Abstract:
The present invention refers to a method for detecting a point mutations of a nucleotide sequence by an improve- ment of the LAMP (loop amplification mediated polymerization) amplification method, as well as to a set of primers and kit there- for. As a non limitative embodiment, the invention refers to the G1849T mutation of the JAK2 gene.

Description:
FIELD OF THE INVENTION 
       [0001]    The current invention refers to a method for detecting point mutations of a nucleotide sequence by an improvement of the LAMP (loop amplification mediated polymerization) amplification method. As non limitative embodiment the invention refers to the G1849T mutation of the JAK2 gene. 
       BACKGROUND 
       [0002]    Myeloproliferative disorders (MPD) are clonal disorders of haematopoietic progenitors, and include the classical MPD chronic myeloid leukaemia (CML), polycythaemia vera (PV), essential thrombocythaemia (ET) and primary myelofibrosis (PMF), as well as chronic eosinophilic leukaemia (CEL), chronic myelomonocytic leukaemia (CMML), and systemic mastocytosis (SM) and others. In the past two decades, mutant alleles have been identified in CML, CMML, CEL and SM2-5, and in each case the causative mutation results in constitutive activation of tyrosine kinase signalling. The genetic causes of the most common MPD remained unknown until the identification of mutations that activate Janus kinase 2 (JAK2) signalling in most patients with PV, ET or PMF(1, 2, 3, 4). JAK2 is a member of the Janus family of cytoplasmic non-receptor tyrosine kinases, which also includes JAK1, JAK3 and TYK2. The mutation is a guanine-to-thymidine substitution at base 1489 (GenBank accession no. NM — 004972), which results in a substitution of valine for phenylalanine at amino acid 617 of the JAK2 protein (JAK2V617F), within the JH2 pseudokinase domain (5). Loss of JAK2 autoinhibition results in constitutive activation of the kinase, analogous to other mutations in MPDs and leukemia that aberrantly activate tyrosine kinases (6,7,8). Direct sequencing is only sensitive down to about 20% of mutant DNA in a wild-type background (9, 10). This issue is quite relevant to chronic myeloid disorders, where blood and marrow are often composed of a mixture of neoplastic and residual normal hematopoietic elements. Especially in the case of ET and MDS, in which phenotypically apparent gene mutations may be present in tiny clones comprising less than 10% of the total marrow cell population. James et al. (11) explored this issue specifically with respect to JAK2 1849 G-T by performing a series of mixing experiments with HEL erythroleukemia cells, which bear the JAK2 mutation, admixed with TF-1 erythroleukemia cells, which do not. They failed to detect the mutated allele when it was present in &lt;5% of the total DNA. With homozygous mutant patient DNA diluted in DNA from a healthy person, sequencing was even less sensitive (10%) than it was with the cell lines (12). 
         [0003]    A common method used is the Amplification Refractory Mutation System (ARMS). It exploits the fact that oligonucleotide primers must be perfectly annealed at their  3 ′ ends for a DNA polymerase to extend these primers during PCR (12). By designing oligonucleotide primers that match only a specific DNA point mutation, such as that encoding JAK2 V617F, ARMS can distinguish between polymorphic alleles. Therefore, these techniques go by the alternative names of “allele-specific PCR” (AS-PCR) or “sequence-specific primer PCR.” The ARMS sensitivity is up to 1 to 2% (13) mutant DNA in a wild-type background. 
         [0004]    Real-time monitoring of PCR product accumulation during thermocycling can be of value as a semiquantitative method and DNA-melting curve assays can be used in conjunction with real-time PCR. Likewise, James et al. (14) compared fluorescent dye chemistry sequencing with two different real-time PCR based mutation detection systems, one using a LightCycler instrument (Roche Diagnostics) and the other using a Taqman ABI Prism 7500 machine (Applied Biosystems). These real-time PCR techniques detected 0.5 to 1% of HEL cell line DNA diluted in TF-1 cell line DNA and 2 to 4% of homozygously mutated patient DNA diluted in DNA from a healthy person. A Restriction Fragment Length Polymorphism (RFLP) analysis is possible since the JAK2 1849 G-T mutation abolishes a motif in the wild-type JAK2 sequence that is recognized by the restriction enzyme BsaXI. Although abolition of a restriction site is not as satisfying as creation of a new site, because a negative enzymatic cleavage reaction could be due either to absence of the mutation or to failure of the digestion procedure, it can be useful as a first pass analysis. Reported proportional sensitivity depends in part on the method used to detect the fragments and is approximately 20% mutant DNA in wild-type background (15, 16). 
         [0005]    Pyrosequencing is a method of rapid genotyping that depends on the liberation of pyrophosphate (PPi) whenever a dNTP is incorporated into a growing DNA chain during template-driven DNA polymerization (17). Pyrosequencing of JAK2 using the automated PSQ HS 96 system (Biotage, Uppsala, Sweden) has been attempted by several groups (17, 18) with dilution experiments similar to those described above showing a reported assay sensitivity of 5 to 10% mutant allele in a wild-type background. 
         [0006]    Several other mutation detection techniques have been described, including single stranded conformational polymorphism (SSCP) analysis, denaturing gradient gel electrophoresis (DGGE), denaturing high-performance liquid chromatography (DHPLC), single-nucleotide primer extension assays (Pronto), and others. In fact, DHPLC can detect the genomic DNA mutation underlying JAK2 V617F reliably, and it can detect mutations at a proportionality of &lt;1 to 2%. However, DHPLC and the other techniques are either technically challenging or labor-intensive or both. They either do not allow high throughput at a cost suitable for a clinical laboratory (SSCP and DGGE) or require a considerable initial investment for equipment (DHPLC). 
         [0007]    Theoretically, protein-based techniques could also be used to detect the JAK2 V617F mutation, but these are generally cumbersome, and access to such resources is limited. Therefore, protein-based assays are usually not preferred if DNA- or RNA-based tests are feasible. 
         [0008]    EP1692281 discloses a method of JAK2 mutation detection based on PCR amplification. The method described presents several limitations. First of all the lower level of sensitivity, that allows detection of the mutant sequences of JAK2 down to 1% of the sample in the best cases. This sensitivity requires the enrichment of the mutants via granulocytes-isolation before extraction. This step is time consuming and labor-intensive and add about 2 hours to the already long procedures (from 2 to 5 hours) requested for the diagnosis. Furthermore, all the methods described are relatively labor intensive and expensive, often requiring specialized equipment that may not always be readily available. 
       DESCRIPTION OF THE INVENTION 
       [0009]    The authors of the current invention have set up a novel method for the detection of point mutations that is selective and rapid. The method departs from the LAMP technology, as disclosed in EP 1020534 and depicted here in  FIG. 1 . 
         [0010]    The assay is easy to be performed, since it needs simple instrumentation and produces the results in a single tube reaction. For these reasons it is also less expensive in respect to the other methods described above. 
         [0011]    The method overcomes the limitations underlined in the other techniques. It is more selective (down to 0.01% mutant sequences in wt background); it is isothermal and rapid, completing the diagnosis in a one hour reaction. 
         [0012]    The method refers to a simultaneous selective amplification and detection of a single base substitution in nucleic acids. 
         [0013]    Therefore it is an object of the invention a method for detecting the presence of a point mutation of a target nucleic acid molecule in a background of nucleic acid wild type molecules, comprising the steps of: 
         [0014]    a. obtaining a nucleic acid sample; 
         [0015]    b. contacting said nucleic acid sample, in appropriate reaction conditions, with a solution comprising a mixture of oligonucleotides and a DNA polymerase with strand displacement activity under hybridization conditions, wherein said mixture of oligonucleotides consists of primers suitable for a loop mediated isothermal amplification of the region of the nucleic acid molecule putatively including the point mutation, said primers comprising:
       i) two outer primers F 3  and B 3 ;   ii) two inner primers FIP and BIP, where FIP includes two oligonucleotide sequences, F 2  and F 1   c , and BIP includes two oligonucleotide sequences, B 2  and B 1   c , where said inner primers FIP and BIP are able to recognize and hybridize to two different and opposite regions, F 2   c  and B 2   c  respectively, of the target nucleic acid molecule, where either the BIP primer is designed to hybridize downstream of the point mutation, or the FIP primer is designed to hybridize upstream of the point mutation, and in the case that the BIP primer is designed to hybridize downstream of the point mutation, then the FIP primer is designed to hybridize to the target sequence such that the point mutation is located in or downstream of the F 2   c  sequence and upstream of F 1   c , or in the case that the FIP primer is designed to hybridize upstream of the point mutation, then the BIP primer is designed to hybridize to the target sequence such that the point mutation is located in or upstream of the B 2   c  sequence and downstream of B 1   c;      iii) a self-annealable extensible primer LB or LF respectively comprising:—a central loop sequence able to selectively recognize and hybridize to the region comprising the putative point mutation of the nucleic acid molecule only if the point mutation is present,—a  5 ′ end sequence and—a  3 ′ end sequence, said  5 ′ end and said  3 ′ end sequences being complementary to each other to form a stem, so that said central loop sequence has an higher hybridization affinity to the region comprising the putative point mutation of the nucleic acid molecule than the hybridization affinity of the  5 ′ end sequence to the  3 ′ end sequence, so that it results in annealing and amplification of the region comprising the putative point mutation of the nucleic acid molecule;   iv) a non extensible moiety able to selectively recognize and hybridize to the WT sequence of nucleic acid molecule;       
 
         [0020]    c. incubating the resulting mixture at a constant temperature; 
         [0021]    d. detecting a signal indicative of amplification of the nucleotide molecule comprising the point mutation. 
         [0022]    In a preferred embodiment the point mutation is located in the region between F 2  and F 1   c  or B 2  and B 1   c ; in an alternative preferred embodiment the point mutation is located in the region probed by B 2  or F 2 . 
         [0023]    In a preferred embodiment the sequence at the  5 ′ end and the sequence at the  3 ′ end of said self-annealable extensible primer is of at least 3 nucleotides. 
         [0024]    In a preferred embodiment the non extensible moiety is a peptide nucleic acid (PNA), preferably having at least 10 nucleotides. 
         [0025]    DNA and RNA have a deoxyribose and ribose sugar backbone, respectively, whereas PNA&#39;s backbone is composed of repeating N-(2-aminoethyl)-glycine units linked by peptide bonds. Purine and pyrimidine bases are linked to the backbone by methylene carbonyl bonds. PNAs are depicted like peptides, with the N-terminus at the first (left) position and the C-terminus at the right. Since the backbone of PNA contains no charged phosphate groups, the binding between PNA/DNA strands is stronger than between DNA/DNA strands due to the lack of electrostatic repulsion. 
         [0026]    In a most preferred embodiment said peptide nucleic acid (PNA) comprises a sequence of bases capable of hybridizing with the region including the putative point mutation resulting in double strand structures having respectively a melting temperature (Tm)=X with the wild type sequence and melting temperature (Tm)=Y with the mutant sequence, where Y&lt;Incubation Temperature X and X is at least 5° C. higher than Y. 
         [0027]    In a preferred embodiment the non extensible moiety is a self-annealed non extensible primer, comprising a central loop sequence able to selectively recognize and hybrizide to the region comprising the wild type sequence of the nucleic acid molecule, a  5 ′ end sequence and a  3 ′ end sequence, said  5 ′ end and said  3 ′ end sequences being complementary to each other to form a stem, so that said central loop sequence has a higher hybridization affinity to the region comprising the wild type sequence of the nucleic acid molecule than the hybridization affinity of the  5 ′ end sequence to the  3 ′ and sequence, so that it results in annealing and blocking of the wt sequence. 
         [0028]    In a preferred embodiment the DNA polymerase with strand displacement activity is the Bst large fragment polymerase, or one of or a combination of: Bca (exo-), Vent, Vent (exo-), Deep Vent, Deep Vent (exo-), φ29 phage, MS-2 phage, Z-Taq, KOD, Klenow fragment. 
         [0029]    In a preferred embodiment the constant temperature is comprised between 62° C. and 67° C. 
         [0030]    In a preferred embodiment the signal indicative of amplification of the nucleotide molecule comprising the point mutation is detected by turbidimetry. Alternatively the signal indicative of amplification of the nucleotide molecule comprising the point mutation is detected by fluorescence. 
         [0031]    In a preferred embodiment the nucleic acid molecule comprises the region of the human JAK2 gene (GenBank accession no. NM — 004972), putatively having the point mutation, guanine-to-thymidine substitution at base 1489 (G1489T). Preferably F 2  and F 1   c  are in position 1730-1750 and 1770-1795 respectively of the NM — 004972 gene sequence; B 2  is in position 1862-1884 of the NM — 004972 gene sequence and B 1   c  is in position 1810-1840 of the NM — 004972 gene sequence. Most preferably the primers have the following sequences: 
         [0000]    
       
         
               
               
               
               
             
           
               
                 F3 
                 5&#39;-GCATCTTTATTATGGCAGAGAG-3&#39;; 
                 (Seq Id No. 1) 
                   
               
               
                   
               
               
                 B3 
                 5&#39;-TGCTCTGAGAAAGGCATTA-3&#39;; 
                 (Seq Id No. 2) 
               
               
                   
               
               
                 FIP 
                 5&#39;-GCTGCTTCAAAGAAAGACTAAGGAAATGGACAACAGTCAAACAAC-3&#39;; 
                 (Seq Id No. 3) 
               
               
                   
               
               
                 BIP 
                 5&#39;-GCTTTCTCACAAGCATTTGGTTTTAAATTAGCCTGTAGTTTTACTTACTCTC-3&#39; 
                 (Seq Id No. 4) 
               
             
          
         
       
     
         [0032]    In a preferred embodiment the non extensible moiety is a PNA molecule, preferably having the structure:  NH2 GAGTATGTGTCTGTGGA CONH2 . 
         [0033]    The method of the invention is applied also to other genes responsible for a pathology or an alteration, as i.e. kRAS, EGFR, and to SNPs. 
     
    
     
         [0034]    The invention will be described with reference to specific not limiting examples, including the following figures: 
           [0035]      FIG. 1 . LAMP Principle (Prior Art) 
           [0036]    The basic reaction is performed by 4 primers specific for 6 regions of a target genomic sequence. Internal primers anneal and extend on the target; the product is displaced in two steps by external primers (F 3 , B 3 ) and is shaped as a double stem-loop structure (starting structure) (panel A). The starting structure is simultaneously amplified from its free  3 ′ and by another internal primer (panel B). DNA concatamers built by inverted repeats of the initial module are progressively synthesized in an exponential fashion (panel C). 
           [0037]      FIG. 2 . LAMP “DUMB-BELL Strategy” Principle (Not Working Control) 
           [0038]    The primers set is designed with the F 1   c  and B 1   c  region complementary respectively to one base upstream and one base downstream the nucleotide of interest in position 1849. Furthermore, the  5 ′ end base of FIP and BIP is specific for the mutated nucleotide of JAK2 and both inner primers have a mismatched base at the third base from  3 ′ end. When the dumb-bell structure is formed, If the target in the reaction is WT, the mutant specific F 1   c  and B 1   c  will not anneal at its  3 ′ end resulting in no amplification. Differently, if mutant sequences are present in solution, the mutant specific F 1   c  and B 1   c  will perfectly anneal, becoming extensible by the polymerase. 
           [0039]      FIG. 3 . LAMP “Allele Specific Loop Primer Extension Strategy” Principle 
           [0040]    The only one loop primer in reaction has the last base in the  3 ′ end complementary to the mutant nucleotide T at position 1849 of the JAK2 gene. It also presents a mismatched base in the third base from the  3 ′ end. If the target in the reaction is WT, the mutant-specific loop primer will not anneal at its  3 ′ end resulting in no amplification. Differently, if mutant sequences are present in solution, the mutant specific loop primer will perfectly anneal, becoming extensible by the polymerase. 
           [0041]      FIG. 4 . LAMP “Self-Annealed Loop Primers Strategy” Principle 
           [0042]    Universal (mutant insensitive) set of primers comprising F 3 , B 3 , FIP and BIP to obtain a dumb-bell presenting the putative mutated nucleotide in the loop region. A particular loop primer designed to recognize the mutated base in the single strand dumb-bell structure is included, together with another modified loop primer complementary to the JAK2 wild type sequence and with the  3 ′ end not extensible. When the mutated JAK2 sequence is present (panel A), the modified mutant loop primer breaks its internal structure to anneal to the target, being consequently extensible by the polymerase: the amplification can proceed. When the wt sequence is present in the sample (panel B), the modified wt loop primer anneals to the wt target resulting in no amplification of the wt sequences and avoiding the aspecific binding of mutant loop primer (“silencing” effect). 
           [0043]      FIG. 5 . LAMP “Mutant Self-Annealed Loop Primer With PNA Strategy” Principle 
           [0044]    Universal (mutant insensitive) set of primers comprising F 3 , B 3 , FIP and BIP to obtain a dumb-bell presenting the putative mutated nucleotide in the loop region. A particular self annealed-loop primer designed to recognize the mutated base in the single strand dumb-bell structure is included, together with a PNA probe. The PNA is designed to be complementary to the loop region comprised between B 2  and B 1   c  presenting the WT nucleotide. It forms a stable duplex only with the wt complementary sequence, preventing the annealing and extension of the mut-self-annealed loop primer and therefore suppressing the amplification (panel B). It does not anneal to the mut JAK2 sequence thanks to the lower affinity (panel A). 
           [0045]      FIG. 6 . Sensitivity of LAMP “DUMB-BELL Strategy” 
           [0046]    The reaction has been conducted on 7 e3 cps/ul wild type plasmid (square), on no-target control and on serial dilutions of mutant plasmid in water (from 7 e3 to 7 e1 cps/ul, rhomboidal points, and 7 e0 cps/ul, circle point). Each samples has been tested in triplicate. The error bars represent one standard deviation. The method amplify the specific target before the aspecific one until 7 e1 cps/ul concentration. The assay shows linearity between 7 e3 and 7 e1 cps/ul mutant sample. 
           [0047]      FIG. 7 . Sensitivity of LAMP “Allele Specific Mutant Loop Primer” 
           [0048]    The reaction has been conducted on 7 e3 cps/ul wild type plasmid (square point), on no-target control and on serial dilutions of mutant plasmid in water (from 7 e3 to 7 e1 cps/ul, rhomboidal points) . Each sample has been tested in triplicate. The error bars represent one standard deviation. The method amplify the specific target before the aspecific one until 7 e2 cps/ul concentration. The assay shows linearity between 7 e3 and 7 e1 cps/ul mutant sample. 
           [0049]      FIG. 8 . Selectivity of LAMP “Self-Annealed Loop Primer” 
           [0050]    The reaction has been conducted on 7 e3 cps/ul wild type plasmid (square point), on no-target control and on serial dilutions of mutant plasmid in wild type plasmid, in proportions from 75% to 1%, 35000 cps total amount of DNA per reaction. Each sample has been tested in triplicate. The error bars represent one standard deviation. The method amplify the specific target before the aspecific one until 1% dose (350 cps mut plasmid plus 34650 cps wt plasmid). The assay shows linearity between 100% and 1% mutant sample in wt background. 
           [0051]      FIG. 9 . LAMP “Self-Annealed Loop Primer with PNA” 
           [0052]    Test of the assay in presence and absence of PNA on mutated and wt plasmid (35000 cps each),In absence of PNA the WT plasmid is aspecifically amplified by the self-annealed mutant loop primer, with a delay of 5 min in respect to the specific mutated target. In presence of PNA, the WT plasmid is not amplified within one hour reaction by the self-annealed mutant loop primer. The amplification of the mutant plasmid is delayed of about 5 minutes. The PNA forms a stable duplex only with the wt complementary sequence preventing the annealing and extension of the mut-self-annealed loop primer and therefore suppressing the amplification within 1 hour of reaction. 
           [0053]      FIG. 10 . Selectivity of LAMP “Self-Annealed Loop Primer with PNA” 
           [0054]    Test of the assay on mutated plasmid (350000 cps), wild type plasmid (350000 cps) and on mutated plasmid serially diluted into wt plasmid in 1, 0.5, 0.1, 0.05 and 0.01% proportion. Error bars correspond to 1 standard deviation. The WT sample (350000 cps wt plasmid) is not amplified in one hour reaction. The specific mutant target is detected down to 0.01% mutant sequences in wt (35 copies tot mutant plasmid in 349650 copies of wt plasmid). The assay is linear down to 0.1% MUT (350 copies tot mutant plasmid in 349650 copies of wt plasmid). 
       
    
    
     EXAMPLE 1 
     Materials, Methods and Results of the JAK2-Modified-LAMP “Dumb-Bell Strategy” 
       [0055]    Reagents 
         [0056]    JAK2 plasmids were synthesized by the supplier GeneArt (Regensburg, Germany) to contain the wild type or the mutant JAK2 sequence. In details:
       JAK2 plasmid which Insert corresponds to the sequence 1689-1722 of MN — 004972, including a G base at nucleotide1849, referred to as “wt plasmid”;   JAK2 plasmid which Insert corresponds to the sequence 1689-1722 of MN — 004972 cloned, including a T base at nucleotide1849, referred to as “mut plasmid”.       
 
         [0059]    Primers: synthesized by the supplier Eurofins MWG Operon (Ebersberg, Germany) referred to as “primers”: 
         [0000]    
       
         
               
               
               
               
             
           
               
                 GA211 (F3) 
                 5&#39; GTCAAACAACAATTCTTTGTACT 3&#39; 
                 (Seq Id No. 5) 
                   
               
               
                   
               
               
                 GA212 (B3) 
                 5&#39; AGCTGTGATCCTGAAACTG 3&#39; 
                 (Seq Id No. 6) 
               
               
                   
               
               
                 GA216(FIP) 
                 5&#39;AATATACTCCATAATTTAAAACCAAATGCTTTCTTTCTTTGAAGCAGCAAGT 3&#39; 
                 (Seq Id No. 7) 
               
               
                   
               
               
                 GA220(BIP) 
                 5&#39;TTTTGTGGAGACGAGAGTAAGTAAAACTACATAAACAAAAACAGATGCTCTGA 3&#39; 
                 (Seq Id No. 8) 
               
               
                   
               
               
                 GA221 (LF) 
                 5&#39; GTGAGAAAGCTTGCTCATCAT 3&#39; 
                 (Seq Id No. 9) 
               
               
                   
               
               
                 GA222 (LB) 
                 5&#39; AGGCTTTCTAATGCCTTTC 3&#39; 
                 (Seq Id No. 10) 
               
             
          
         
       
     
         [0060]    Reaction buffer: 100 mM Tris HCl pH 8.8, 50 mM KCl, 40 mM MgSO4, 50 mM (NH4)2SO4, 0.5% Tween, 5% DMSO “buffer 5×” 
         [0061]    dNTPs mix 25 mM (Fermentas), “dNTPs” 
         [0062]    Bst Large Fragment polymerase 8 U/ul (New England Biolabs), “Polymerase”Sterile apyrogen water (SALF Spa), “ddw” 
         [0063]    Procedure 
         [0064]    Sample Preparation 
         [0065]    Prepare reaction mix as follows: 0.2 μM outer primers (F 3  and B 3 ), 1.6 μpM inner primers (FIP and BIP), 0.8 uM loop primers (LF and LB), 1× buffer solution, 1.4 mM dNTPs mix, 8 U Bst Polymerase. Final volume of the reaction mix must be 4/5  of the total reaction volume (i.e. 20 μl reaction mix +5 μl sample). Always keep reagents on ice. Prepare the mix for at least 17 samples, comprising 3 negative control (7e3 cps/ul wild type plasmid), 12 positive control (3 samples 7e3 cps/ul mutant plasmid, 3 samples 7e2 cps/ul mutant plasmid , 3 samples 7e1 cps/ul mutant plasmid, 3 samples 7e0 cps/ul mutant plasmid) 1 no-target control. 
         [0000]    
       
         
               
             
               
               
               
               
               
               
               
             
               
               
               
               
               
               
               
             
           
               
                 TABLE 1 
               
             
             
               
                   
               
               
                 sample mix composition 
               
             
          
           
               
                 Sample tube 
                 1-3 
                 4-6 
                 7-9 
                 10-12 
                 13-15 
                 16-19 
               
               
                   
               
             
          
           
               
                 Target to be 
                 Wt 
                 Mut 
                 Mut 
                 Mut 
                 Mut 
                   
               
               
                 add (5 μl) 
                 plasmid 
                 plasmid 
                 plasmid 
                 plasmid 
                 plasmid 
               
               
                   
                 7e3 cps/ 
                 7e3 cps/ 
                 7e2 cps/ 
                 7e1 cps/ 
                 7e0 cps/ 
               
               
                   
                 μl 
                 μl 
                 μl 
                 μl 
                 μl 
               
               
                 GA 211 100 μM 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
               
               
                 GA212 100 μM 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
               
               
                 GA 221 100 μM 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
               
               
                 GA 221 100 μM 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
               
               
                 GA 216 100 μM 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
               
               
                 GA 220 100 μM 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
               
               
                 Buffer 
                 2.5 
                 2.5 
                 2.5 
                 2.5 
                 2.5 
                 2.5 
               
               
                 LAMP 5x 
               
               
                 Bst Polymerase 
                 1 
                 1 
                 1 
                 1 
                 1 
                 1 
               
               
                 8 U/μl 
               
               
                 dNTPs 25 mM 
                 1.4 
                 1.4 
                 1.4 
                 1.4 
                 1.4 
                 1.4 
               
               
                 Ddw to 20 μl 
                 13.18 
                 13.18 
                 13.18 
                 13.18 
                 13.18 
                 13.18 
               
               
                   
               
             
          
         
       
     
         [0066]    Dispense 20 μl of reaction mix in the strip. Keep the strips on ice. Always keep the reaction mix on ice from now on. 
         [0067]    Prepare serial dilutions of the target (“target dilutions”) from shipped solution (wt plasmid and mut plasmid). Shipped solution is a 7*10 10  copies/μl. Dilute initially the mutant plasmid to a 7*10 4  copies/μl in Tris 10 mM, then dilute serially to 7e3 cps/μl, 7e2 cps/μl, 7e1 cps/ and 7e0 cps/μl in Tris 10 mM. Dilute the wt plasmid to 7*10 3  copies/μl in Tris 10 mM. 
         [0068]    Add 5 μl of target dilutions to the strips, in triplicate. Add 5 μl of the target dilutions starting from the less concentrated one to the most concentrated one. Close all the tubes. 
         [0069]    Reaction 
         [0070]    The reaction follows the method scheme of  FIGS. 1 and 2 . 
         [0071]    Program the turbidimeter (Teramecs) for incubation at constant temperature and real time monitoring of turbidity, in order to obtain a constant reaction temperature of 66° C. for 1 hour. 
         [0072]    Put the strips in the instrument immediately before the beginning of the programs. Start the program. 
         [0073]    Data Analysis 
         [0074]    Analyze the variation of absorbance in terms of a.u. (arbitrary units of absorbance) to find the threshold time for each sample analyzed. The threshold time is the minute at which the sample absorbance, after baseline subtraction, reaches the arbitrary unit value representing the threshold (in this case 0.1 a.u.). The threshold time reached by each samples is correlated with its Log of DNA copies/μl. 
         [0075]    Results 
         [0076]    “LAMP JAK2 Dumb-bell strategy” is based on the Eiken LAMP method for SNP detection (described in EP 1231281, 20, 21, 22, as well as on http://loopamp.eiken.co.jp/e/lamp/snps_anim.html). As shown in  FIG. 2 , the primers set is designed with the F 1   c  and B 1   c  region complementary respectively to one base upstream and one base downstream the nucleotide of interest in position 1849. Furthermore, the  5 ′ end base of FIP and BIP is specific for the mutated nucleotide of JAK2 and both inner primers have a mismatched base at the third base from  3 ′ end. When the dumb-bell structure is formed, if the target in the reaction is WT, the mutant specific F 1   c  and B 1   c  will not anneal at its  3 ′ end resulting in no amplification because the mismatch at its  3 ′end should not be extensible. Differently, if mutant sequences are present in solution, the mutant specific F 1   c  and B 1   c  will perfectly anneal, becoming extensible by the polymerase. 
         [0077]    A shown in  FIG. 6 , the assay was able to detect the mutant plasmid from 7e3 cps/μl to 7e0 cps/μl (35 copies tot mutant plasmid). It amplifies aspecifically the wt plasmid 7e3 cps/μl, not distinguishing the lower concentrations of mut plasmid from the aspecific target. The level of selectivity should be less than 1%, which is the limit shown by the other techniques in literature. With this approach we don&#39;t have any clear advantage. 
       EXAMPLE 2 
     Materials, Methods and Results of the JAK2-Modified-LAMP “Allele Specific Loop Primer Extension Strategy” 
       [0078]    Reagents 
         [0079]    JAK2 plasmids were synthesized by the supplier GeneArt (Regensburg, Germany) to contain the wild type or the mutant JAK2 sequence. In details:
       which Insert corresponds to the sequence 1689-1722 of MN — 004972, including a G base at nucleotide1849, referred to as “wt plasmid”   which Insert corresponds to the sequence 1689-1722 of MN — 004972 cloned, including a T base at nucleotide1849, referred to as “mut plasmid”       
 
         [0082]    Primers: synthesized by Eurofins MWG Operon, referred to as “primers”: 
         [0000]    
       
         
               
               
               
               
             
           
               
                 JAKR5 (F3) 
                 5&#39; TCTATAGTCATGCTGAAAGTAGGAG 3&#39; 
                 (Seq Id No. 11) 
                   
               
               
                   
               
               
                 JAKR2 (B3) 
                 5&#39; AAGGCATTAGAAAGCCTGTAGT 3&#39;  
                 (Seq Id No. 12) 
               
               
                   
               
               
                 JAKR7 (FIP) 
                 5&#39;ACAAAGAATTGTTGTTTGACTGTTGTCCATTGCATCTTTATTATGGCAGAGAGAA3&#39; 
                 (Seq Id No. 13) 
               
               
                   
               
               
                 JAKR8 (BIP) 
                 5&#39; AGTCTTTCTTTGAAGCAGCAAGTATGATGTTACTTACTCTCGTCTCCACAGA 3&#39; 
                 (Seq Id No. 14) 
               
               
                   
               
               
                 JAKR9 (LB) 
                 5&#39; AGCATTTGGTTTTAAATTATGGAGTA G GT T  3&#39; 
                 (Seq Id No. 15) 
               
             
          
         
       
     
         [0083]    The underlined base corresponds to a mismatched nucleotide. The bold base corresponds to the mutated nucleotide at position 1849 of the JAK2 gene. 
         [0084]    Reaction buffer: 100 mM Tris HCl pH 8.8, 50 mM KCl, 40 mM MgSO4, 50 mM (NH4)2SO4, 0.5% Tween, “buffer 5×” 
         [0085]    dNTPs mix 2 mM (Fermentas), “dNTPs” 
         [0086]    Bst Large Fragment polymerase 8 U/ul (New England Biolabs), “Polymerase” 
         [0087]    Sterile apyrogen water (SALF Spa), “ddw” 
         [0088]    Procedure 
         [0089]    Sample Preparation 
         [0090]    Stock the primers in aliquots. It is better to store stock solutions at −20° C., while working dilutions should be stored at 4° C. 
         [0091]    Prepare reaction mix as follows: 0.2 μM outer primers (F 3  and b 3 ), 1.6 μM inner primers (FIP and BIP), 0.8 uM loop primer (LB), 1× buffer solution, 1.4 mM dNTPs mix, 8 U Bst Polymerase. Final volume of the reaction mix must be 4/5  of the total reaction volume (i.e. 20 μl reaction mix+5 μl sample). Always keep reagents on ice. Prepare the mix for at least 14 samples, comprising 3 negative controls (7e3 cps/ul wild type plasmid), 9 positive control (3 samples 7e3 cps/ul mutant plasmid, 3 samples 7e2 cps/ul mutant plasmid , 3 samples 7e1 cps/ul mutant plasmid) 1 no-target control. 
         [0000]    
       
         
               
             
               
               
               
               
               
               
               
             
               
               
               
               
               
               
               
             
           
               
                 TABLE 2 
               
             
             
               
                   
               
               
                 sample mix composition 
               
             
          
           
               
                 Sample tube 
                 1-3 
                 4-6 
                 7-9 
                 10-12 
                 13-15 
                 16-19 
               
               
                   
               
             
          
           
               
                 Target to be 
                 Wt 
                 Mut 
                 Mut 
                 Mut 
                 Mut 
                   
               
               
                 add (5 μl) 
                 plasmid 
                 plasmid 
                 plasmid 
                 plasmid 
                 plasmid 
               
               
                   
                 7e3 cps/ 
                 7e3 cps/ 
                 7e2 cps/ 
                 7e1 cps/ 
                 7e0 cps/ 
               
               
                   
                 μl 
                 μl 
                 μl 
                 μl 
                 μl 
               
               
                 JAKR5 100 μM 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
               
               
                 JAKR2 100 μM 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
               
               
                 JAKR7 100 μM 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
               
               
                 JAKR8 100 μM 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
               
               
                 JAKR9 100 μM 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
               
               
                 Buffer 
                 2.5 
                 2.5 
                 2.5 
                 2.5 
                 2.5 
                 2.5 
               
               
                 LAMP 10x 
               
               
                 Bst Polymerase 
                 1 
                 1 
                 1 
                 1 
                 1 
                 1 
               
               
                 8 U/μl 
               
               
                 dNTPs 25 mM 
                 1.4 
                 1.4 
                 1.4 
                 1.4 
                 1.4 
                 1.4 
               
               
                 Ddw to 20 μl 
                 14 
                 14 
                 14 
                 14 
                 14 
                 14 
               
               
                   
               
             
          
         
       
     
         [0092]    Dispense 20 μl of reaction mix in the strip. Keep the strips on ice. Always keep the reaction mix on ice from now on. 
         [0093]    Prepare serial dilutions of the target (“target dilutions”) from shipped solution (wt plasmid and mut plasmid). Shipped solution is a 7*10 10  copies/μl. Dilute initially the mutant plasmid to a 7*10 4  copies/μl in Tris 10 mM, then dilute serially to 7e3 cps/μl, 7e2 cps/μl, 7e1 cps/μl in Tris 10 mM. Dilute the wt plasmid to 7*10 3  copies/μl in Tris 10 mM. Add 5 μl of target dilutions to the strips, in triplicate. Add 5 μl of the target dilutions starting from the less concentrated one to the most concentrated one. Close all the tubes. 
         [0094]    Reaction 
         [0095]    The reaction follows the method scheme of  FIG. 3 . 
         [0096]    Program the turbidimeter (Teramecs) for incubation at constant temperature and real time monitoring of turbidity 
         [0097]    in order to obtain a constant reaction temperature of 65° C. for 1 hour. 
         [0098]    Put the strips in the instrument immediately before the beginning of the programs. Start the program. 
         [0099]    Data Analysis 
         [0100]    Analyze the variation of absorbance in terms of a.u. to find the threshold time for each sample analyzed. The threshold time is the minute at which the sample absorbance, after baseline subtraction, reaches the arbitrary unit value representing the threshold (in this case 0.1 a.u.). The threshold time reached by each samples is correlated with its Log of DNA copies/μl. 
         [0101]    Results 
         [0102]    This approach consists of a selective mutant amplification based on a mutant-specific loop primer ( FIG. 3 ). We designed a universal (mutant insensitive) set of primers comprising F 3 , B 3 , FIP and BIP to obtain a dumb-bell presenting the putative mutated nucleotide in the loop region comprised between B 2  and B 1   c . We therefore designed only one loop primer presenting the last base in the  3 ′ end complementary to the mutant nucleotide T at position 1849 of the JAK2 gene. It also presents a mismatched base in the third base from the  3 ′ end. 
         [0103]    If the target in the reaction is WT, the mutant-specific loop primer will not anneal at its  3 ′ end resulting in no amplification. Differently, if mutant sequences are present in solution, the mutant specific loop primer will perfectly anneal, becoming extensible by the polymerase. 
         [0104]    We tested this assay on the mutant plasmid from 7e3 cps/μl to 7e1 cps/μl. (35000 and 350 copies tot mutant plasmid) and on the aspecific wt plasmid ( 7  e 3  cps/μl), all in triplicate. The assay amplifies aspecifically the wt plasmid 7e3 cps/μl, not distinguishing the 7e1 cps/μl concentrations of mut plasmid from the aspecific target. The level of selectivity should be less than 1%, which is the limit shown by the other techniques in literature. With this approach we don&#39;t have any clear advantage. ( FIG. 7 ). 
       EXAMPLE 3 
     Materials, Methods and Results of the JAK2-modified-LAMP “Self-annealing Loop Primer Strategy” 
       [0105]    Reagents 
         [0106]    JAK2 plasmids were synthesized by the supplier GeneArt (Regensburg, Germany) to contain the wild type or the mutant JAK2 sequence. In details:
       which Insert corresponds to the sequence 1689-1722 of MN — 004972, including a G base at nucleotide 1849, referred to as “wt plasmid”   which Insert corresponds to the sequence 1689-1722 of MN — 004972 cloned, including a T base at nucleotide 1849, referred to as “mut plasmid”       
 
         [0109]    Primers: synthesized by Eurofins MWG Operon, referred to as “primers”:
       GA231 (F 3 )  5 ′ GCATCTTTATTATGGCAGAGAG  3 ′ (Seq Id No. 16)   GA232 (B 3 )  5 ′ TGCTCTGAGAAAGGCATTA  3 ′ (Seq Id No. 17)   GA233 (FIP)  5 ′ GCTGCTTCAAAGAAAGACTAAGGAAATGGACAACAGTCAAACAAC  3 ′ (Seq Id No. 18)   GA234 (BIP)  5 ′ GCTTTCTCACAAGCATTTGGTTTTAAATTAGCCTGTAGTTTTACTTACTCTC  3 ′ (Seq Id No. 19)   GA235 (LF)  5 ′GTCTCCACTGGAGTATGTGTCTGTGGAGAddC 3 ′ (Seq Id No. 20) the underlined base is the wild type nucleotide in position 1849 of the JAK2 gene. ddC stands for not-extensible dideoxy-cytosine.   GA236 (LB)  5 ′ GTCTCCACTGGAGTATGTTTCTGTGGAGAC  3 ′ (Seq Id No. 21) the underlined base is the mutant nucleotide in position 1849 of the JAK2 gene.       
 
         [0116]    Reaction buffer: 100 mM Tris HCl pH 8.8, 50 mM KCl, 40 mM MgSO 4 , 50 mM (NH 4 ) 2 SO 4 , 0.5% Tween, “buffer 5×”dNTPs mix 25 mM (Fermentas), “dNTPs” 
         [0117]    Bst Large Fragment polymerase 8 U/ul (New England Biolabs), “Polymerase” 
         [0118]    Sterile apyrogen water (SALF Spa), “ddw” 
         [0119]    Procedure 
         [0120]    Sample Preparation 
         [0121]    Stock the primers in aliquots. It is better to store stock solutions at −20° C., while working dilutions should be stored at 4° C. 
         [0122]    Prepare reaction mix as follows: 0.2 μM outer primers (F 3  and B 3 ), 1.6 μM inner primers (FIP and BIP), 0.8 uM both self-annealed loop primers (not-extensible LF and LB), 1× buffer solution, 1.4 mM dNTPs mix, 8 U Bst Polymerase. Final volume of the reaction mix must be 4/5  of the total reaction volume (i.e. 20 μl reaction mix+5 μl sample). Always keep reagents on ice. Prepare the mix for at least 26 samples, comprising 3 negative controls (100% wild type plasmid, 7e3 cps/ul, 21 positive control (3 samples 100% (7e3 cps/ul) mutant plasmid, 3 samples 75% mutant plasmid diluted in wt plasmid, 3 samples 50% mutant plasmid diluted in wt plasmid, 3 samples 25% mutant plasmid diluted in wt plasmid, 3 samples 10% mutant plasmid diluted in wt plasmid, 3 samples 10% mutant plasmid diluted in wt plasmid, 3 samples 5% mutant plasmid diluted in wt plasmid, 3 samples 1% mutant plasmid diluted in wt plasmid, and one no target control. 
         [0000]    
       
         
               
             
               
               
               
               
               
               
               
             
               
               
               
               
               
               
               
             
           
               
                 TABLE 3 
               
             
             
               
                   
               
               
                 sample mix composition 
               
             
          
           
               
                 Sample tube 
                 1-3 
                 4-6 
                 7-9 
                 10-12 
                 13-15 
                 16-19 
               
               
                   
               
             
          
           
               
                 Target to be 
                 Wt 
                 Mut 
                 Mut 
                 Mut 
                 Mut 
                   
               
               
                 add (5 μl) 
                 plasmid 
                 plasmid 
                 plasmid 
                 plasmid 
                 plasmid 
               
               
                   
                 7e3 cps/ 
                 7e3 cps/ 
                 7e2 cps/ 
                 7e1 cps/ 
                 7e0 cps/ 
               
               
                   
                 μl 
                 μl 
                 μl 
                 μl 
                 μl 
               
               
                 GA231 100 μM 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
               
               
                 GA232 100 μM 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
               
               
                 GA233 100 μM 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
               
               
                 GA234 100 μM 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
               
               
                 GA235 100 μM 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
               
               
                 GA236 100 μM 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
               
               
                 Buffer 
                 2.5 
                 2.5 
                 2.5 
                 2.5 
                 2.5 
                 2.5 
               
               
                 LAMP 10x 
               
               
                 Bst Polymerase 
                 1 
                 1 
                 1 
                 1 
                 1 
                 1 
               
               
                 8 U/μl 
               
               
                 dNTPs 25 mM 
                 1.4 
                 1.4 
                 1.4 
                 1.4 
                 1.4 
                 1.4 
               
               
                 Ddw to 20 μl 
                 13.8 
                 13.8 
                 13.8 
                 13.8 
                 13.8 
                 13.8 
               
               
                   
               
             
          
         
       
     
         [0123]    Dispense 20 μl of reaction mix in the strip. Keep the strips on ice. Always keep the reaction mix on ice from now on. 
         [0124]    Prepare serial dilutions of the target (“target dilutions”) from shipped solution (wt plasmid and mut plasmid). Shipped solution is a 7*10 10  copies/μl. Dilute initially the mutant plasmid to a 7*10 4  copies/μl in Tris 10 mM, then dilute serially the mutant plasmid in wt plasmid to obtain the following concentrations of mutant sequences in wild type background: 75%, 50%, 25%, 10%, 5%, 1% (total amount per tube, 7e3 cps/μl). Add 5 μl of target dilutions to the strips, in triplicate. Add 5 ul of the target dilutions starting from the less concentrated one to the most concentrated one. Close all the tubes. 
         [0125]    Reaction 
         [0126]    The reaction follows the method scheme of  FIG. 4 . 
         [0127]    Program the turbidimeter (Teramecs) for incubation at constant temperature and real time monitoring of turbidity, in order to obtain a constant reaction temperature of 65° C. for 1 hour. 
         [0128]    Put the strips in the instrument immediately before the beginning of the programs. Start the program. 
         [0129]    Data Analysis 
         [0130]    Analyze the variation of absorbance in terms of a.u. to find the threshold time for each sample analyzed. The threshold time is the minute at which the sample absorbance, after baseline subtraction, reaches the arbitrary unit value representing the threshold (in this case 0.1 a.u.). The threshold time reached by each samples is correlated with its Log of DNA copies/μl. 
         [0131]    Results 
         [0132]    This approach consists of a selective mutant amplification based on a particular loop primer design resulting in selective hybridization of such loop primer to the dumb-bell formed from the mutant sequence ( FIG. 4 ). We designed a universal (mutant insensitive) set of primers comprising F 3 , B 3 , FIP and BIP to obtain a dumb-bell presenting the putative mutated nucleotide in the loop region comprised between B 1  and B 2 . Other experiments were performed presenting the putative mutated nucleotide in the loop region into B 2  or comprised between B 2  and B 1   c , with no relevant differences. We included in the primer set a particular loop primer presenting a 8-bases sequence region at its  5 ′ end complementary to its own sequence in  3 ′ end. Consequently, this special loop primer forms an intra-molecular hairpin structure in equilibrium with its open form at the reaction temperature (65° C.). 
         [0133]    When the mutated JAK2 sequence is present, this modified loop primer breaks its internal structure to anneal to the target, thanks to the thermodynamic equilibrium (Tm between primer and specific target=65° C.). The loop primer annealed to the specific mutated target is consequently extensible by the polymerase: the amplification can proceed. 
         [0134]    When the wt sequence is present in the sample, the same loop primer (specific for the MUT JAK2 gene) presents a Tm with aspecific target (59° C.) lower than the intra-molecular hairpin structure (65° C.). This results in auto-sequestration of the modified loop primer that prefers to fold in the hairpin structure rather than to form a duplex with aspecific target, since the intramolecular forces are higher than the intermolecular ones. To limit the competition of the loop primer previously described for the wild type sequences likely to be present in large excess in the clinical sample, we added another modified loop primer characterized by a structure similar to the one previously described, but whit a sequence complementary to the JAK2 wild type sequence (with G base at position 1489). 
         [0135]    The  3 ′ end of this “competitor” loop primer is made not extensible by a modification ( 3 ′ dideoxy). The task of this competitor is to “silence” the wt and allow the specific mutant primer to find its target. 
         [0136]    When the “competitor” recognizes the specific wild type sequence, it breaks its intramolecular structure to anneal to the WT target, thanks to a higher affinity (Tm duplex wt target-wt modified loop primer=67° C.); The loop primer annealed to the wt target is not extensible, resulting in no amplification of the wt sequences. Since the reaction is conducted at constant temperature, the wt-loop primer will remain annealed to the wt sequences preventing aspecific annealing of the MUT loop primer. 
         [0137]    Differently, the “competitor” presents a Tm with its aspecific (mutant) target (62° C.) lower than the intra-molecular hairpin structure that it forms with itself (65° C.). This results in auto-sequestration of the modified loop primer that prefers to fold in the hairpin structure rather than to form a duplex with the aspecific target, since the intramolecular forces are higher than the intermolecular ones. 
         [0138]    The selectivity of this assay has been evaluated, performing the reaction on serial dilutions of mutant plasmid in wild type background ( FIG. 8 ). The selectivity achieved is significantly less than 1% (350 copies tot mutant plasmid in 34650 copies of wt plasmid). This approach has higher selectivity than the assays described in literature. 
         [0139]    The assay is linear between 100% mutant (35000 cps) and 1% mutant in 99% wild type (350 copies tot mutant plasmid in 34650 copies of wt plasmid). It allows detection and quantification of low percentage of mutant sequences in large amount of wt. It represents an improvement in respect of the other approaches shown in the previous slides and in respect to the methods described in literature. 
       EXAMPLE 4 
     Materials, Methods and Results of the JAK2-modified-LAMP “Self-annealing Loop Primer Strategy with PNA” 
       [0140]    Reagents 
         [0141]    JAK2 plasmids were synthesized by the supplier GeneArt (Regensburg, Germany) to contain the wild type or the mutant JAK2 sequence. In details:
       which Insert corresponds to the sequence 1689-1722 of MN — 004972, including a G base at nucleotide 1849 , referred to as “wt plasmid”   which Insert corresponds to the sequence 1689-1722 of MN — 004972 cloned, including a T base at nucleotide1849, referred to as “mut plasmid”       
 
         [0144]    Primers: synthesized by Eurofins MWG Operon, referred to as “primers”: 
         [0000]    
       
         
               
               
               
               
             
           
               
                 GA231 (F3) 
                 5&#39; GCATCTTTATTATGGCAGAGAG 3&#39; 
                 (Seq Id No. 16) 
                   
               
               
                   
               
               
                 GA232 (B3) 
                 5&#39; TGCTCTGAGAAAGGCATTA 3&#39; 
                 (Seq Id No. 17) 
               
               
                   
               
               
                 GA233 (FIP) 
                 5&#39; GCTGCTTCAAAGAAAGACTAAGGAAATGGACAACAGTCAAACAAC 3&#39; 
                 (Seq Id No. 18) 
               
               
                   
               
               
                 GA234 (BIP) 
                 5&#39;GCTTTCTCACAAGCATTTGGTTTTAAATTAGCCTGTAGTTTTACTTACTCTC 3&#39; 
                 (Seq Id No. 19) 
               
               
                   
               
               
                 GA236 (LB) 
                 5&#39; GTCTCCACTGGAGTATGT T TCTGTGGAGAC 3&#39; 
                 (Seq Id No. 22) 
               
             
          
         
       
     
         [0145]    The underlined base corresponds to the mutated nucleotide at position 1849 of the JAK2 gene. 
         [0146]    PNA: Eurogentec, referred to as “PNA” GM43  NH2 GAGTATGT G TCTGTGGA CONH2    
         [0147]    The underlined base corresponds to the wild type nucleotide at position 1849 of the JAK2 gene. 
         [0148]    Reaction buffer: 100 mM Tris HCl pH 8.8, 50 mM KCl, 40 mM MgSO4, 50 mM (NH4)2SO4, 0.5% Tween, “buffer 5×” 
         [0149]    dNTPs mix 25 mM (Fermentas), “dNTPs” 
         [0150]    Bst Large Fragment polymerase 8 U/μl (New England Biolabs), “Polymerase” 
         [0151]    Sterile apyrogen water (SALF Spa), “ddw” 
         [0152]    Procedure 
         [0153]    Sample Preparation 
         [0154]    Stock the primers in aliquots. It is better to store stock solutions at −20° C., while working dilutions should be stored at 4° C. 
         [0155]    Prepare reaction mix as follows: 0.2 μM outer primers (F 3  and B 3 ), 1.6 μM inner primers (FIP and BIP), 0.8 uM self-annealed loop primer specific for mutant JAK2 (LB), 0.8 uM PNA, 1× buffer solution, 1.4 mM dNTPs mix, 8 U Bst Polymerase. Final volume of the reaction mix must be 4/5  of the total reaction volume (i.e. 20 μl reaction mix+5 μl sample). Always keep reagents on ice. Prepare the mix for at least 23 samples, comprising 3 negative controls (100% wild type plasmid, 7e4 cps/μl), 18 positive control (3 samples 100% mutant plasmid, 3 samples 1% mutant plasmid diluted in wt plasmid, 3 samples 0.5% mutant plasmid diluted in wt plasmid, 3 samples 0.1% mutant plasmid diluted in wt plasmid, 3 samples 0.05% mutant plasmid diluted in wt plasmid, 3 samples 0.01% mutant plasmid diluted in wt plasmid (total amount of DNA 7e4 cps/μl), and one no target control. 
         [0000]    
       
         
               
             
               
               
               
               
               
               
               
             
           
               
                 TABLE 4 
               
             
             
               
                   
               
               
                 sample mix composition 
               
             
          
           
               
                 Sample tube 
                 1-3 
                 4-6 
                 7-9 
                 10-12 
                 13-15 
                 16-19 
               
               
                   
               
               
                 Target to be 
                 Wt 
                 Mut 
                 Mut 
                 Mut 
                 Mut 
                 Mut 
               
               
                 add (5 μl) 
                 plasmid 
                 plasmid 
                 plasmid 
                 plasmid 
                 plasmid 
                 plasmid 
               
               
                   
                 7e4 cps/ 
                 7e4 cps/ 
                 7e3 cps/ 
                 7e2 cps/ 
                 7e1 cps/ 
                 7e0 cps/ 
               
               
                   
                 μl 
                 μl 
                 μl 
                 μl 
                 μl 
                 μl 
               
               
                 GA231 100 μM 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
               
               
                 GA232 100 μM 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
               
               
                 GA233 100 μM 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
               
               
                 GA234 100 μM 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
               
               
                 PNA 100 μM 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
               
               
                 GA236 100 μM 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
               
               
                 Buffer 
                 2.5 
                 2.5 
                 2.5 
                 2.5 
                 2.5 
                 2.5 
               
               
                 LAMP 10x 
               
               
                 Bst Polymerase 
                 1 
                 1 
                 1 
                 1 
                 1 
                 1 
               
               
                 8 U/μl 
               
               
                 dNTPs 25 mM 
                 1.4 
                 1.4 
                 1.4 
                 1.4 
                 1.4 
                 1.4 
               
               
                 Ddw to 20 μl 
                 13.8 
                 13.8 
                 13.8 
                 13.8 
                 13.8 
                 13.8 
               
               
                   
               
             
          
         
       
     
         [0156]    Dispense 20 μl of reaction mix in the strip. Keep the strips on ice. Always keep the reaction mix on ice from now on. 
         [0157]    Prepare serial dilutions of the target (“target dilutions”) from shipped solution (wt plasmid and mut plasmid). Shipped solution is a 7*10 10  copies/μl. Dilute initially the mutant plasmid to a 7*10 4  copies/μl in Tris 10 mM, then dilute serially the mutant plasmid in wt plasmid to obtain the following concentrations of mutant sequences in wild type background: 1%, 0.5%, 0.1%, 0.05%, 0.01% (total amount per tube, 7e4 cps/ul). 
         [0158]    Add 5 μl of target dilutions to the strips, in triplicate. Add 5 ul of the target dilutions starting from the less concentrated one to the most concentrated one. Close all the tubes. 
         [0159]    Reaction 
         [0160]    The reaction follows the method scheme of  FIG. 5 . 
         [0161]    Program the turbidimeter (Teramecs) for incubation at constant temperature and real time monitoring of turbidity in order to obtain a constant reaction temperature of 65° C. for 1 hour. 
         [0162]    Put the strips in the instrument immediately before the beginning of the programs. Start the program. 
         [0163]    Data Analysis 
         [0164]    Analyze the variation of absorbance in terms of a.u. to find the threshold time for each sample analyzed. The threshold time is the minute at which the sample absorbance, after baseline subtraction, reaches the arbitrary unit value representing the threshold (in this case 0.1 a.u.). The threshold time reached by each samples is correlated with its Log of DNA copies/μl. 
         [0165]    Results 
         [0166]    This approach consists of a selective mutant amplification based on a particular loop primer design resulting in selective hybridization of such loop primer to the dumb-bell formed from the mutant sequence ( FIG. 5 ). We designed a universal (mutant insensitive) set of primers comprising F 3 , B 3 , FIP and BIP to obtain a dumb-bell presenting the putative mutated nucleotide in the loop region comprised between B 1  and B 2 . Other experiments were performed presenting the putative mutated nucleotide in the loop region into B 2  or comprised between B 2  and B 1   c , with no relevant differences. We included in the primer set a particular loop primer presenting a 8-bases sequence region at its  5 ′ end complementary to its own sequence in  3 ′ end. Consequently, this special loop primer forms an intra-molecular hairpin structure in equilibrium with its open form at the reaction temperature (65° C.). 
         [0167]    When the mutated JAK2 sequence is present, this modified loop primer breaks its internal structure to anneal to the target, thanks to the thermodynamic equilibrium (Tm between primer and specific target=65° C.). The loop primer annealed to the specific mutated target is consequently extensible by the polymerase: the amplification can proceed. 
         [0168]    When the wt sequence is present in the sample, the same loop primer (specific for the MUT JAK2 gene) presents a Tm with aspecific target (59° C.) lower than the intra-molecular hairpin structure (65° C.). This results in auto-sequestration of the modified loop primer that prefers to fold in the hairpin structure rather than to form a duplex with aspecific target, since the intramolecular forces are higher than the intermolecular ones. To further increase the discrimination capability of the LAMP system based on selective self-annealed loop primer, we added to the reaction mix a Peptide Nucleic Acid (PNA). PNAs are non-extensible and not-displaceable oligonucleotides where the ribose-phosphate backbone is replaced by (2-aminoethyl)-glycine units linked by amide bonds. Each base pairing DNA/PNA contributes to the stability of the duplex structure more than a regular base pairing DNA/DNA. Therefore a single mismatch in a PNA/DNA duplex results in a significant difference in Tm. A PNA probe fully complementary to the WT sequence of the JAK2 gene prevents annealing and extension of the mutant self-annealed primer, suppressing amplification. In presence of a single mismatch, PNA does not inhibit loop primer hybridization, which leads to amplification. Therefore PNA can be used to selectively block the Wt sequence present in the sample. 
         [0169]    The PNA is designed to be complementary to the loop region comprised between B 2  and B 1   c  presenting the WT nucleotide. It forms a stable duplex only with the wt complementary sequence (Tm 65.7° C.), preventing the annealing and extension of the mut-self-annealed loop primer and therefore suppressing the amplification. It does not anneal to the mut JAK2 sequence thanks to the lower affinity (Tm=56° C.). 
         [0170]    The PNA principle has been tested performing the reaction on 7 e3 cps/ul wild type plasmid and on 7 e3 cps/ul mutant plasmid, in parallel in absence and presence of the PNA “wt blocker” probe ( FIG. 9 ). In absence of PNA the WT plasmid is aspecifically amplified by the self-annealed mutant loop primer, with a delay of 5 min in respect to the specific mutated target. In presence of PNA, the WT plasmid is not amplified within one hour reaction by the self-annealed mutant loop primer. The amplification of the mutant plasmid is delayed of about 5 minutes. The PNA forms a stable duplex only with the wt complementary sequence preventing the annealing and extension of the mut-self-annealed loop primer and therefore suppressing the amplification within 1 hour of reaction. 
         [0171]    The selectivity of this assay has been evaluated, performing the reaction on serial dilutions of mutant plasmid in wild type background ( FIG. 10 ). The selectivity achieved is less than 0.01% (35 copies tot mutant plasmid in 34965 copies of wt plasmid). This approach has higher selectivity than the assays described in prior art, about 3 Logs more in respect to direct sequencing, RFLP and pyrosequencing and about 2 Logs in respect to ARMS, Real-time techniques and DNA-melting curve analysis. As to LAMP dumb-bell method, it is intrinsically not useful to detect single point mutations in a high background of wild type sequences. 
         [0172]    The WT sample (35000 cps wt plasmid) is not amplified in one hour reaction. The specific mutant target is detected down to 0.01% mutant sequences in wt (35 copies tot mutant plasmid in 34965 copies of wt plasmid). This approach has a higher selectivity than the assays described in literature (about 2 Logs). The assay is linear down to 0.1% MUT (350 copies tot mutant plasmid in 34650 copies of wt plasmid). It allows detection and quantification of low percentage of mutant sequences in large amount of wt. It represents a further improvement in respect of the other strategies described in this report and in respect to the methods described in literature. 
       EXAMPLE 5 
     LAMP “Self-Annealed Loop Primer with PNA” on Clinical Samples: Comparison with ARMs 
       [0173]    29 samples of DNA extracted from patients at Ospedali Riuniti di Bergamo were analyzed using JAK2 LAMP “self-annealed loop primer with PNA” strategy, as described in the EXAMPLE 4. The results obtained have been compared with the ones obtained at the hospital using the ARMs technology. The ARMS exploits the fact that oligonucleotide primers must be perfectly annealed at their  3 ′ ends for a DNA polymerase to extend these primers during PCR. By designing oligonucleotide primers that match only the specific JAK2 point mutation ARMS can distinguish between wild type and mutant alleles. 
         [0174]    As shown in Table 5, all the samples diagnosed as positive by ARMS have been detected as positive by LAMP. Out of 15 samples resulted negative by ARMS, 11 have been diagnosed as negative by LAMP and 4 as low positive. To exclude that the 4 discordant samples resulted mutated by LAMP were false positive and to confirm that the mutation diagnosis was due to an higher selectivity of the modified-LAMP method, we tested the samples using a third assay. The assay consists in PCR amplification of the JAK2 region of interest in presence of the PNA molecule complementary to the wild type target. The purpose is to enrich the mutated base, if present, by suppression of the wild type via PNA clamping. If the mutated region is enriched to a level of 20% of the sample, it can be detected by the direct-sequencing. The primers (GA231 forward and GA232 reverse) and the PNA are the same described above (paragraph “Example 4”). The amplification was performed in presence of 1× reaction buffer, 2.5 mM MgCl 2 , 200 μM dNTPs, 500 nM forward and reverse primers, 1.5M PNA and 0.025 U Taq Gold in a final volume of 45 μl. 5 μl of target 20 ng/μl was added to the reaction mix. The resulting solution was incubated in a thermocycler, following a thermal program consisting in 10 min at 95° C. followed by 35 cycles of 30 sec at 94° C., 40 sec at 62° C. cycles, 30 sec at 58° C. and 30 sec at 72° C. and finishing with 10 min at 72° C. for the final extension. The four discordant clinical samples, one no-target control sample and a positive and negative plasmid target were tested in duplicate. The resulting amplification products were separated on an agarose gel containing EtBr to visualize the amplification bands. The no-target control was not amplified. The negative control containing the wild type plasmid was slightly amplified, and a weak band was visible on the agarose gel. The positive control containing the mutated plasmid was strongly amplified presenting a strong band on the agarose gel. The clinical samples were amplified. The amplification products were consequently analyzed via automatic-sequencing. All the discordant clinical samples show a double peak in position 1849, corresponding to the Guanine (wild type) base and the Thymine (mutated) base. This result confirm that the four discordant samples have been correctly diagnosed mutated by LAMP, while they results false negative by ARMS. 
         [0000]    
       
         
               
               
               
               
             
           
               
                   
                 TABLE 5 
               
               
                   
                   
               
               
                   
                   
                   
                 LAMP self-annealed 
               
               
                   
                 sample 
                 ARMs 
                 loop primer with PNA 
               
               
                   
                   
               
             
             
               
                   
                 PIGI 
                 − 
                 + (low) 
               
               
                   
                 PEVI 
                 − 
                 − 
               
               
                   
                 ACGI 
                 + 
                 + 
               
               
                   
                 BEMA 
                 + 
                 + 
               
               
                   
                 BILU 
                 + 
                 + 
               
               
                   
                 PAAN 
                 − 
                 + (low) 
               
               
                   
                 BOMA 
                 − 
                 − 
               
               
                   
                 OLIN 
                 − 
                 − 
               
               
                   
                 PALO 
                 + 
                 + 
               
               
                   
                 BOED 
                 + 
                 + 
               
               
                   
                 SAGE 
                 + 
                 + 
               
               
                   
                 BAGI 
                 + 
                 + 
               
               
                   
                 FEGI 
                 + 
                 + 
               
               
                   
                 BEAL 
                 + 
                 + 
               
               
                   
                 TALU 
                 + 
                 + 
               
               
                   
                 CAPI 
                 + 
                 + 
               
               
                   
                 SAGI 
                 + 
                 + 
               
               
                   
                 SAVGI 
                 + 
                 + 
               
               
                   
                 PECA 
                 + 
                 + 
               
               
                   
                 SCLU 
                 − 
                 − 
               
               
                   
                 BILU2 
                 − 
                 + (low) 
               
               
                   
                 NAGI 
                 − 
                 − 
               
               
                   
                 MAST 
                 − 
                 − 
               
               
                   
                 COSA 
                 − 
                 − 
               
               
                   
                 GUAL 
                 − 
                 − 
               
               
                   
                 COCL 
                 − 
                 − 
               
               
                   
                 PEMG 
                 − 
                 − 
               
               
                   
                 SABA 
                 − 
                 + (low) 
               
               
                   
                 ANPI 
                 − 
                 − 
               
               
                   
                   
               
             
          
         
       
     
       EXAMPLE 6 
     Fluorescent JAK2-Modified-LAMP “Self-Annealing Loop Primer Strategy” 
       [0175]    Reagents 
         [0176]    JAK2 plasmids were synthesized by the supplier GeneArt (Regensburg, Germany) to contain the wild type or the mutant JAK2 sequence. In details:
       which Insert corresponds to the sequence 1689-1722 of MN — 004972, including a G base at nucleotide1849, referred to as “wt plasmid”   which Insert corresponds to the sequence 1689-1722 of MN — 004972 cloned, including a T base at nucleotide1849, referred to as “mut plasmid”       
 
         [0179]    Primers: synthesized by Eurofins MWG Operon, referred to as “primers”:
       GA231 (F 3 )  5 ′ GCATCTTTATTATGGCAGAGAG  3 ′ (Seq Id No. 16)   GA232 (B 3 )  5 ′ TGCTCTGAGAAAGGCATTA  3 ′ (Seq Id No. 17)   GA233 (FIP)  5 ′ GCTGCTTCAAAGAAAGACTAAGGAAATGGACAACAGTCAAACAAC  3 ′ (Seq Id No. 18)   GA234 (BIP)  5 ′GCTTTCTCACAAGCATTTGGTTTTAAATTAGCCTGTAGTTTTACTTACTCTC  3 ′ (Seq Id No. 19) GA236 (LB)  5 ′TAMRA-TGTCTCCACTGGAGTATGTTTCTGTGGAGAC  3 ′ (Seq Id No. 21). The underlined base corresponds to the mutated nucleotide at position 1849 of the JAK2 gene. The bold Tymine base at  5 ′ end is not complementary to the target sequence. It has been added to separe the fluorophore from the Guanine base downstream, which has a quenching effect.   GA235 (LF)  5 ′- 5 ′GTCTCCACTGGAGTATGTGTCTGTGGAGAddC 3 ′(Seq Id No. 20) the underlined base is the wild type nucleotide in position 1849 of the JAK2 gene. ddC stands for not-extensible dideoxy-citosine.       
 
         [0185]    Reaction buffer: 100 mM Tris HCI pH 8.8, 50 mM KCl, 40 mM MgSO4, 50 mM (NH4)2SO4, 0.5% Tween, “buffer 5×” 
         [0186]    dNTPs mix 25 mM (Fermentas), “dNTPs” 
         [0187]    Bst Large Fragment polymerase 8 U/μl (New England Biolabs), “Polymerase” 
         [0188]    Sterile apyrogen water (SALF Spa), “ddw” 
         [0189]    Procedure 
         [0190]    Sample Preparation 
         [0191]    Stock the primers in aliquots. It is better to store stock solutions at −20° C., while working dilutions should be stored at 4° C. 
         [0192]    Prepare reaction mix as follows: 0.2 μM outer primers (F 3  and B 3 ), 1.6 μM inner primers (FIP and BIP), 0.8 μM fluorescent self-annealed loop primer specific for mutant JAK2 (LB), 0.8 μM self annealed not-extensible loop primer for wild type JAK2 (LF), 1× buffer solution, 1.4 mM dNTPs mix, 8 U Bst Polymerase. Final volume of the reaction mix must be 4/5  of the total reaction volume (i.e. 20 μl reaction mix+5 μl sample). Always keep reagents on ice. Prepare the mix for at least 23 samples, comprising 3 negative controls (100% wild type plasmid, 7e3 cps/μl), 18 positive control (3 samples 100% mutant plasmid, 3 samples 1% mutant plasmid diluted in wt plasmid, 3 samples 0.5% mutant plasmid diluted in wt plasmid, 3 samples 0.1% mutant plasmid diluted in wt plasmid, 3 samples 0.05% mutant plasmid diluted in wt plasmid, 3 samples 0.01% mutant plasmid diluted in wt plasmid (total amount of DNA 7e3 cps/μl), and one no target control. 
         [0000]    
       
         
               
             
               
               
               
               
               
               
               
             
               
               
               
               
               
               
               
             
           
               
                 TABLE 6 
               
             
             
               
                   
               
               
                 sample mix composition 
               
             
          
           
               
                 Sample tube 
                 1-3 
                 4-6 
                 7-9 
                 10-12 
                 13-15 
                 16-19 
               
               
                   
               
             
          
           
               
                 Target to be 
                 Wt 
                 Mut 
                 Mut 
                 Mut 
                 Mut 
                   
               
               
                 add (5 μl) 
                 plasmid 
                 plasmid 
                 plasmid 
                 plasmid 
                 plasmid 
               
               
                   
                 7e3 cps/ 
                 7e3 cps/ 
                 7e2 cps/ 
                 7e1 cps/ 
                 7e0 cps/ 
               
               
                   
                 μl 
                 μl 
                 μl 
                 μl 
                 μl 
               
               
                 GA231 100 μM 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
               
               
                 GA232 100 μM 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
                 0.05 
               
               
                 GA233 100 μM 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
               
               
                 GA234 100 μM 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
                 0.4 
               
               
                 GA235 100 μM 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
               
               
                 GA236 100 μM 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
                 0.2 
               
               
                 Buffer 
                 2.5 
                 2.5 
                 2.5 
                 2.5 
                 2.5 
                 2.5 
               
               
                 LAMP 10x 
               
               
                 Bst Polymerase 
                 1 
                 1 
                 1 
                 1 
                 1 
                 1 
               
               
                 8 U/μl 
               
               
                 dNTPs 25 mM 
                 1.4 
                 1.4 
                 1.4 
                 1.4 
                 1.4 
                 1.4 
               
               
                 Ddw to 20 μl 
                 13.8 
                 13.8 
                 13.8 
                 13.8 
                 13.8 
                 13.8 
               
               
                   
               
             
          
         
       
     
         [0193]    Dispense 20 μl of reaction mix in the strip. Keep the strips on ice. Always keep the reaction mix on ice from now on. 
         [0194]    Prepare serial dilutions of the target (“target dilutions”) from shipped solution (wt plasmid and mut plasmid). Shipped solution is a 7*10 10  copies/μl. Dilute initially the mutant plasmid to a 7*10 4  copies/μl in Tris 10 mM, then dilute serially the mutant plasmid in wt plasmid to obtain the following concentrations of mutant sequences in wild type background: 1%, 0.5%, 0.1%, 0.05%, 0.01% (total amount per tube, 7e3 cps/ul. 
         [0195]    Add 5 μl of target dilutions to the strips, in triplicate. Add 5 μl of the target dilutions starting from the less concentrated one to the most concentrated one. Close all the tubes. 
         [0196]    Reaction 
         [0197]    The reaction follows the method scheme of  FIG. 4 . 
         [0198]    Program the real time instrument for incubation at constant temperature in order to obtain a constant reaction temperature of 65° C. for 1 hour. Program the real time instrument in order to obtain a fluorescence reading per minute. 
         [0199]    Put the strips in the instrument immediately before the beginning of the programs. Start the program. 
         [0200]    Data Analysis 
         [0201]    The fluorescent self-annealed loop primer in reaction produces a fluorescent signal once it is excited by an appropriated wavelenght-light emission. When the LAMP reaction proceeds, the fluorescent self-annealed loop primer is incorporated in the amplification products, being consequently annealed to a complementary nucleotide sequence. The fluorescent self-annealed loop primer is designed to be complementary to a sequence containing at least one Guanine nucleotide close to its 5′ end. The Guanine base can absorbe the wavelengh emitted by the fluorophore (TAMRA in our case), causing a fluorescent signal quenching. The LAMP reaction can be consequently detected by analysis of the variation of fluorescence in terms of signal quenching, to find the threshold time relative to each analyzed sample. The threshold time is the minute at which the fluorescence signal in reaction reaches 50% of quenching. The threshold time reached by each samples is correlated with its Log of DNA copies/μl. 
         [0202]    Results 
         [0203]    This approach consists of a selective mutant amplification based on a particular loop primer design resulting in selective hybridization of such loop primer to the dumb-bell formed from the mutant sequence ( FIG. 4 ). We designed a universal (mutant insensitive) set of primers comprising F 3 , B 3 , FIP and BIP to obtain a dumb-bell presenting the putative mutated nucleotide in the loop region comprised between B 1  and B 2 . Other experiments were performed presenting the putative mutated nucleotide in the loop region into B 2  or comprised between B 2  and B 1   c , with no relevant differences. We included in the primer set a particular loop primer presenting a 8-bases sequence region at its  5 ′ end complementary to its own sequence in  3 ′ end. 
         [0204]    Consequently, this special loop primer forms an intra-molecular hairpin structure in equilibrium with its open form at the reaction temperature (65° C.). 
         [0205]    When the mutated JAK2 sequence is present, this modified loop primer breaks its internal structure to anneal to the target, thanks to the thermodynamic equilibrium (Tm between primer and specific target=65° C.). The loop primer annealed to the specific mutated target is consequently extensible by the polymerase: the amplification can proceed. 
         [0206]    When the wt sequence is present in the sample, the same loop primer (specific for the MUT JAK2 gene) presents a Tm with aspecific target (59° C.) lower than the intra-molecular hairpin structure (65° C.). This results in auto-sequestration of the modified loop primer that prefers to fold in the hairpin structure rather than to form a duplex with aspecific target, since the intramolecular forces are higher than the intermolecular ones. To limit the competition of the loop primer previously described for the wild type sequences likely to be present in large excess in the clinical sample, we added another modified loop primer characterized by a structure similar to the one previously described, but whit a sequence complementary to the JAK2 wild type sequence (with G base at position 1489). 
         [0207]    The  3 ′ end of this “competitor” loop primer is made not extensible by a modification ( 3 ′ dideoxy). The task of this competitor is to “silence” the wt and allow the specific mutant primer to find its target. 
         [0208]    When the “competitor” recognizes the specific wild type sequence, it breaks its intramolecular structure to anneal to the WT target, thanks to a higher affinity (Tm duplex wt target-wt modified loop primer=67° C.); The loop primer annealed to the wt target is not extensible, resulting in no amplification of the wt sequences. Since the reaction is conducted at constant temperature, the wt-loop primer will remain annealed to the wt sequences preventing aspecific annealing of the MUT loop primer. 
         [0209]    Differently, the “competitor” presents a Tm with its aspecific (mutant) target (62° C.) lower than the intra-molecular hairpin structure that it forms with itself (65° C.). This results in auto-sequestration of the modified loop primer that prefers to fold in the hairpin structure rather than to form a duplex with the aspecific target, since the intramolecular forces are higher than the intermolecular ones. 
         [0210]    To follow the reaction on a real-time instrument, we labeled the  5 ′ end of the mutant modified loop primer with a FAM dye. To avoid the binding of the fluorophore to the guanine base present at the  5 ′ end of the modified loop primer, which has a quenching effect, we added a Thymine base to the extremity of the probe. The modified-labeled primer, when present in solution, emits a fluorescent signal if excited by an appropriate-wavelength light. When the LAMP reaction starts and proceeds, the fluorescent self-annealed loop primer is incorporated in the amplification products, being consequently annealed to a complementary nucleotide sequence, containing several Guanine residues. The Guanine bases can absorb the wavelength emitted by the fluorophore, causing a fluorescent signal quenching visible in real time. The LAMP reaction can be consequently monitored throughout the analysis of the decreasing of fluorescence signal due to the “quenching effect” determined by LAMP product generation. 
       REFERENCES 
       [0211]    1. Levine, R. L. et al. Activating mutation in the tyrosine kinase JAK2 in polycythemia vera, essential thrombocythemia, and myeloid metaplasia with myelofibrosis.  Cancer Cell  7,387-397 (2005). 
         [0212]    2. James, C. et al. A unique clonal JAK2 mutation leading to constitutive signalling causes polycythaemia vera.  Nature  434,1144-1148 (2005). 
         [0213]    3. Baxter, E. J. et al. Acquired mutation of the tyrosine kinase JAK2 in human myeloproliferative disorders.  Lancet  365,1054-1061 (2005). 
         [0214]    4. Kralovics, R. et al. A gain of function mutation of JAK2 in myeloproliferative disorders. N. Engl. J. Med. 352,1779-1790 (2005). 
         [0215]    5. Nelson M E, Steensma D P: JAK2 V617F in myeloid disorders: what do we know now, and where are we headed? Leuk Lymphoma 2006, 47:177-194 
         [0216]    6. James C, Ugo V, Le Couedic J-P, Staerk J, Delhommeau F, Lacout C, Garcon L, Raslova H, Berger R, Bennaceur-Griscelli A, Villeval J L, Constantinescu S N, Casadevall N, Vainchenker W: A unique clonal JAK2 mutation leading to constitutive signalling causes polycythaemia vera. Nature 2005, 434:1144-1148 
         [0217]    7. De Keersmaecker K, Cools J: Chronic myeloproliferative disorders: a tyrosine kinase tale. Leukemia 2005, 20:200-205 
         [0218]    8. Kaushansky K: On the molecular origins of the chronic myeloproliferative disorders: it all makes sense. Blood 2005, 105:4187-4190 
         [0219]    9. Baxter E J, Scott L M, Campbell P J, East C, Fourouclas N, Swanton S, Vassiliou G S, Bench A J, Boyd E M, Curtin N, Scott M A, Erber W N, Green A R: Acquired mutation of the tyrosine kinase JAK2 in human myeloproliferative disorders. The Lancet 2005, 365:1054-1061 
         [0220]    10. Smith T A, Whelan J, Parry P J: Detection of single-base mutations in a mixed population of cells: a comparison of SSCP and direct sequencing. Genet Anal Tech Appl 1992,9:143-145 
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         [0222]    12. Newton C R, Graham A, Heptinstall L E, Powell S J, Summers C, Kalsheker N, Smith J C, Markham A F: Analysis of any point mutation in DNA: the amplification refractory mutation system (ARMS). Nucleic Acids Res 1989, 17:2503-2516 
         [0223]    13. Jones A V, Kreil S, Zoi K, Waghorn K, Curtis C, Zhang L, Score J, Seear R, Chase A J, Grand F H, White H, Zoi C, Loukopoulos D, Terpos E, Vervessou EC, Schultheis B, Emig M, Ernst T, Lengfelder E, Hehlmann R, Hochhaus A, Oscier D, Silver R T, Reiter A, Cross N C: Widespread occurrence of the JAK2 V617F mutation in chronic myeloproliferative disorders. Blood 2005, 106:2162-2168 
         [0224]    14. James C, Delhommeau F, Marzac C, Teyssandier I, Couedic JP, Giraudier S, Roy L, Saulnier P, Lacroix L, Maury S, Tulliez M, Vainchenker W, Ugo V, Casadevall N: Detection of JAK2 V617F as a first intention diagnostic test for erythrocytosis. Leukemia 2006, 20:350-353 
         [0225]    15. Baxter E J, Scott L M, Campbell P J, East C, Fourouclas N, Swanton S, Vassiliou G S, Bench A J, Boyd E M, Curtin N, Scott M A, Erber W N, Green AR: Acquired mutation of the tyrosine kinase JAK2 in human myeloproliferative disorders. The Lancet 2005, 365:1054-1061 
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