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Journal of Virological Methods 187 (2013) 26–31 Contents lists available at SciVerse ScienceDirect Journal of Virological Methods journal homepage: www.elsevier.com/locate/jviromet Application of the pseudo-plaque assay for detection and titration of Crimean-Congo hemorrhagic fever virus Engin Berber a , Nurettin Canakoglu a , Mustafa D. Yoruk a , Sukru Tonbak a , Munir Aktas b , Mustafa Ertek c , Yusuf Bolat a , Ahmet Kalkan d , Aykut Ozdarendeli a,e,∗ a Department of Virology, College of Veterinary Medicine, Firat University, Elazig, Turkey Department of Parasitology, College of Veterinary Medicine, Firat University, Elazig, Turkey c Refik Saydam National Public Health Agency, Ankara, Turkey d Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Karadeniz Technical University, Trabzon, Turkey e Department of Microbiology, Medical Faculty, Erciyes University, Kayseri, Turkey b a b s t r a c t Article history: Received 24 February 2012 Received in revised form 21 July 2012 Accepted 24 July 2012 Available online 10 August 2012 Keywords: Titration Detection Crimean-Congo hemorrhagic fever Turkey-Kelkit06 Pseudo-plaque assay A pseudo-plaque assay was developed for detection and quantitation of Crimean-Congo hemorrhagic fever virus Turkey-Kelkit06. Enzyme-catalyzed color development of infected cells probed with antiCrimean-Congo hemorrhagic fever virus antibodies was used for determining the titer of Crimean-Congo hemorrhagic fever Turkey-Kelkit06 and for its detection in samples from persons infected with the Crimean-Congo hemorrhagic fever virus. The pseudo-plaque assay accuracy was confirmed by comparing pseudo-plaque assay titers with fluorescent immunofocus assay and focus formation assay titers using three stocks of virus. No significant difference in virus titers of Crimean-Congo hemorrhagic fever Turkey-Kelkit06 among the three methods was observed. The pseudo-plaque assay is more sensitive than the fluorescent immunofocus assay for detecting the virus in primary isolates of Crimean-Congo hemorrhagic fever virus collected from humans, but no difference in sensitivity between the two methods was observed in the cell-adapted strain of Crimean-Congo hemorrhagic fever Turkey-Kelkit06. The pseudoplaque assay is suitable for titration of Crimean-Congo hemorrhagic fever Turkey-Kelkit06, which does not develop plaques, suggesting it may also be suitable for the detection of other viruses. © 2012 Elsevier B.V. All rights reserved. 1. Introduction Crimean-Congo hemorrhagic fever virus is a Nairovirus of the family Bunyaviridae that causes hemorrhage and severe illness in humans with high mortality rates (Ergonul, 2006; Whitehouse, 2004). The virus is tick-borne, transmitted by the bite of infected ticks to livestock and humans or by exposure to the tissues or blood of infected animals (Hoogstraal, 1979). Since Crimean-Congo hemorrhagic fever was first identified in the Crimea and the former Belgian Congo, the disease has been reported in widespread areas of Africa, the Middle East, and Eurasia (Ergonul, 2006; Maltezou et al., 2010; Papa et al., 2002). A large Crimean-Congo hemorrhagic fever outbreak occurred in Turkey in 2002 (Karti et al., 2004). The numbers of Crimean-Congo hemorrhagic fever cases ∗ Corresponding author at: Department of Microbiology, Medical Faculty, Erciyes University, Kayseri, Turkey. Tel.: +90 0352 2076666x23387; fax: +90 0352 437 52 85. E-mail addresses: [email protected], [email protected] (A. Ozdarendeli). 0166-0934/$ – see front matter © 2012 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.jviromet.2012.07.025 have gradually increased in Turkey making the virus a public health concern (Ergonul, 2006; Ozdarendeli et al., 2010). Virus detection is the primary method of diagnosis of early stage disease. Diagnostic assays for acute Crimean-Congo hemorrhagic fever infection include virus culture, immunohistochemistry, antigen-detection enzyme immunoassay (EIA), and reverse transcription-PCR (RT-PCR) (Burt et al., 1998; Donets et al., 1982; Ozdarendeli et al., 2008; Saijo et al., 2002b). Although RTPCR is easy, rapid, and the most sensitive method of detection of Crimean-Congo hemorrhagic fever virus, it only confirms the presence of the viral genome and does not provide information on the presence of infectious virions. Currently, plaque assays and fluorescent focus assays are used for measuring virus infectivity of Crimean-Congo hemorrhagic fever virus in vitro. Alternative methods for measuring virus infectivity of Crimean-Congo hemorrhagic fever virus have not been considered. In the present study, a pseudo-plaque assay based on enzymecatalyzed color development of infected cells probed with anti-Crimean-Congo hemorrhagic fever virus antibodies was used for determining the titer of Crimean-Congo hemorrhagic fever virus Turkey-Kelkit06 and for detection of the virus in clinical samples collected from Crimean-Congo hemorrhagic fever human cases. E. Berber et al. / Journal of Virological Methods 187 (2013) 26–31 The results obtained by pseudo-plaque assay were compared with a fluorescence immunofocus assay and a focus formation assay. 2. Materials and methods 2.1. Cells, virus and antibodies Vero E6 cells (African green monkey kidney) obtained from ATCC (CRL 1586) and SW-13 cells (adrenocortical carcinoma, Leibovitz et al., 1973) obtained from the Refik Saydam National Public Health Agency (RSPHA, Turkey) were maintained in Dulbecco’s modified Eagle’s medium (DMEM) supplemented with 10% heat-inactivated fetal bovine serum (FBS), 100 mM l-glutamine, 50 U/ml penicillin, 50 g/ml streptomycin (Sigma–Aldrich, Germany). Crimean-Congo hemorrhagic fever virus Turkey-Kelkit06 strain was isolated in 2006 from the blood of a patient from the Kelkit Valley region of Turkey (Tonbak et al., 2006). Crimean-Congo hemorrhagic fever virus Turkey-Kelkit06 was passaged 3 times by intracerebral inoculations of 2–3 days old suckling mice. The mice were euthanized 5 days post-infection (PI), and their brains homogenized to 10% (w/v) with DMEM and clarified by centrifugation at 10,000 × g for 15 min. Aliquots were stored at −80 ◦ C. CrimeanCongo hemorrhagic fever virus stocks were prepared on Vero E6 and SW-13 cells by infection of T175 cell culture flasks with a 1:100 dilution of the parent virus stock. Supernatants were collected 4 days PI, cleared of cell debris by centrifugation at 500 × g for 20 min, at 4 ◦ C, and aliquots were stored at −80 ◦ C. Polyclonal rabbit and mouse anti-Crimean-Congo hemorrhagic fever virus sera were generated in rabbits and mice immunized with inactivated Crimean-Congo hemorrhagic fever virus TurkeyKelkit06 strain. The entire protocol was approved by the local ethics committee of the Firat University. 2.2. Human sera Serum samples from 12 patients, including one fatality, were obtained from the Refik Saydam National Public Health Agency, The National Crimean-Congo Hemorrhagic Fever Reference Center of Turkey. All patients had laboratory-confirmed Crimean-Congo hemorrhagic fever infection and acquired the virus during the 2007 outbreaks in Turkey’s Kelkit Valley region. 27 washes in TBST, goat anti-mouse -gal conjugate, diluted 1:1500 in TBST (Southern Biotech, USA), was added to each well, and the plate was incubated for 1 h at room temperature with gentle rocking. After extensive washing, the substrates NBT (nitro blue tetrazolium) and X-gal (5-bromo-4-choloro-3-indolyl-betad-galactopyranoside) were added to each well and incubated at 37 ◦ C. To avoid overdevelopment, microplates were checked every 10 min under a microscope. When infected cells appeared medium blue to dark purple in color, TBST was added to stop the reaction. All handling of virus was performed in a biosafety level 3 laboratory. 2.4. Focus formation assay Crimean-Congo hemorrhagic fever Turkey-Kelkit06 stock viruses were titrated by the focus formation assay following the peroxidase–antiperoxidase method described by Okuna et al. with minor modifications (Okuno et al., 1985a, 1985b). Vero E6 or SW13 cells were seeded into 96-well plates (Corning, USA) and grown to 90% confluency. For the Crimean-Congo hemorrhagic fever virus Turkey-Kelkit06 infectivity assay, a microplate with triplicate wells containing 10-fold diluted virus stock was incubated at 37 ◦ C with 5% CO2 for 1 h. The viral inocula were removed and washed with PBS, and the cell monolayer was covered with virus medium containing 1% CMC (Sigma–Aldrich, Germany) then incubated at 37 ◦ C and 5% CO2 for 24 h. The medium was removed, and the cells were washed with PBS, fixed with 10% neutral buffered formaldehyde at room temperature for 20 min, and washed twice with TBST. The cells were permeated with 1% Nonidet-P 40 (NP-40) in TBST for 30 min with gentle rocking, and blocked with 5% skim milk in TBST. Infected cells were probed with rabbit anti-Crimean-Congo hemorrhagic fever virus polyclonal antisera (1:1500) and incubated for 1 h at room temperature with gentle rocking. The cells were treated with goat anti-rabbit IgG (1:1000; Sigma–Aldrich, Germany) and rabbit peroxidase–antiperoxidase (PAP) (1:200; Sigma–Aldrich, Germany). Each step was preceded by washing the wells 3–4 times with TBST. Finally, viral antigens in infected cells were detected by staining with 3,3n -diaminobenzidine tetrahydrochloride (DAB) (Sigma–Aldrich, Germany) and H2 O2 for 10–20 min at room temperature. The DAB solution was removed, and the cells were rinsed with deionized water to stop the reaction. The stained cells (the foci) were examined microscopically. 2.5. Fluorescent immunofocus assay 2.3. Pseudo-plaque assay The pseudo-plaque assay was based on the FastPlaxTM Titer Kit (Novagen, USA) used in the baculovirus expression system. Crimean-Congo hemorrhagic fever virus Turkey-Kelkit06 stock viruses were titrated by the pseudo-plaque assay with some modifications (Mitchell et al., 2010). Vero E6 or SW-13 cells were grown to confluence in 96-well microtiter plates (Corning, USA) in DMEM containing 10% FBS at 37 ◦ C with 5% CO2 for 18–24 h. The cells were washed twice with 10 mM phosphate buffer saline (PBS, pH 7.2) and incubated with 10-fold serially diluted virus suspension in triplicate wells at 37 ◦ C with 5% CO2 for 1 h. After incubation, the inoculum was removed and the cell monolayer was overlaid with virus medium containing 1% carboxymethyl cellulose (CMC) (Sigma–Aldrich, Germany) incubated at 37 ◦ C with 5% CO2 for 8–24 h. The cells were fixed with 10% neutral buffered formaldehyde for 20 min, washed twice with TBST (100 mM Tris–HCl pH 8.0, 1.5 M NaCl, 1% Tween 20), permeabilized with 0.1% Triton X 100 in PBS for 20 min with gentle rocking and then blocked with 5% skim milk in PBS. Polyclonal mouse antiCrimean-Congo hemorrhagic fever virus serum diluted 1:1500 in TBST was added to each well, and the plate was incubated for 1 h at room temperature with gentle rocking. Following three 10-min Lab Tek II 8-well chamber slides (Sigma–Aldrich, Germany) were seeded with Vero E6 or SW-13 cells at a density of 3 × 105 and incubated at 37 ◦ C with 5% CO2 to produce a confluent monolayer. The cell monolayers were inoculated with 10-fold serially diluted virus. After absorption for 1 h at 37 ◦ C, the supernatants were removed and the cells were washed with PBS. The cell monolayer was overlaid with virus medium containing 1% CMC then incubated 37 ◦ C with 5% CO2 for 8 to 24 h. After fixation with 10% neutral buffered formaldehyde at room temperature for 20 min, the cells were permeated with 0.1% Triton X 100 in PBS for 20 min with gentle rocking and blocked with 5% skim milk in PBS. Slides were moved to a moist chamber, incubated with rabbit anti-Crimean-Congo hemorrhagic fever virus polyclonal antisera (1:1000) for 1 h in TBST at 37 ◦ C and washed 3 times with TBST. Antibody-labeled cells were detected after cells were incubated for 1 h with goat anti-rabbit IgG conjugated with fluorescein isothiocyanate (FITCH) (Southern Biotech, USA) and diluted 1:1000 in TBST and then washed three times with TBST and once with distiled water. The cells were mounted in anti-fading medium (Sigma–Aldrich, Germany) and analyzed by immunofluorescence microscopy (Olympus BX50, Japan). Images were captured with Olympus DP72 digital camera and Olympus DP2-BSW software. 28 E. Berber et al. / Journal of Virological Methods 187 (2013) 26–31 Fluorescent foci that were located within the 0.7 cm2 area of each well were counted, and virus titers were calculated and expressed as fluorescent focus units per ml. new cells with succeeding generations. Smaller satellite foci, probably resulting from dissemination of progeny virus from the initial site of infection, surrounded the primary plaques (Fig. 2A–D). 2.6. Statistical analysis 3.2. Time course for the development of pseudo-plaque assay Statistical analyses were conducted using Graph Pad Prism, v 4.0. A dilution of Crimean-Congo hemorrhagic fever virus TurkeyKelkit06 known to produce 30–50 pseudo-plaques per well was infected, fixed and stained 2–5 days PI. There were no detectable pseudo-plaques on PI day 2 (Fig. 3). Pseudo-plaques were visible 3–5 days PI and increased each day in size but not in number (Fig. 3). Even though the pseudo-plaques were not visible until 3 days PI by naked eye, we were able to detect the pseudo-plaques at 24 h PI under ordinary light microscopy. 3. Results 3.1. Titration of Crimean-Congo hemorrhagic fever virus Turkey-Kelkit06 in VERO E6 and SW-13 cells by pseudo-plaque assay Vero E6 and SW-13 cells were grown to confluence in 24well cell culture plates and infected with 10-fold serial dilutions of virus. Cells were fixed 5 days PI, and blue pseudo-plaques were detected with polyclonal mouse anti-Crimean-Congo hemorrhagic fever virus serum following degradation of X-gal by -galactosidase linked to secondary antibodies. The pseudo-plaque titers of Crimean-Congo hemorrhagic fever virus Turkey-Kelkit06 in Vero E6 were not significantly different from viral titers in SW13 cells; mean Crimean-Congo hemorrhagic fever virus titers were slightly greater in SW-13 cells (5.2 versus 5.1 log10 PPA/ml). In the SW-13 cell line, the pseudo-plaques were less distinct than in the Vero E6 cell line, but they were still quantifiable (Fig. 1A and B). The intensity of staining was strongest at the center of each pseudo-plaque and gradually decreased with increased distance from the center, indicating that the virus had spread and infected 3.3. Linear relationship between dilution and virus titer in the pseudo-plaque assay After optimizing pseudo-plaque assay on 24-well plates for quantitation of Crimean-Congo hemorrhagic fever virus TurkeyKelkit06, Vero E6 or SW-13 cells were seeded into 96-well tissue culture plates. The cell monolayers were incubated with 10 fold serially diluted virus and overlaid with virus medium containing 1% CMC. Cells were fixed at 24 h PI and processed for pseudo-plaque assay. The pseudo-plaques were counted under light microscope. The pseudo-plaque titers of Crimean-Congo hemorrhagic fever virus Turkey-Kelkit06 in Vero E6 and SW-13 cells were 4.3 × 105 and 5.1 × 105 PPA/ml, respectively. These data indicated that 96well plates were suitable for determining the titer of the virus by pseudo-plaque assay. To determine a correlation between dilution and virus titer by pseudo-plaque assay, Vero E6 and SW-13 cells were infected with 10-fold dilutions of the virus, and the pseudo-plaques were counted under the microscope 24 h PI by pseudo-plaque assay. Fig. 4 shows the linear relationship (log 10) between virus dilutions and the number of pseudo-plaques per well. The number of pseudo-plaques counted for each Crimean-Congo hemorrhagic fever virus dilution in this assay showed low variation among replicates. 3.4. Comparison of virus titer as determined by the pseudo-plaque assay, fluorescent immunofocus assays, and focus formation assay Pseudo-plaque assay accuracy was measured by comparing pseudo-plaque assay titers with the titers of the focus formation assay and the fluorescent immunofocus assay. For this purpose, Vero E6 and SW-13 cells were seeded into 96-well plates for the pseudo-plaque assay and the focus formation assay and into 8well chamber slides for the fluorescent immunofocus assay. Serial 10-fold dilutions of three different stocks of Crimean-Congo hemorrhagic fever virus Turkey-Kelkit06 were inoculated onto Vero E6 and SW-13 cells and overlaid with virus medium containing 1% CMC. Cells were fixed at 24 h PI and processed as described (Fig. 5). The three stocks exhibited approximate virus titers of 104 and 105 infectious units (Table 1). The Kruskal–Wallis test showed no significant differences among the assays (P > 0.05). 3.5. Application of the pseudo-plaque assay for clinical investigation Fig. 1. Dose-dependent response for pseudo-plaque titration of Crimean-Congo hemorrhagic fever virus Turkey-Kelkit06. Vero E6 (A) and SW-13 (B) cells were infected with 10-fold dilutions of Crimean-Congo hemorrhagic fever virus TurkeyKelkit06 in duplicate, fixed 5 days PI, and then stained for Crimean-Congo hemorrhagic fever virus Turkey-Kelkit06. Viral titers were determined by counting pseudo-plaques at 10−4 dilutions. Crimean-Congo hemorrhagic fever confirmed human sera from 12 individuals was investigated by pseudo-plaque assay and fluorescent immunofocus assay. Vero E6 cells were incubated with 50 l of 5-fold diluted sera in triplicate wells and overlaid with the medium containing 1% CMC. Cells were fixed 8 or 24 h PI and processed for pseudo-plaque assay and fluorescent immunofocus E. Berber et al. / Journal of Virological Methods 187 (2013) 26–31 29 Fig. 2. Prototypical morphologies of Crimean-Congo hemorrhagic fever virus Turkey-Kelkit06 pseudo-plaques. Vero E6 (A and B) and SW-13 (C and D) cells were infected with Crimean-Congo hemorrhagic fever virus Turkey-Kelkit06 and then fixed 24 h PI (A and C; magnification: 100×) and 5 days PI (B and D; magnification: 40×). The presence of polyclonal mouse anti-Crimean-Congo hemorrhagic fever virus serum-stained pseudo-plaques was determined using light microscopy. assay (Fig. 6). Six of the 12 samples were found to be positive at 8 h PI by pseudo-plaque assay, and 10 were found to be positive at 24 h PI. At 8 h PI, there were no positive samples by fluorescent immunofocus assay, while seven samples were positive at 24 h PI. 4. Discussion Accurate titration of viruses is a crucial step in the field of virology. To date, several methods have been used for viral titration depending on the nature of the virus (Counihan et al., 2006; Cruz and Shin, 2007; Payne et al., 2006; Shepherd et al., 1986; Yang et al., 1998). Plaque forming unit (PFU) assays and endpoint titration assays are the most common. Both PFU and endpoint titration assays for a 50% tissue culture infectious dose (TCID50) require a monolayer of cells susceptible to virus infection and that develop a virus-induced cytopathic effect (CPE) (Dulbecco and Vogt, 1954; Reed and Muench, 1938). These traditional methods cannot be used to quantify viruses that produce little or no CPE. Crimean-Congo hemorrhagic fever virus often tends to develop a noncytopathic persistent infection of cell cultures, depending on the strain of the virus. Formation of plaques and CPE may take place after serial passage of the virus (Shepherd et al., 1986). If the virus Fig. 3. Course of development of visible Crimean-Congo hemorrhagic fever virus Turkey-Kelkit06 pseudo-plaques. Vero E6 cells infected with Crimean-Congo hemorrhagic fever virus Turkey-Kelkit06 were fixed and stained at the indicated times post-infection. 30 E. Berber et al. / Journal of Virological Methods 187 (2013) 26–31 Fig. 4. Linear relationship between virus dilutions and number of pseudo-plaques per well. Vero E6 cells (A) and SW-13 cells (B) in 96-well microplates were infected with serially diluted Crimean-Congo hemorrhagic fever virus Turkey-Kelkit06 and stained by pseudo-plaque assay 24 h PI; correlation coefficient, r = −0.8814 (A), and −0.8879 (B). Fig. 5. Detection of Crimean-Congo hemorrhagic fever virus Turkey-Kelkit06 using pseudo-plaque assay, focus formation assay and fluorescent immunofocus assay. CrimeanCongo hemorrhagic fever virus Turkey-Kelkit06-infected Vero E6 cells were fixed at 24 h and stained with polyclonal mouse anti-Crimean-Congo hemorrhagic fever virus serum and secondary antibody conjugated with -gal (A); stained with rabbit anti-Crimean-Congo hemorrhagic fever virus serum and PAP complex (B); or stained with polyclonal mouse anti-Crimean-Congo hemorrhagic fever virus serum and secondary antibody conjugated with FITCH (C). Fig. 6. Comparison of pseudo-plaque and fluorescent immunofocus assays with a Crimean-Congo hemorrhagic fever confirmed human serum. Crimean-Congo hemorrhagic fever infection was detected 8 h PI and 24 h PI by pseudo-plaque assay (A). Fluorescent immunofocus assay detected Crimean-Congo hemorrhagic fever infection only 24 h PI (B) (NC; mock infected Vero E6 cells 24 h PI). Table 1 Titration with focus formation assay (FFA), fluorescent immunofocus assay (FIFA), and pseudo-plaque assay (PPA) on Vero E6 and SW-13 cells. Virusa Vero E6 cells b Stock 1 Stock 2 Stock 3 a b FFA 3.8 × 105 3.4 × 104 2.5 × 105 SW-13 cells FIFA PPA FFA FIFA PPA 2.1 × 105 2.0 × 104 3.4 × 105 4.5 × 105 3.8 × 104 3.3 × 105 3.5 × 105 4.0 × 104 2.0 × 105 2.2 × 105 8.0 × 103 2.3 × 105 5.5 × 105 6.3 × 104 2.2 × 105 Stocks of Crimean-Congo hemorrhagic fever virus Turkey-Kelkit06. Viral titer (log10 FFA, FIFA, or PPA/ml). E. Berber et al. / Journal of Virological Methods 187 (2013) 26–31 does not develop plaques, virus titration must be conducted by immunofluorescence assay with specific polyclonal or monoclonal antibodies. A pseudo-plaque assay for titration and clonal isolation of adeno-associated viruses was described by Mitchell et al. (2010). Pseudo-plaque assay relies on the NBT and X-gal staining method, which enables visualization of infected cells by probing the cells with specific antbodies. Enzyme-catalyzed color development of infected cells is detected, not directly from plaque formation, but from antibody-mediated detection of viral antigens. A major advantage of pseudo-plaque assay is that, since the method relies on detection of viral antigens in infected cells using virus specificantibodies, it does not require the development of CPE in the infected cell monolayer. The pseudo-plaque assay in 96-well microtiter plates to titrate Crimean-Congo hemorrhagic fever virus Turkey-Kelkit06 in Vero E6 and SW-13 cells proved to be a simple and rapid means of analyzing a large number of samples. Results were obtained 24 h after cell infection, a reduction in titration times from 3–5 days. The plaque assay is the gold standard for quantitation of Crimean-Congo hemorrhagic fever virus. Researchers have used fluorescent immunofocus assay to determine viral infectivity of Crimean-Congo hemorrhagic fever virus. These studies were performed with a liquid overlay and, after 24 h, cell infection fluorescent foci were used to calculate titration (Connolly-Andersen et al., 2007, 2009), possibly allowing a secondary infection, which could affect titration results. In this pseudo-plaque assay, an overlay of CMC was used to prevent a secondary infection. The pseudo-plaque assay accuracy was confirmed by comparing its results with focus formation and fluorescent immunofocus titers using 3 stocks of the virus. No significant differences were observed in the virus titers across the three methods (Table 1). No difference in sensitivity was observed in virus detection in the cell-adapted strain of Crimean-Congo hemorrhagic fever virus Kelkit06, but pseudo-plaque assay was more sensitive than the fluorescent immunofocus assay in detecting the virus from primary isolates of Crimean-Congo hemorrhagic fever virus from humans. 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