JCM Accepts, published online ahead of print on 3 January 2007 J. Clin. Microbiol. doi:10.1128/JCM.01956-06 Copyright © 2007, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights Reserved. 1 Characteristics of the m2000 Automated Sample Preparation and Multiplex 2 Real Time PCR System for the Detection of Chlamydia trachomatis and 3 Neisseria gonorrhoeae 4 D E 5 Running Title: Abbott m2000 CT/NG Prototype Assay Study with Surplus 6 Specimens 7 T P 8 R. Marshall *1, M. Chernesky 2, D. Jang2, E.W. Hook3, C. P. Cartwright 4, B. 9 Howell-Adams1, S. Ho1, J. Welk1, J. Lai-Zhang1, J. Brashear1, B. Diedrich1, K. 10 Otis1, E. Webb1, J. Robinson1, and H. Yu1 E C 11 12 13 14 15 16 17 1 Abbott Molecular Inc., Des Plaines, IL, USA; C A 2 McMaster University/St. Joseph’s Healthcare, Hamilton, ON, Canada; 3 University of Alabama, Birmingham, AL, USA; 4 University of Minnesota Medical School and Hennepin County Medical Center, Minneapolis, MN, USA 18 *Corresponding author 19 1300 E. Touhy Ave 20 Des Plaines, IL 60018 21 Tel: 224-361-7350 22 Fax: 224-361-7507 23 Email: [email protected] Abbott m2000 CT/NG Prototype Assay Study with Surplus Specimens December 19, 2006 1 24 ABSTRACT 25 We evaluated a new real time PCR based prototype assay for the detection of 26 Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) developed by 27 Abbott Molecular Inc. This assay is designed to be performed on the Abbott 28 m2000™ real time instrument system that consists of m2000sp™ for sample 29 preparation and m2000rt™ for real time PCR amplification and detection. Limit of 30 detection of this prototype assay was determined to be 20 copies of target DNA 31 for both CT and NG using serially diluted linearized plasmids. No cross-reactivity 32 could be detected when 55 non-gonococcal Neisseria isolates and 3 non- 33 trachomatis Chlamydia isolates were tested at 1 million copies of genome 34 equivalent per reaction. Concordance with Roche AMPLICOR™, BDProbeTec™ 35 ET, and Gen-Probe APTIMA® Combo 2 were assessed using unlinked/de- 36 identified surplus clinical specimens previously analyzed with these tests. For 37 CT, concordance for positive results ranged from 93.7% to 100% while 38 concordance for negative results ranged from 98.2% to 100%. For NG, 39 concordance for positive and negative results ranged from 91.4% to 100%, and 40 99.3 to 100%, respectively. A workflow analysis of the prototype assay was 41 conducted to obtain information on throughput under laboratory conditions. At 48 42 samples/run, the time to first result for both CT and NG was 4.5 hrs. A total of 43 135 patient specimens could be analyzed in 8.9hr with 75 min hands-on time. 44 This study demonstrated technical and clinical feasibility of the new Abbott real 45 time PCR CT/NG assay. D E T P E C C A Abbott m2000 CT/NG Prototype Assay Study with Surplus Specimens December 19, 2006 2 46 INTRODUCTION 47 Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are 48 common sexually transmitted microorganisms. These bacteria infect epithelial 49 cells of the cervix and urethra of women and men, but symptoms of lower genital 50 tract infection are expressed in only a small percentage of patients (1). Most 51 infections remain undiagnosed and untreated; increasing the risk of ascending 52 infections, especially in women, who may experience, pelvic inflammatory 53 disease, ectopic pregnancy or infertility. 54 epidemic” are so significant that public health authorities are initiating screening 55 programs to identify and treat infected individuals and their partners. Traditional 56 samples such as cervical and urethral swabs and less invasive clinical samples 57 such as first void urine [FVU] and vaginal swabs have been shown to be effective 58 indicators of infection when tested by nucleic acid amplification tests [NAATs] 59 (2,3,8,11,14-19). For NAA testing to be successfully implemented in screening 60 programs, assays will need to possess appropriate analytical performance 61 characteristics and be sufficiently automated to enable large numbers of 62 specimens to be analyzed rapidly with minimal intervention. 63 magnetic sampler platform combined with homogeneous real-time multiplexed 64 PCR has been developed for the diagnosis of urogenital infection with CT and 65 NG with the dual goals of improving the workflow and diagnostic sensitivity and 66 specificity of NAAT for these organisms. This report describes the characteristics 67 of a prototype assay including its analytical sensitivity and specificity. Residual 68 samples that had been tested using a variety of other assays were analyzed to D E T P The consequences of this “silent E C C A Abbott m2000 CT/NG Prototype Assay Study with Surplus Specimens December 19, 2006 An automated 3 69 examine concordance of results across assay platforms. In addition, an analysis 70 of the workflow, throughput and labor requirements of the m2000™ assay was 71 performed. 72 METHODS 73 Clinical samples: Cervical, vaginal and urethral specimens that had been 74 analyzed using 75 BDProbeTec™ ET from Becton-Dickinson [n=496], or AMPLICOR™ CT from 76 Roche [n=67], and FVU previously tested for CT and NG with either APTIMA® 77 Combo 2 from Gen-Probe [n=496], or BDProbeTec ET [n=156] were shipped 78 from the several laboratories to Abbott Laboratories for m2000 testing. All swab 79 samples were collected in the proprietary transport devices provided by the 80 various assay manufacturers and were stored and shipped per manufacturers’ 81 instructions. Swab specimens containing sufficient volume (minimum of 500µl) 82 were tested directly on m2000. For swabs with no or not enough liquid media 83 remaining, the volume was brought up to 1 mL using Abbott specimen transport 84 buffer, allowing for further testing. FVU samples were collected in either the 85 manufacturer supplied device (APTIMA Combo 2) or in DNA/RNA Protect™ 86 (Sierra Diagnostics, Sonora, CA) for BDProbeTec ET testing and were stored 87 and shipped to Abbott per manufacturers’ instructions. 88 samples were coded and patient identifiers removed. After blinded testing of 89 samples in the m2000 system, concordance of positive and negative test results 90 was determined by comparing m2000 results with those obtained using the FDA- 91 cleared tests. Samples yielding discordant results for CT were subsequently for CT either LCx from Abbott D E Laboratories [n=64], T P E C C A Abbott m2000 CT/NG Prototype Assay Study with Surplus Specimens December 19, 2006 Prior to shipment, all 4 92 retested using either the LCx CT assay or the Real Art C. trachomatis ™ PCR kit 93 (artus, Hamburg, Germany). 94 Magnetic sample preparations [sp]: 95 technology [Abbott Molecular Inc.] captured DNA from 400 µL specimens and an 96 internal control sequence (linearized plasmid DNA containing hydroxypyruvate 97 reductase gene from the pumpkin plant) added to each specimen, using silica- 98 based magnetic particles. The microparticles were washed 3 times, allowing for 99 the removal of PCR amplification inhibitors. Each sample was eluted in 100 µL 100 of elution buffer and 25 µL was added to an equal volume of PCR master mix. In 101 this study, 48 specimens were processed per run. 102 PCR amplification and real-time sequence detection: The assay amplifies a 103 region of CT cryptic plasmid and a region in the NG opacity (Opa) gene, as well 104 as an internal control. The master mix contained a CT probe labeled with 5’FAM- 105 3’BHQ1 for the detection of a 102-base CT cryptic plasmid DNA amplicon; an NG 106 probe labeled with 5’VIC-3’ BHQ2 for the detection of a 122-base Opa gene of 107 NG DNA amplicon; and an internal control probe labeled with 5’NED-3’BHQ2 for 108 the detection of a 129 base amplicon of the hydroxypyruvate reductase gene 109 from the pumpkin plant. The homogenous assay format allowed for the detection 110 of all 3 DNA sequences without the necessity of opening the reaction vessels. 111 Amplification and detection was performed in an m2000rt™ PCR instrument. 112 Analytical sensitivity and specificity: Serial dilutions of linearized plasmids 113 containing the CT and NG target sequences were analyzed in the system to 114 determine the limits of detection of the assay for each analyte. The CT dilution The m2000sp™ sample preparation D E T P E C C A Abbott m2000 CT/NG Prototype Assay Study with Surplus Specimens December 19, 2006 5 115 panel consisted of members at 20, 75, 300, 3X103, 4X104, and 8X105 116 copies/assay. 117 1.5X103, 1.5X104, and 3X105 copies/assay. 118 replicates were analyzed. To assess analytical specificity, genomic DNA was 119 prepared from a panel of 55 non-gonoccocal Neisseria organisms and 3 non- 120 trachomatis Chlamydiae (Table 1) at 1 million copies/assay and analyzed in the 121 m2000 system. 122 Throughput experiments: During this study, a prototype m2000sp instrument 123 capable of preparing and analyzing a maximum of 48 samples was utilized. Runs 124 were conducted using various numbers of samples to determine both the time to 125 first result and the time to completion (total run time and hands-on time) in both 126 the sample preparation (sp) and real-time PCR (rt) components of the assay. 127 RESULTS 128 The NG dilution panel consisted of members at 20, 75, 300, For each concentration, 16 D E T P E C C A Analytical sensitivity of the m2000 real time PCR CT/NG prototype assay 129 was assessed by analyzing a dilution series of 16 replications at each 130 concentration level (8X105 copies/reaction to 20 copies/reaction) of linearized 131 plasmid DNA. Representative amplification curves for the CT and NG 132 components of the assay are shown in Figure 1. 133 amplification corresponds to higher levels of target. The amplification curves of 134 the 16 replicate samples at each concentration were tightly grouped particularly 135 at or above 300 plasmid copies. A target concentration of 20 copies per reaction 136 yielded robust amplification curves among all 16 replicates for each target, Abbott m2000 CT/NG Prototype Assay Study with Surplus Specimens December 19, 2006 Earlier detection of 6 137 indicating that both CT and NG targets can be reproducibly detected at a level of 138 20 genome equivalents per PCR reaction. 139 All of the organisms included in the specificity panel (Table 1) gave 140 negative results in the m2000 test when tested at 1 million genome equivalents 141 per reaction (data not shown), a concentration of target significantly above what 142 would be expected in a typical biological specimen. Six of the non-gonococcal 143 Neisseria isolates (marked with asterisks) used in the specificity panel had 144 previously been demonstrated to cross-react with the Amplicor N. gonorrhoeae 145 assay (7). D E T P E C 146 The workflow of a typical assay run of 48 samples is shown in Figure 2 147 and includes the following steps: 1) 15 min hands-on, reagent set-up, and 148 sample load on m2000sp; 2) 100 min walk-away automated DNA extraction 149 (m2000sp); 3) 3 min hands-on PCR master mix reagent load on m2000sp; 4) 16 150 min walk-away, automated PCR plate preparation (m2000sp); 5) 5 min hands-on, 151 PCR plate seal and transfer to m2000rt; 6) 126 min walk-away, automated 152 amplification and detection (m2000rt); 7) 2 min hands-on, result review and print 153 out (m2000rt). Since the sp and rt components of the assay can be overlapped, 154 preparation of the m2000sp for the second batch of samples was carried out 155 during step 4 of processing the first batch of samples and the automated 156 extraction for the second sample set was performed while the first batch of 157 samples were undergoing simultaneous PCR-amplification and product detection 158 on the m2000rt (step 6) as shown in Figure 2. This enabled a total of 45 159 specimens to be analyzed in 4.5 hours, with the analysis of an additional 45 C A Abbott m2000 CT/NG Prototype Assay Study with Surplus Specimens December 19, 2006 7 160 specimens being completed in 6.7 hours. Analysis of a third set of 45 specimens 161 could be commenced once the samples from the second sample batch reached 162 step 4 of the process, enabling a maximum of 135 specimens to be analyzed and 163 reported in 8.9 hours. For convenience, the final set of specimens could be left 164 in the m2000rt at the conclusion of a shift to complete the analytical process, and 165 the post-analytical steps completed the following day. The total hands-on time 166 for completing three runs (135 specimens) was approximately 75 min. 167 addition to the actual assay time, approximately 15 min of daily maintenance was 168 required on the m2000sp and could be completed either prior to, or at the 169 conclusion of, testing. No daily maintenance was required on the m2000rt. D E T P E C In The concordance of the results obtained with the m2000 assay and other 170 171 currently available assays is shown in Table 2. 172 specimens, 99.1% (325/328) concordance was obtained with m2000 for 173 BDProbeTec ET positive samples, 96.3% (26/27) for AMPLICOR positive 174 samples and 100% (32/32) for LCx positive samples. The levels of concordance 175 of m2000 for CT negative swab samples were 98.2% (165/168) with 176 BDProbeTec ET, 100% (40/40) with AMPLICOR, and 100% (32/32) with LCx. 177 Overall, the agreement for CT results on swab samples ranged from 98.5% to 178 100%. 179 concordant with 93.7% (59/63) of APTIMA Combo 2, and 96.8% (60/62) of 180 BDProbeTec ET positive samples. Concordance of negative samples was 99.3% 181 (430/433) with APTIMA Combo 2 and 98.9% (93/94) with BDProbeTec ET. The 182 overall agreement of m2000 CT results on FVU with both APTIMA Combo 2 and C A For CT results of swab For FVU specimens tested for CT, the m2000 assay result was Abbott m2000 CT/NG Prototype Assay Study with Surplus Specimens December 19, 2006 8 183 BDProbeTec ET was 98.6%. All FVU specimens (n=6) that on initial testing were 184 negative in the m2000 CT assay but had been reported as positive in either the 185 APTIMA Combo 2 (n=4) or BDProbeTec ET (n=2) assays were negative upon 186 retesting with LCx CT, and both BDProbeTec ET positive/m2000 negative 187 samples were also negative in the RealArt CT assay. The single urine sample 188 that yielded a BDProbeTec ET negative/m2000 positive result on initial testing 189 was negative by the LCx and positive by RealArt CT on repeat testing. 190 Concordance of results for FVU samples tested for NG was 91.4% (32/35) for 191 APTIMA Combo 2 positive samples and 100% (35/35) for BDProbeTec ET 192 positive samples, with concordance for APTIMA Combo 2 and BDProbeTec ET 193 negative samples being 99.3% (460/463) and 100% (121/121), respectively. The 194 overall agreement on FVU NG results was 99.2% with APTIMA Combo 2 and 195 100% with BDProbeTec ET. NG testing was not performed on all of the swab 196 samples using BDProbeTec, Amplicor and LCx. Therefore no concordance on 197 swab samples for NG results was available. 198 DISCUSSION 199 D E T P E C C A The new m2000 real time PCR prototype assay demonstrated an 200 analytical sensitivity of 20 genome equivalents of DNA per reaction for both CT 201 and NG. Since the cryptic plasmid of CT is typically present at approximately 7 to 202 10 copies per elementary body (EB) (13), this corresponds to a detection limit of 203 2 EBs. Similarly, approximately 11 copies of the Opa gene are found in the NG 204 genome (12), thus, 20 copies of genomic DNA corresponds to approximately 2 205 organisms. Further testing also revealed that the limit of detection for CT was Abbott m2000 CT/NG Prototype Assay Study with Surplus Specimens December 19, 2006 9 206 maintained when 20 copies of CT and 10 million copies of NG were co-present in 207 a sample. Vice versa, the limit of detection for NG was maintained when 20 208 copies of NG and 10 million copies of CT were co-present in a sample (data not 209 shown). Previous studies have shown a range of analytical sensitivity endpoints 210 for other commercial available assays. For example, Chong et al (4) 211 demonstrated an endpoint of 12 EB's for the LCx Chlamydia test and 0.01 EB's 212 for the APTIMA Combo 2 assay. For 15 common CT serovars, the package 213 inserts report limits of detection of 1 IFU per reaction for COBAS AMPLICOR, 5- 214 200 [median of 35] EBs per reaction for BDProbeTec ET, and 1 IFU per assay for 215 APTIMA Combo 2. For NG, the package insert claims are 5 CFU/test on 15 216 strains of NG for COBAS AMPLICOR, 5-25 cells per reaction [median of 10 cells] 217 for 39 strains of NG for BDProbeTec ET, and 50 cells/assay on 57 strains of NG 218 for APTIMA Combo 2. 219 D E T P E C C A Prior to formally evaluating the new m2000 assay in clinical trials, we 220 elected to perform a preliminary assessment of assay performance by testing 221 residual material from swab and urine samples previously collected for, and 222 tested by, other FDA-cleared assays. This protocol involved shipping of positive 223 and negative samples to Abbott where they were tested in a blinded fashion. For 224 each specimen type the agreements were close to 100% for CT or NG positive 225 and negative samples suggesting that the m2000 assay may be expected to offer 226 comparable clinical performance to that reported for currently available tests. 227 Additional testing of the few samples yielding discordant results revealed 228 somewhat inconsistent patterns of positive and negative results in the different Abbott m2000 CT/NG Prototype Assay Study with Surplus Specimens December 19, 2006 10 229 assays suggesting that most, if not all, of these specimens were low level 230 positives producing inconsistent results near the limits of analytical sensitivity for 231 the various assays. A multicenter evaluation of the BD Probe Tec ET system for 232 CT and NG evaluated swabs and urine from men and women and compared 233 performance to the LCx assay (17). The study found that the sensitivity rates for 234 male urethral swab or FVU and female CS ranged from 92.5 to 98.5% but that 235 female FVU rates were more than 10% lower for both CT and NG. This may be 236 a reflection of lower analytical sensitivity (3) and inhibitors in urine (10), which 237 have been reported for most assays including the ProbeTec ET test (5,6). The 238 Roche COBAS AMPLICOR tests for CT and NG were evaluated in 8 US centers 239 (11,16,20). For both organisms, urine sensitivity rates were usually lower than 240 for swabs but comparisons were to cell culture and DFA and did not employ 241 amplification methods other than PCR. 242 revealed that 2.4% of the specimens were inhibitory when initially tested. The 243 transcription 244 demonstrated excellent sensitivity for CT and NG compared to other commercial 245 NAAT's with a slightly lower value for NG detection in urine from asymptomatic 246 women (8). D E T P E C C A mediated amplification The internal controls for AMPLICOR assay (APTIMA Combo 2) also 247 The m2000 assay was also challenged for specificity by using numerous 248 strains of non-gonoccocal Neisseria and 3 non-trachomatis strains of Chlamydia, 249 and all yielded negative results at 1 million genome copies per reaction.Analytical 250 specificity data reported in the package inserts of commercially available assays 251 and in the present report are similar, with little or no specific cross-reactivity Abbott m2000 CT/NG Prototype Assay Study with Surplus Specimens December 19, 2006 11 252 observed when physiological levels of nucleic acids from related organisms are 253 tested in the assay. 254 evaluations of current assays reported aberrant numbers of false positive results 255 (11,16-18,20). Not surprisingly, therefore, none of the multicenter D E 256 Concern about the relative risk of false positive results increasing to an 257 unacceptable level as NAA testing for CT and NG is expanded to low-prevalence 258 populations has been expressed, including suggestions that all NAAT positive 259 results be confirmed by retesting samples in the same assay or, ideally, a 260 different one (6). The present study provides an insight into the feasibility of 261 using the new m2000 real time PCR assay in this capacity, since it was capable 262 of generating reliable results on specimens collected in transport systems not 263 designed for the m2000. Although further laboratory validation is needed to fully 264 substantiate the interchangibility of samples between the m2000 and other assay 265 systems, this capability may help establish the optimal role, either confirmatory or 266 screening, for the various testing platforms (8). 267 T P E C C A Since the establishment of screening programs will undoubtedly increase 268 testing volume for the laboratory, sample processing and testing workflow will 269 become increasingly important and a preliminary assessment of these 270 parameters was made for the m2000 system. 271 maximum capacity of processing 96 samples at a time, matching 96 well PCR 272 reactions on the thermal cycler. At the time of the study, however, software for 273 handling only 48 samples per run was available for evaluation. Figure 2 274 demonstrates the workflow of the assay. For both CT and NG results, time to first The m2000 system has the Abbott m2000 CT/NG Prototype Assay Study with Surplus Specimens December 19, 2006 12 275 result on 45 specimens, was 4.5hrs. 90 patient specimens were tested in 6.7 hrs 276 and 135 specimens were tested in 8.9 hrs. When the 96-samples/run capability 277 becomes available, time to first result on 93 CT and NG patient results is 278 estimated to be 5.6hrs, and 186 or 279 patient specimens can be tested using 279 this format in 8hrs and 11hrs respectively. 280 improvement compared to the manual versions of AMPLICOR, BDProbeTec ET, 281 and APTIMA Combo 2, and would approach the throughput of automated 282 BDProbeTec ET with Viper™ and Aptima Combo 2 with TIGRIS®. Hanson and 283 Cartwright (9) adapted the automated liquid-handling Tecan Genesis RSP 100 284 system to the LCx Chlamydia test and reported preservation of assay accuracy 285 while reducing technician pipetting time by 75%. Vincelette et al (20) reported 286 that COBAS AMPLICOR for CT allowed automation of amplification and 287 detection. One technician performed 3 to 4 hours of hands-on work, while testing 288 96 specimens in a workday. Significantly improving the efficiency of CT/NG NAA 289 testing requires the kind of integrated approach to automating sample 290 preparation, amplification, detection and reporting afforded by the Abbott m2000 291 system. D E This would present a significant T P E C C A 292 In conclusion, this study reports the first evaluation of the Abbott m2000 293 prototype real time PCR CT/NG assay and demonstrated satisfactory preliminary 294 analytical and clinical performance. The workflow assessment of the prototype 295 assay also offered important throughput information to testing laboratories. More 296 studies with larger patient sample size will be conducted to provide further 297 assessment of the clinical performance characteristics of the assay. 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Abbott m2000 CT/NG Prototype Assay Study with Surplus Specimens December 19, 2006 17 Table 1. Isolate composition of the Specificity Panel. No. of Strains Tested 2 1 1 2 1 2 1 1 1 1 1 1 6 1 2 1 2 2 3 1 3 21 1 Organism C. pneumoniae C. psittaci N. animalis N. caniae N. canis N. cinerea N. cuniculi N. denitrificans N. elongata elongata N. elongata glycolytica N. flavescens N. iguanae N. lactamica N. macacae N. meningitidis N. meningitidis-B N. meningitidis-C N. meningitidis-D N. mucosa N. polysaccharea N. sicca* N. subflava* N. weaveri D E T P E C C A *1 of the 3 N. sicca Isolates and 5 of the 21 N. subflava isolates in the specificity panel had previously been demonstrated to cross-react with the Roche Amplicor N. gonorrhoeae assay (7). Abbott m2000 CT/NG Prototype Assay Study with Surplus Specimens December 19, 2006 18 Table 2. Concordance of m2000 CT and NG results with other amplification assays. Specimen Type Swabs Urine Tested previously by (n) BDProbeTec (496) Amplicor (67) LCx (64) Aptima Combo 2 (496) BDProbeTec (156)* m2000 CT concordance with Positive 99.1% (325/328) 96.3% (26/27) 100% (32/32) 93.7%(59/63) 99.3%(430/433) 96.8%(60/62) 98.9%(93/94) m2000 NG concordance with Negatives 98.2% (165/168) Overall Positives Negatives Overall 98.8% ND ND ND 100% (40/40) 98.5% ND ND ND 100% (32/32) 100% ND ND ND 98.6% 91.4%(32/35) 99.3%(460/463) 99.2% D E T P 98.6% 100%(35/35) 100%(121/121) * Urine specimens tested using BDProbeTec were collected, transported and E C stored in DNA/RNA Protect and was validated by the laboratory. C A Abbott m2000 CT/NG Prototype Assay Study with Surplus Specimens December 19, 2006 19 100% 1.8 CT amplification 1.6 1.4 1.2 D E 1 0.8 0.6 8e5 0.4 4e4 3e3 300 20 75 T P 0.2 0 15 20 25 30 35 1.4 NG amplification 1.2 1 0.8 0.6 0.4 3e5 0.2 C A 1.5e4 1.5e3 40 E C -0.2 300 75 45 20 0 15 20 25 30 35 40 45 -0.2 Cycle Number Figure 1. Fluorescent detection during 45 amplification cycles of Chlamydia trachomatis and Neisseria gonorrhoeae target DNA on cloned and quantified linearized plasmid dilution series. The CT dilution panel consisted of members at 20, 75, 300, 3X103, 4X104, and 8X105 copies/assay, and the NG dilution panel consisted of members at 20, 75, 300, 1.5X103, 1.5X104, and 3X105 copies/assay as labeled by the curves. Figure 2. Throughput with one m2000sp and one m2000rt. m2000sp m2000rt m2000sp m2000rt m2000sp D E 8am 9am 10am 11am 12pm 1pm 2pm 3pm 4pm 5pm 45 specimens 48 samples + 3 controls 48 samples in 4.5 hrs T P E C 48 samples C A 90 specimens + 6 controls 48samples in 6.7 hrs 48 samples m2000rt Total hands-on time (for 3 runs) = 75min 48 samples 135 specimens + 9 controls in 8.9 hrs
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