation of a targeted therapy contribute significantly to reducing the mortality of infections, which in many cases start in biofilms, sedentary associations of microorganisms in and on the body. Gene expression in biofilms is clearly different from that of planktonic or freely submersed cells.

Biofilms contribute to numerous clinical pictures in the realm of infections, both as mono- species biofilms (endocarditis, infections of implants or catheters) or multi-species biofilms (oral biofilms, chronic wounds, otitis media). This life form offers microorganisms important advantages, such as inner-biofilm food chains, increased recalcitrance against antibacterial drugs and protection from immune mechanisms. While biofilms have been studies extensively in vitro, our knowledge about medically relevant biofilms in vivo is limited, as models fail to accurately depict the complex ecological conditions of the human body. No methods are available in routine diagnostic to detect and analyse biofilms.

Fluorescence in situ hybridization (FISH) is a method of molecular biology that allows for the visualization and identification of a microorganism, irrespective of having cultured the microorganism. The principle of FISH is based on oligonucleotide probes coupled to a fluorescent dye. These probes bind, in dependency of the sequence match, to bacterial sequences, for example the bacterial ribosomal RNA. Thus, bacteria can not only be visualized in their natural habitat, but also identified by species or strain. Combining different specific probes having different fluorescent tags allows for simultaneously showing several populations at once (Multiplex-FISH). FISH of tissue sections was established by embedding tissue samples in synthetic resin. This allows for analysing the number, spatial distribution and bacterium-host interactions even of bacteria that can not be cultured, in their natural habitat. FISH is an ideal instrument for the analysis of biofilms and infections in situ.

Suitable probe panels can help diagnosing infections through FISH. Protocols for fixating, embedding and hybridization are needed and must be adjusted to each other in order to achieve optimal results. Since specificity of the oligonucleotide probes is an indispensable requirement for using FISH for diagnostic purposes, and in some applications, sequences having only one mismatch at the site of probe recognition must be discerned, adequate positive and negative controls need to be performed for each hybridization.

Such controls are usually fixated in fixation solution, and are stored subsequently at -20°C. This process however impedes the proliferation of standardized commercial control preparations having the quality that is necessary for routine application.

Currently, the user needs to keep the necessary control strains in culture. This is difficult to realize for users in clinical pathology, particularly if the controls concern hard to culture oral flora that grow slowly (anaerobic organisms), which even well equipped microbiological laboratories find impossible to keep in routine stock. Furthermore, the rRNA content of the control strains used is often not controlled or standardized due to different conditions of culture, which can make interpretation of results achieved by different laboratories very difficult. Furthermore, control preparations prepared ad-hoc have a short shelf life due to the instability of RNA and need to be generated repeatedly, which again impacts the reproducibility of results. Another disadvantage is that when shipping such control preparations, the cold chain needs to be maintained.

Departing from the above state of the art, the objective of the instant invention is to provide means and methods for facilitating routine FISH analysis by adequate control preparations. This objective is attained by the subject matter of the independent claims.

According to a first aspect of the invention, a control preparation for use in a method for detection of a target microorganism in microbiological pathology is provided. The control preparation of the invention is characterized in that it comprises a plurality of section bodies, wherein the section bodies are joint by a joining polymer, and wherein each section body comprises a matrix polymer, and wherein

a. a first section body comprises a first nucleic acid sequence, which is 100% identical to a nucleic acid sequence comprised in the target microorganism;

b. a second section body comprises a second nucleic acid sequence, which in comparison to said first nucleic acid sequence, contains a deletion, an additional nucleotide or a different nucleotide in one, two, three or four positions of said second nucleic acid sequence.

The first nucleic acid sequence is thus 100% reverse complementary to a nucleic acid sequence, that can be used for detection of the target microorganism (such as a FISH probe), and will bind under stringent conditions to such FISH probe, while a probe nearly identical in sequence, i.e. one that differs in one, two, three or four positions would not bind.

A second section body similarly disposed within the control preparation comprises a second nucleic acid sequence, which is almost, but not 100% identical with a nucleic acid sequence of the target microorganism. Typically, the difference to the reverse complementary nucleic acid sequence of the target microorganism (i.e., to the first nucleic acid sequence of the first section body) is one, two, three or four positions, in which the second nucleic acid sequence shows a deletion, an additional or a different nucleotide. The second nucleic acid sequence is thus reverse complementary identical in one, two, three or four positions to a nucleic acid sequence that can be used for detection of the target microorganism (such as the FISH probe mentioned above).

The first section body thus serves as a "positive control" while the second section body serves as a negative control or specificity control. The probe employed in this context, which is specific for a DNA or RNA sequence occurring in the target microorganism, should show binding to the first section body, but not to the second (or else the binding conditions would be nonspecific).

In the present specification, nucleic acid sequences are given in the direction of 5' (left end) to 3' (right end) according to the convention of biology. If a sequence A is designated

..reverse complementary" to a sequence B, A and B can hybridize in perfect fashion, i.e. each position of A, counted from the 5' end, corresponds to a perfectly matched (A matches T or U and G matches C) position of B counted from the 3' end.

Examples of reverse complementary sequences are ATC and GAT. The sequence directly (not reverse!) complementary to ATC is TAG.

Identity in the context of the present specification is a single quantitative parameter representing the result of a sequence comparison (Alignment) position by position as a quantitative result (percent identity). Methods of sequence comparison are known in the art; the BLAST algorithm available publicly is an example. One example for comparison of nucleic acid sequences is the BLASTN algorithm that uses the default settings: Expect threshold: 10; Word size: 28; Max matches in a query range: 0; Match/Mismatch Scores: 1 .- 2; Gap costs: Linear.

Unless otherwise stated, identity values given in the present specification refer to values obtained with the BLAST programme package using default parameters (Altschul et al., J. Mol. Biol. 215:403-410 (1990)). This programme is publicly available

(http://blast.ncbi.nlm.nih.gov/). In certain embodiments, the first and the second nucleic acid sequence each independently of the other have a length of approximately 12 to 30 nucleotides. In certain embodiments, the first and the second nucleic acid sequence each independently of the other are comprised within a longer sequence.

In certain embodiments, the first and the second nucleic acid sequence, or the probes used in the methods of the invention as disclosed herein, each independently of any other are DNA or RNA oligonucleotides or RNA analogues (such as 2'-0-methyl-RNA; LNA (Jocked" nucleic acids, in which the 2'-0 and the 4'-C are bridged by a covalent linkage); PNA

(..peptide nucleic acids", nucleobases linked by a peptide chain); BNA (ribose analogues bridged by a amino ethylene moiety between the 2'-0 and the 4'-C); morpholino RNA and equivalents of these building blocks known to the skilled artisan, and mixtures thereof).

In certain embodiments, the first and the second nucleic acid sequence each independently of the other are an RNA sequence.

In certain embodiments, the first nucleic acid sequence a RNA sequence specific for the target microorganism, typically a 16S rRNA-, 23S rRNA-, 18S rRNA-, ISR (intergenic spacer region) or mRNA sequence or a part thereof.

In certain embodiments, the first and the second nucleic acid sequence each independently of the other are part of a 16S, 23S, 18S or ISR- RNA sequence.

In certain embodiments, the first and the second nucleic acid sequence each independently of the other is provided on particles or compartments, particularly cells, having a size of 0, 1 pm to 30 pm. This leads to fluorescence signals generated by hybridization of a FISH probe are concentrated in space and thus easier to detect. In certain embodiments, the compartments are cells, particularly cells of the target microorganism, i.e. cells that comprise the first or second nucleic acid sequence as part of their genetic makeup, for example as ribosomal RNA.

In certain embodiments, each section body comprises a plurality of individuals of exactly one microorganism embedded in the matrix polymer, with each section body having individuals of a different microorganism, wherein said first nucleic acid sequence is comprised in the microorganism of said first section body and said second nucleic acid sequence is comprised in said microorganism of said second section body.

In certain particular embodiments, the nucleic acid sequence are part of a microorganism embedded in the matrix polymer, for examples as ribosomal RNA of the microorganism. Even more particularly, the first (NASI ) and second nucleic acid sequence (NAS2) is taken from the following table: Table 1

Candida spp. NAS 1 GCAGGCCUUUGCUCGA SEQ ID NO 013 Candida albicans

AUAUAUUAGC HQ876034

NAS 2 GCAGGCCUUUGCUCGA SEQ ID NO 014 Aspergillus

AUACAUUAGC fumigatus

AF548061

Filifactor NAS 1 UCAAAACGAUAGUGGA SEQ ID NO 015 Filifactor alocis alocis CAAAGA

CP002390

NAS 2 UCAAAGAGAAAUCGGA SEQ ID NO 016 Filifactor villosus

CAAAGA

F53721 1

Tannerella NAS 1 U ACAG G G G AAU AAAAU SEQ ID NO 017 Tannerella forsythia GAGAUACG forsythia

NAS 2 UAUACGGGAAUAACGG SEQ ID NO 018 Porphyromonas

GCGAUACG gingivalis

NR_074234

Porphyromo- NAS 1 GAAUAACGGGCGAUAC SEQ ID NO 019 Porphyromonas nas gingivalis GAGUAUUG gingivalis

NR_074234

NAS 2 GAAUAACGGGCGAUAC SEQ ID NO 020 Porphyromonas

GUGUAUUG gulae

AF208290

Prevotella NAS 1 UUGUAAACUGCUUUUG SEQ ID NO 021 Prevotella intermedia UUGGGGAGUAAAG intermedia

NAS 2 UUGUAAACUGCUUUUU SEQ ID NO 022 Prevotella

UAGGGGAAUAAAG byrantii B'l A,

NR_028866

Aggregatibac- NAS 1 GAAUCUGUCUUAUGGA SEQ ID NO 023 Aggregatibacter ter actinomycetemc

AY362884

actinomyce- omitans temcomitans

NAS 2 GAAUCUGGCUUAUGGA SEQ ID NO 024 Haemophilus influenzae

M35019

Fusobac- NAS 1 GAGAGCUUUGCGUCCC SEQ ID NO 025 Fusobacterium terium spp. AUUAG nucleatum

AB573068

subsp.

nucleatum

NAS 2 GAGAGCUUUGCGUCCU SEQ ID NO 026 Leptotrichia

AUUAG buccalis

CP001685 In certain embodiments, the joining polymer and the matrix polymer comprise a common monomer unit. This enhances the chemical union of the two components and facilitates microtome sectioning of the compound as a single preparation.

In certain embodiments, the joining polymer and the matrix polymer are made of essentially the same monomer units. In certain embodiments, the joining polymer and the matrix polymer comprise, or essentially are made of, polymethacrylic acid alkyl esters, particularly polymethylmetacrylate. This polymer is well known in histology and can be used by trained staff without further instructions for making section preparations. It is well suited for employment of FISH probes.

In certain embodiments, the control preparation is positioned on a microscopic sample holder and each section body is positioned within the control preparation so that the identity of the section body can be identified unambiguously by its position relative to

a. a shape of the control preparation;

b. a shape of said sample holder and/or

c. a reference point or reference body disposed on said sample holder.

This arrangement allows avoiding mistakes in positioning the control preparation, which could ultimately lead to an erroneous attribution of the measurement being made. In certain embodiments, the control preparation is shaped as a cuboid tapering or thinning on one side to facilitate cutting on the microtome.

In embodiments where a reference body is present, this can be used for orientation of the control preparation, but also as a reference of fluorescence intensity, which depends on the microscope (e.g. quality of the light source, correct beam path). Thus, the reference body can be used as an internal validation and quality control of the fluorescence signal for the positive and negative controls. The control body is a symmetrical or asymmetrical form and of a stable, standardized autofluorescence in a given fluorescence channel.

According to a second aspect of the invention, a method for detection of a target

microorganism in a tissue preparation is provided. This method comprises the following steps:

a. The tissue preparation is contacted with a fluorescently labelled oligonucleotide probe.

Said oligonucleotide probe is specific for the target microorganism under conditions that allow binding of the oligonucleotide probe to a target sequence, wherein said target sequence is 100% reverse complementary to said probe, and wherein said conditions will inhibit binding of said oligonucleotide probe to a sequence that is different in one to four positions to said target sequence (its reverse complementary sequence);

b. In another step, said fluorescently labelled oligonucleotide probe used in the preceding step a is contacted with a control preparation according to the first aspect of the invention or any of its embodiments to achieve a positive control. The first nucleic acid sequence of the first section body of the control preparation is 100% reverse complementary identical to the sequence of said fluorescently labelled oligonucleotide probe, i.e. the oligonucleotide probe hybridizes perfectly to the nucleic acid of the target organism and the positive control. The second nucleic acid sequence of said second section body is different in comparison to said first nucleic acid sequence, in that it contains a deletion, an additional nucleoside or a different nucleoside in one, two, three or four positions of said second nucleic acid sequence. Thus, it does not match perfectly and will not show a binding of the oligonucleotide probe to the second section body under conditions that require 100% match (negative or specificity control).

c. Subsequently, the results of steps a and b are analysed optically either by inspection or automated image analysis. If the fluorescently oligonucleotide probe has bound to the target sequence in step a, and the fluorescently oligonucleotide probe likewise has bound to the first nucleic acid sequence of the first section body in step b, but has not bound to the second nucleic acid sequence of the second section body in step b, the interpretation is that the target microorganism is present in the sample.

Different species or genera of microorganisms may be detected using oligonucleotide probes, labelled with different fluorescent dyes, or combination of different dyes.

In certain embodiments, any one of the following fluorescent dyes are employed: FITC, cyanin 3, TAMRA, Texas red and cyanin 5, or derivatives of these dyes. In certain

embodiments, FITC, cyanin 3 and cyanin 5 are employed. Depending on the equipment of the microscope with fitting filter sets, 2 or 3 oligonucleotide probes may be combined, optionally together with the nucleic acid dye DAPI. Confocal microscopy and the analysis of spectra allow detecting more than a dozen of different dyes or combinations thereof.

In certain embodiments, the analysis of the method is performed automatically.

In certain embodiments, a first and a second target microorganism of different species having the same genus are detected or discriminated in a tissue preparation. Therein, a first, second (3 ^rd , 4 ^th ...) fluorescently labelled oligonucleotide probe is used that is specific for each first and second (and 3 ^rd , 4 ^th ... where applicable) microorganism. Ideally, the control preparation provides a positive control and a negative control for each pair of

microorganisms in such fashion that two closely related but genetically distinct pathogens can serve to complement each other's positive and negative control. Thus, a first

oligonucleotide probe is used, which is specific for the first target microorganism, and which is 100% reverse complementary identical to the first nucleic acid sequence of said first section body, and a second oligonucleotide probe is used, which is specific for the second target microorganism, and which is 100% reverse complementary identical to the second nucleic acid sequence of said second section body.

Particular embodiments of the invention make use of the following sequence pairs:

Table 2: Example:

First probe: detection of Enterococcus faecalis

E. faecalis specific probe 3'- GGG TAG TCT CCC CCT ATT-5' Probe S6 (SEQ ID NO 027) rRNA sequence of E. faecalis 5'-CCC AUC AGA GGG GGA UAA-3' positive control (SEQ ID NO 005)

rRNA sequence of E. faecium 5'-CCC AUC AGA AGG GGA UAA-3' negative control (SEQ ID NO 006)

Second probe: detection of Enterococcus faecium

E. faecium-spez. Probe 3'- GTA AGT CAA CCC GTG AGA TCG TTC T-5' Probe S7 (SEQ ID NO 028)

E. faecium rRNA Seq. 5'-CAU UCA GUU GGG CAC UCU AGC AAG A-3' positive control (SEQ ID NO 029)

E. faecalis rRNA Seq. 5'-CAU UUA GUU GGG CAC UCU AGC GAG A-3' negative control (SEQ ID NO 030)

The reverse complementary sequences of the preceding sample sequences are employed as first and second nucleic acid sequence of the control preparation. In particular

embodiments, the sequences are provided as part of the16S RNA comprised within said species, wherein cells of the species are embedded and fixed within said control preparation.

In certain embodiments, the sequences named in a and b are comprised as part of a bacterial RNA. In certain embodiments, the sequences named in a and b are DNA or DNA analogues, in which case the positions designated as U (uracil) may be T (thymidine).

In certain embodiments, the probe named in c. is a DNA oligomer or an oligomer comprising or consisting of DNA analogues.

According to a third aspect of the invention, a kit for use in a method for detection of a target microorganism in a tissue preparation is provided. This kit comprises the following

components: a. A fluorescently labelled oligonucleotide probe as specified under the above aspects and embodiments of the invention. The oligonucleotide probe is specific for the target microorganism under conditions that allow binding of the oligonucleotide probe to a target sequence that is 100% reverse complementary to said probe, and wherein said conditions will inhibit binding of said oligonucleotide probe to a sequence that is different in one, two, three or four positions to said target sequence. In other words, this fluorescently labelled oligonucleotide probe is a FISH probe employable for specific detection of the target organism having a length of 12 to 30 nucleotides and being 100% reverse complementary to the first nucleic acid sequence of the control preparation.

b. A fluorescently labelled nonsense oligonucleotide probe, which does not bind to the RNA or DNA of any known microorganism under the conditions identified in paragraph a. This nonsense probe serves the purpose of controlling whether the conditions or the nature of the preparation / sample favour an unspecific binding of nucleic acids to the preparation. In certain embodiments, controls are used that show a similar or identical base composition compared to the specific

oligonucleotide probe (para a). Such composition can be achieved by using the sequence complementary (not reverse complementary) to the specific probe. For a probe sequence ATG, this would be TAC (the probes of the invention are longer, but the principle of base composition is demonstrated with this short sequence).

c. A control preparation according to the first aspect of the invention or any of its

embodiments mentioned herein. This comprises a first nucleic acid sequence of the first section body, which hybridizes to said fluorescently labelled oligonucleotide probe under the conditions identified in paragraph a (i.e., is 100% reverse complementary identical), and a second nucleic acid sequence of said second section body, which does not hybridize to said fluorescently labelled oligonucleotide probe under the conditions identified in paragraph a.

d. Optionally, the kit further comprises more components. Of special mention are: i. A fluorescent dye binding to polynucleotides in an unspecific fashion, particularly 4',6-diamidino-2-phenylindol (DAPI).

ii. A fluorescently labelled oligonucleotide probe binding to a 16S-RNA consensus sequence that is comprised in the great majority of bacteria (a so-called „panbacterial probe") and serves to detect the presence of bacteria without further specificity of species or genus. iii. A fluorescently labelled oligonucleotide probe binding to a 16S-RNA consensus sequence that is comprised in all species of a genus and serves to detect the presence of bacteria of a particular genus without species specificity; iv. A fluorescently labelled oligonucleotide having no target in currently known

bacteria (nonsense probe), which serves to identify unspecific binding.

In certain embodiments, the kit is designed for use in a method for detecting and

discriminating a first and a second target microorganism of different species, but of the same genus, or of different genera or bacterial groups, in a tissue preparation. It comprises a fluorescently labelled first oligonucleotide probe ("first probe"), wherein said first

oligonucleotide probe is specific for said first target microorganism under conditions that allow binding of the oligonucleotide probe to a target sequence, wherein said target sequence is 100% reverse complementary to said oligonucleotide probe, and wherein said conditions will inhibit binding of said oligonucleotide probe to a sequence that is different in one, two, three or four positions to said target sequence. Furthermore, it comprises a fluorescently labelled second oligonucleotide probe ("second probe"), wherein said second oligonucleotide probe is specific for said second target microorganism under the conditions identified above (paragraph a. i.).

Optionally, a fluorescently labelled nonsense oligonucleotide probe, which does not bind to the RNA or DNA of a known microorganism under the conditions identified above is also contained within the kit. A panbacterial probe may also be comprised as part of the kit.

Furthermore, the kit comprises a control preparation according to according to any one of the aspects or embodiments disclosed herein, wherein the control preparation comprises:

i. A first nucleic acid sequence of the first section body that hybridizes to the first

oligonucleotide probe under the conditions identified in paragraph a. above and that does not hybridize to said fluorescently labelled second oligonucleotide probe under such conditions.

ii. A second nucleic acid sequence of the second section body, which does not hybridize to the first oligonucleotide probe but with the second oligonucleotide probe under such conditions.

In certain embodiments a combination of reagents for practicing the method of the invention (kit) comprises the following sequences:

a. A first nucleic acid sequence comprising a sequence designated NAS 1 in table 1 (positive control) b. a second nucleic acid sequence comprising a sequence designated as NAS 2 in table 1 and associated (same line) to the sequence designated as NAS 1 in the preceding paragraph (negative or specificity control)

c. a fluorescently labelled oligonucleotide probe that is completely reverse

complementary to the first nucleic acid sequence named in paragraph a.

In certain embodiments a combination of reagents for practicing the method of the invention (kit) comprises the following sequences:

a. a fluorescently labelled oligonucleotide probe;

b. a first nucleic acid sequence (positive control)

c. a second nucleic acid sequence (negative / specificity control)

d. a probe specific for eubacteria (S1 )

e. genus specific probes (S4, S8, S10, S16, S17 and/or S18)

f. species specific probes (S5, S6, S7, S9, S1 1 , S12, S13, S14 and/or S15)

The control preparations and FISH kits of the present invention allow routine detection and visualization of biofilms and microorganisms in tissues and on medical devices by microscope for the first time. The pathogens associated with an infection can thus by identified quickly, which allows starting therapy early and specifically.

Advantages of the invention with view to the state of the art are, inter alia, that the control preparations may be supplied commercially as object holders having the standard dimensions of microscopy as a kit having a composition designed to optimally suit the application at hand. The control preparations do not require refrigeration, are insensitive to temperature changes and can be stored for at least three years. Laborious cultivation of control strains by the user can thus be avoided. Another advantage is the constant quality of the control preparations, achieved by invariant ribosomal content of the bacteria, and an internal option for validating the fluorescence intensity through the reference body.

On the level of process management, the control preparations of the invention allow controlling of the signal intensity in FISH and avoid making the result of the process dependent on the proficiency level of the person performing the process. They further provide for a more efficient use of reagents, as in one section, several bacterial species may be hybridized in one step. This further leads to time savings upon analysis of the experiment, i.e. at the microscope, as all controls are placed within one slide. Automation of the hybridization and analysis process is also facilitated. The control preparations of the invention help to avoid user errors at the microscope by facilitating an unambiguous association of bacterial species through the asymmetrical section (avoids confusion when pipetting).

The invention is further illustrated by the following examples and figures, which are meant to illustrate but not limit the invention:

Brief description of the figures

Fig. 1 shows the setup of the control preparation schematically.

Fig. 2 shows the top view onto a section of the control preparation schematically.

Fig. 3 shows an exemplary procedure for detecting microorganisms relevant in

cardiology.

Fig. 4 shows an exemplary procedure for detecting microorganisms relevant for oral medicine.

Examples

Exemplary FISH Kits for diagnosis of endocarditis and peri-implantitis are shown.

Cardiac kit

The exemplary „cardiac kit" facilitates the diagnosis of life-threatening cardiac infections, such as endocarditis, and the recommendation of a specific antibacterial regime during or after cardiac valve or prosthesis operations.

The FISH probe panel of the example detects 95% of typical endocarditis pathogens even in heart valves and prosthesis negative in culture, according to current ESC guidelines (staphylococci, streptococci, enterococci and Candida).

Table 3; cardiac kit sequences

S2 No rRNA of most microorganisms

SEQ ID NO 32 ACT CCT ACG GGA GGC AGC of the bacteria domain, but of the

16S rRNA gene

S3

CGA CGG AGG GCA TCC TCA Nonsense sequence, no target

SEQ ID NO 33

S4

TCC TCC ATA TCT CTG CGC Staphylococcus spp.

SEQ ID NO 34

S5

GAA GCA AGC TTC TCG TCC G Staphylococcus aureus

SEQ ID NO 35

S6 Enterococcus faecalis, E.

TTA TCC CCC TCT GAT GGG

SEQ ID NO 36 sulfureus, Granulicatella spp.

S7 TCT TGC TAG AGT GCC CAA CTG E. faecium, E. durans,

SEQ ID NO 37 AAT G Lactobacillus buchneri

S8

CAC TCT CCC CTY CTG CAC Streptococcus spp.

SEQ ID NO 38

S9

TATTGCAACCCTCTGTACCA Tropheryma whipplei

SEQ ID NO 39

S10 GCT AAT ATA TTC GAG CAA AGG

Candida spp.

SEQ ID NO 40 CCT GC

In certain embodiments, the following combinations of two or three probes are employed:

Table 4, cardiac kit composition

Sequence ID 5'-fluorescent For detection of

dye

Cardio Mix 1 S1 Cy3 bacteria

S3 FITC

Cardio Mix 2 S6 Cy3 Enterococcus faecalis

S7 FITC Enterococcus faecium

Cardio Mix 3 S4 Cy3 Staphylococcus spp.

S8 FITC Streptococcus spp.

Cardio Mix 4 S9 Cy3 Tropheryma whipplei

S10 FITC Candida spp.

Cardio Mix 5 S5 Cy3 Staphylococcus aureus

S4 FITC Staphylococcus spp.

Cardio Mix 6 S4 Cy3 Staphylococcus spp.

S8 FITC Streptococcus spp. S1 Cy5 bacteria

Cardio Mix 7 S6 Cy3 Enterococcus faecalis

S7 FITC Enterococcus faecium S1 Cy5 bacteria

Cardio Mix 8 S1 Cy3 bacteria

S10 FITC Candida spp.

S3 Cy5

Cardio Mix 9 S5 Cy3 Staphylococcus aureus

S4 FITC Staphylococcus spp.

S1 Cy5 bacteria

The concept behind the endocarditis kit for a microscope with filter sets for FITC, Cy3 and DAPI is shown schematically in Fig. 3.

Kit: rare cardiac pathogens

Additionally, we have developed a FISH probe panel for rare pathogens of endocarditis, such as Tropheryma whipplei, Bartonella spp., Propionibacterium spp., Lactobacillus spp. and Aerococcus spp.. A further component of the kits is the reagent for pulping the microorganisms and for tissue permeabilisation of the FISH probes. Both are requisites for successfully performing FISH on cardiac valves.

Oral Kit

The exemplary „oral kit" facilitates the identification of pathogens in periodontitis, a widespread disease, and in peri-implantitis (infection of dental implants).

The focus of the exemplary kits is in detection of pathogens of oral biofilms that are hard or impossible to keep in culture. The panel of probes for the typical causative agents of periodontitis is shown in the following table:

Table 5; probe sequences of the oral kit

S2 No rRNA of most microorganisms

SEQ ID NO 32 ACT CCT ACG GGA GGC AGC of the bacteria domain, but of the

16S rRNA gene

S3 CGA CGG AGG GCA TCC TCA Nonsense sequence, no target

SEQ ID NO 33

S4 TCC TCC ATA TCT CTG CGC Staphylococcus spp.

SEQ ID NO 34

S10 GCT AAT ATA TTC GAG CAA AGG Candida spp.

SEQ ID NO 40 CCT GC

S1 1 TCT TTG TCC ACT ATC GTT TTG A Filifactor alocis

SEQ ID NO 41

S12 CGT ATC TCA TTT TAT TCC CCT Tannerella forsythia

SEQ ID NO 42 GTA

S13 CAA TAC TCG TAT CGC CCG TTA Porphyromonas gingivalis

SEQ ID NO 43 TTC

S14 CTT TAC TCC CCA ACA AAA GCA

SEQ ID NO 44 GTT TAC AA Prevotella intermedia/ falsenii

S15 Aggregatibacter

TCC ATA AGA CAG ATT C

SEQ ID NO 45 actinomycetemcomitans

S16

CTA ATG GGA CGC AAA GCT CTC Fusobacterium spp.

SEQ ID NO 46

In certain embodiments, the following combinations are employed:

Table 6, composition of oral kit

Oral Mix 5 S13 Cy3 Porphyromonas gingivalis

S14 FITC Prevotella intermedia

Oral Mix 6 S15 Cy3 Aggregatibacter

S18 actinomycetemcomitans

FITC Treponema spp.

Oral Mix 7 S1 Cy3 Bacteria

S8 FITC Streptococcus spp.

S3 Cy5

Oral Mix 8 S17 Cy3 Actinomyces spp.

S10 FITC Candida spp.

S3 Cy5

Oral Mix 9 S16 Cy3 Fusobacterium spp.

S13 FITC Porphyromonas gingivalis

S12 Cy5 Tannerella forsythia.

Oral Mix 10 S1 1 Cy3 Filifactor alocis

S4 FITC Staphylococcus spp.

S1 Cy5 Bacteria

Oral Mix 1 1 S18 Cy3 Treponema spp.

S14 FITC Prevotella intermedia S15 Cy5 Aggregatibacter

actinomycetemcomitans

The table in particular comprises pathogens that can be detected in periodontitis by means of PCR methods, and the of which is detection is established for dental practices. Examples are Tannerella forsythia, Porphyromonas gingivalis, Prevotella intermedia, A. actinomycetemcomitans, Filifactor alocis and Treponema spp.. The pathologist or microbiologist can affirm the relative components and their spatial distribution within the biofilm. Additionally, the indicator pathogen can be identified and the therapeutic success can be assessed.

The oral kit can be applied both to histological tissue sections and to dental plaque. The kit detects classic periodontitis pathogens, but also Candida and Actinomycetes, which have a decisive role in therapy of peri-implantitis. Such mix also must contain a nonsense probe to facilitate an unambiguous interpretation of results. Probe binding properties, hybridization buffer and the fluorescence dye labels of the particular probes necessitate different probe combinations in a plurality of mixes. The concept behind the oral kit for a microscope with filter sets for FITC, Cy3 and DAPI is shown schematically in Fig. 4.

Manufacture of the control preparations

In order to obtain the control preparations, the respective bacterial cultures are poured into synthetic resin and sections are made.

The synthetic resin is particularly suited for embedding because the hybridizations mix (including the FISH probes) can permeate the material unhindered, and the conditions for hybridization can be selected in a way to guarantee unimpeded association of probes to the bacterial RNA where a target sequence is present.

Several small blocks comprising bacterial species are made and combined into joint blocks, and sectioned, in order to save material, reagents and time. This facilitates the analysis of several controls per section.

Steps

Bacterial cultures are spun down during the exponential growth phase and are processed according to the embedding instructions of the Technovit 8100 technical manual (Heraeus Kulzer GmbH, 61273 Wehrheim). The bacterial pellet is kept during each change of solvent.

During the last step, the solution of methacrylate and the hardener are poured into small forms having an approx. size of 0,5 x 0,5 x 0,4 cm.

The hardened cylinders with bacteria inside are then jointly brought into a larger (approx.. 1 ,0 x 0,8 x 0,4 cm) block, and are sectioned.

Workflow and reagents