Integrating CRISPR and isothermal amplification reactions in single-tubes for ultrasensitive detection of nucleic acids: the SARS-CoV-2 RNA example

Clustered regularly interspaced short palindromic repeats (CRISPR) and CRISPR-associated protein (CRISPR-Cas) systems have advanced rapidly for the detection of nucleic acids and molecular diagnoses. The sensitivity of techniques directly using CRISPR-Cas systems for target recognition and signal generation is limited by the kinetics of trans-cleavage. Thus, CRISPR-Cas systems have been coupled with isothermal amplification techniques. One strategy for integrating CRISPR-Cas and amplification reactions into a single-tube is to place reagents in separate locations within the tube, maintaining optimum conditions for each reaction. A more challenging strategy is to mix all reagents and allow nucleic acid amplification and CRISPR-based detection to proceed in a homogeneous solution. This desirable approach requires substantial understanding of the compatibility of enzymatic reactions, systematic optimization, and appropriate adjustments of the integrated reactions to ensure high sensitivity. Ultrasensitive techniques have been developed for the detection of SARS-CoV-2 in single-tubes. In this review, we highlight the principle, research needs, and challenges of ultrasensitive single-tube RNA detection using CRISPR technology. We stress the importance of understanding the kinetics of trans-cleavage activity of CRISPR-Cas systems.