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123

MOLECULAR BIOLOGY TECHNIQUES

Human Immunodeficiency Virus (HIV) Structure:

• HIV belonging to the Retroviridae family and Lentivirinae  subfamily is a nonsegmented, single-stranded,

diploid (two identical strands of the RNA genome), positive sense RNA (ss

 RNA) virus. The following

HIV genes are important in HIV testing:
• The env gene which encodes for

• gp160 (an envelope glycoprotein which is later cleaved into gp120 and gp41)
• gp120 (binds to the CD4 receptor protein)
• gp41 (a transmembrane protein)

• The gag gene (group-specific antigen) which encodes for

• p55 (the gag precursor protein)
• p24 (capsid protein)
• p17 (matrix protein)
• p9 (nucleocapsid protein)
• p7 (nucleocapsid protein)

• The pol gene which encodes for

• p65 (a protease)
• p66 and p51 (reverse transcriptase dimer)
• p31 (integrase)

Figure 14-12B HIV ELISA (enzyme-linked immunoabsorbent assay) test. The serologic tests for HIV in-

fection are based upon detection of antibodies in the serum directed against HIV proteins. The ELISA is the
first test used clinically to detect the possibility of HIV infection. Remember that the ELISA does NOT detect
the HIV virus per se but only antibodies directed against HIV proteins. The HIV ELISA test can produce false-
positive results 
which means that a person’s serum may contain cross-reactive antibodies to HIV proteins
even though the person has never been exposed to HIV. Sources of false positives include multiple pregnan-
cies, multiple blood transfusions, autoimmune disorders, chronic hepatitis, chronic alcoholism, hepatitis B
vaccination, influenza vaccination, rabies vaccination, renal failure, cystic fibrosis, syphilis infection, malaria
infection (important because many Africans are exposed to malaria), infection with other human retroviruses
(e.g., HTLV 1/II), association with large animals (e.g., animal trainers, veterinarians), and hemodialysis. An
ELISA includes the following steps:

• A number of known HIV proteins are attached to a plate
• A person’s serum is applied to the plate. If the person’s serum has antibodies (Abs) that cross-react with HIV

proteins, the antibodies will bind to the HIV proteins.

• Antibody binding to HIV proteins can be detected by an HRP-labeled secondary antibody which can be react-

ed with a chromogenic substrate to produce a colormetric reaction (usually brown in color).

Figure 14-12C HIV Western blot test. If a positive ELISA result is obtained, it must be confirmed by a

Western blot. Again, remember that an HIV Western blot does NOT detect the HIV virus per se but only an-
tibodies directed against HIV proteins.

• A number of known HIV proteins are separated based on size by PAGE. The separated HIV proteins are

transferred to a nitrocellulose membrane. A person’s serum is applied to the nitrocellulose membrane. If the
person’s serum has antibodies (Abs) that cross-react with HIV proteins, the antibodies will bind to the HIV
proteins. Antibody binding to HIV proteins can be detected by an HRP-labeled secondary antibody which
can be reacted with a chromogenic substrate to produce a colormetric reaction (usually brown in color).

• Patient no. 1 shows a high positive (HP) HIV Western blot reaction.
• Patient no. 2 shows a low positive (LP) HIV Western blot reaction.
• Patient no. 3 shows an indeterminate (I) HIV Western blot reaction. Almost all HIV-infected patients with

an indeterminate result will develop a positive result within 1 month (called seroconversion).

• Patient no. 4 shows a negative (N) result.

To identify the actual HIV virus, nucleic acid-based tests (e.g., RT-PCR, Quantiplex branched DNA test)

are used to detect a 142-base target sequence in a highly conserved region of the HIV gag gene. These tests
use a patient’s white blood cells because retroviruses incorporate into host cell DNA. These tests are not used
in population screening but generally later in the disease process to assess the viral load in an AIDS patient
undergoing antiretroviral drug therapy.

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124

CHAPTER 14

5'

3'

3'

5'

3

4

1

2

3

4

1

2

3

4

1

5

4

3

2

1

Ligated

DNA probe

template

ss DNA

template

DNA

ligase

Ligated DNA

probes

ss DNA

ds DNA

94°

denature

55-65°

hybridize

1

2

3

4

DNA Probes

Repeat cycle

● Figure 14-13

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125

MOLECULAR BIOLOGY TECHNIQUES

Ligase Chain Reaction (LCR).

LCR is a DNA amplification technique that detects specific

DNA sequences by amplifying the DNA probes. LCR can be used to identify tumor types, to detect
single-base mutation genetic disorders (e.g., sickle cell disease), and to detect infectious diseases
(e.g., Chlamydia trachomatis, gonorrhea). LCR involves the following steps:

• Each cycle of the LCR reaction begins with 94

C heat treatment to separate the double-stranded

DNA (dsDNA) into single-stranded DNA (ssDNA), that is, denatured.

• The DNA probes include four probes (nos. 1, 2, 3, 4) one for every side of the ssDNA. The DNA

probes hybridize to the ssDNA at 55–65

C.

• As long as there are no base mismatches at the junction of the DNA probes, DNA ligase can lig-

ate each pair of DNA probes to form ligated DNA probes.

• The cycle is repeated, whereby both ssDNA and the ligated DNA probes are used as templates.

The ability of ligated DNA probes to serve as templates in subsequent cycles leads to exponen-
tial amplification.

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126

CHAPTER 14

Neutrophils

Monocytes

Lymphocytes

Cells

Fluid system

Laser

Side scatter

Forward scatter

Forward

scatter detector

Side

scatter

detector

Flourescent

detectors

Computer data

analysis

Optics

A

CD8+

27%

CD8+
CD4+

2%

CD8-
CD4-

2%

CD4+

68%

Orange

flourophore

CD4 Antibody

Red

flourophore

CD8 Antibody

Forward scatter

Side scatter

CD8 Antibody

CD3 Antibody

CD8+

1%

CD8-
CD3-

1%

CD8+
CD3+

85%

CD3+

6%

Cytotoxic CD8+ T cell

Leukemia

Labels

CD8+ cytotoxic

T lymphocytes

Labels

All T lymphocytes

CD20 Antibody

CD3 Antibody

CD20+

2%

CD20-
CD3-

96%

CD20+
CD3+

0%

CD3+

2%

Adenosine Deaminase

Deficiency (ADA; “Bubble Boy”)

Labels

All B lymphocyte

Labels

All T lymphocytes

CD20 Antibody

CD3 Antibody

CD20+ 80%

CD20-
CD3-

18%

CD20+
CD3+

0%

CD3+

2%

Di George Syndrome

Labels

All B lymphocytes

Labels

All T lymphocytes

CD20 Antibody

CD3 Antibody

CD20+

2%

CD20-
CD3-

18%

CD20+
CD3+

0%

CD3+ 80%

X-linked Infantile (Bruton)

Agammaglobulinemia

Labels

All B lymphocytes

Labels

All T lymphocytes

B

C

D

E

● Figure 14-14

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127

MOLECULAR BIOLOGY TECHNIQUES

Flow Cytometry.

Flow cytometry is a technique for the analysis of multiple parameters of cells

within a heterogenous population. Parameters include cell size, intracellular complexity (granules,
nucleus shape, etc.), and cell surface fluorescent staining.

• The fluidic system passes thousands of cells per second through a laser beam one at a time.
• As the cell passes through the laser, the cell will scatter light in the forward direction called for-

ward scatter. The forward scatter light is quantified by a detector which converts the light inten-
sity into a voltage pulse. The size of the voltage pulse recorded for each cell that passes through
the laser is proportional to cell size. Therefore, forward scatter allows the measurement of cell
size. 
This data is plotted on a histogram.

• As the cell passes through the laser, the cell will also scatter light in the side direction called side

scatter. The side scatter light is quantified by a detector (located 90 degrees to the laser path) which
again converts the light intensity into a voltage pulse. The size of the voltage pulse recorded for
each cell that passes through the laser is proportional to intracellular complexity. Therefore, side
scatter allows the identification of intracellular complexity. 
This data is plotted on a histogram.

• The histograms of the forward scatter (X axis) and side scatter (Y axis) can be combined to form

a  two-dimensional dot plot. A two-dimensional dot plot of flow cytometry using peripheral
blood shows three populations: lymphocytes, monocytes, and neutrophils. Remember that each
dot on a dot plot represents a cell.

• A common method used to study cell characteristics using flow cytometry involves the use of

fluorescent-labeled antibodies that bind to the cell surface. When a fluorescent-labeled cell pass-
es through the laser, the laser will strike the fluorophore and a fluorescent signal will be emitted.
The fluorescent signal is quantified by a detector which converts the fluorescence intensity into
a voltage pulse. The size of the voltage pulse recorded for each cell that passes through the laser
is proportional to the amount of fluorescence emitted.

• A typical flow cytometry study uses two fluorescent-labeled antibodies. For example, a CD8

antibody with a red fluorophore identifies CD8

T lymphocytes and a CD4 antibody with an

orange fluorophore identifies CD4

T lymphocytes. The data for each antibody is plotted on a

histogram. The histograms can be combined to form a two-dimensional dot plot. A two-
dimensional dot plot of this example studying T lymphocytes in peripheral blood shows four pop-
ulations: a CD8

T lymphocytes making up 

27% of the cells, CD8

and CD4

T lymphocytes

making up 

2% of the cells, CD8

and CD4

T lymphocytes making up 

2% of the cells, and

CD4

T lymphocytes making up 

68% of the cells.

Figure 14-14B Two-dimensional dot plot of a cytotoxic CD8

T-cell leukemia. Peripheral blood

sample from a leukemia patient is run through flow cytometry using two fluorescent-labeled antibod-
ies: CD8 antibody which labels CD8

cytotoxic T lymphocytes and CD3 antibody which labels all T

lymphocytes. The two-dimensional dot plot shows four populations of cells with CD8

and CD3

T

lymphocytes making up 85% of the cells. This high percentage (85%) would be consistent with a cyto-
toxic CD8

T-cell leukemia where the patient has a large increase in CD8

cytotoxic T lymphocytes.

Figure 14-14C Two-dimensional dot plot of X-linked infantile (Bruton) agammaglobulinemia.

Peripheral blood sample from a patient is run through flow cytometry using two fluorescent-labeled
antibodies: CD20 antibody which labels all B lymphocytes and CD3 antibody which labels all T
lymphocytes. The two-dimensional dot plot shows four populations of cells with CD20

B lympho-

cytes making up only 2% of the cells and CD3

T lymphocytes making up 80% of the cells. These

percentages would be consistent with X-linked infantile (Bruton) agammaglobulinemia where the
patient basically has no B lymphocytes but only T lymphocytes present. Note that there can never
be any CD20

and CD3

cells because these two markers have been chosen to distinguish B lym-

phocytes from T lymphocytes; there can never be a B lymphocyte that is also CD3

, and visa versa.

Figure 14-14D Two-dimensional dot plot of DiGeorge syndrome. Peripheral blood sample

from a patient is run through flow cytometry using two fluorescent-labeled antibodies: CD20 anti-
body which labels all B lymphocytes and CD3 antibody which labels all T lymphocytes. The two-
dimensional dot plot shows four populations of cells with CD 20

B lymphocytes making up 80%

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