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Isothermal amplification is a molecular biology technique that is used for the amplification of DNA or RNA at a constant temperature, eliminating the need for the thermal cycling equipment utilized in traditional PCR (polymerase chain reaction). This method has garnered significant attention and is becoming increasingly important in fields such as infectious disease diagnostics, genomic research, environmental monitoring, and food safety due to its speed, simplicity, and robustness [1].


Mechanism of isothermal amplification

Instead of melting DNA strands apart at high temperatures, isothermal amplification takes advantage of DNA polymerases with high strand displacement activity, like Bst or phi29 DNA polymerases. Essentially, such enzymes can push their way in and directly unzip the DNA as they synthesize complementary strands. These polymerases can amplify a target in less than an hour, and in some cases in as little time as 10 minutes. Isothermal amplification systems can use sequence-specific primers to detect target genes, or random primers for whole genome amplification.

Table 1. List of the various isothermal amplification methods.

NASBANucleic acid sequence-based amplification (NASBA) is a method used to amplify RNA.
LAMPLoop-mediated isothermal amplification (LAMP) is a single tube technique for the amplification of DNA. It uses 4-6 primers, which form loop structures to facilitate subsequent rounds of amplification.
HDAHelicase-dependent amplification (HDA) uses the double-stranded DNA unwinding activity of a helicase to separate strands for in vitro DNA amplification at constant temperature.
RCARolling circle amplification (RCA) starts from a circular DNA template and a short DNA or RNA primer to form a long single stranded molecule.
MDAMultiple displacement amplification (MDA) is a technique that initiates when multiple random primers anneal to the DNA template and the polymerase amplifies DNA at constant temperature.
WGAWhen MDA is used to amplify DNA from a whole genome of a cell it is called whole genome amplification (WGA). (Other methods of WGA include MALBAC, LIANTI, DOP-PCR.)
RPARecombinase polymerase amplification (RPA) is a low temperature DNA and RNA amplification technique.


Commonly used isothermal amplification methods

The widely used isothermal techniques are LAMP, MDA, and RCA.

LAMP

LAMP is a fast and simple DNA amplification method under isothermal conditions that utilizes a DNA polymerase with strong strand displacement activity. One of the most popular modifications of LAMP is RT-LAMP which incorporates reverse transcriptase to create a cDNA template from RNA. LAMP is especially useful in field settings for rapidly diagnosing plant pathogens or infectious disease agents like malaria, Zika, or tuberculosis.

MDA-WGA and RCA

MDA-WGA and RCA are the most efficient techniques to increase the amount of DNA from limited sample input [2]. MDA is an isothermal amplification technique which starts by binding random primers to multiple sites of denatured DNA. The polymerase amplification involves strand displacement. Therefore, additional priming events occur on each displaced strand, yielding a branched DNA product. WGA focuses on amplifying the entire genome for situations with limited DNA. This is particularly useful in genetic disease research, where many repetitions are required. DNA amplified by MDA-WGA can be used in downstream applications such as next-generation sequencing, Sanger sequencing, genotyping with microarrays, and single nucleotide polymorphism (SNP) genotyping [3].

RCA is an isothermal amplification of circular DNA templates. It could be performed with random primers, resulting in a branched DNA product, or using specific primers that increase specificity and help ensure that only the intended DNA sequences are amplified. RCA products can be used in downstream applications such as NGS, Sanger sequencing, SNP detection, DNA enrichment, and as a template for cell-free protein expression [4].


Enzymes used in isothermal techniques

The enzyme often used for LAMP is Bst DNA Polymerase, an enzyme derived from the large fragment of Bacillus stearothermophilus DNA Polymerase I. Bst DNA Polymerase contains 5´→3´ DNA polymerase activity and strong strand displacement activity but lacks 5´→3´ exonuclease activity. Bst DNA Polymerase works at an optimal 65 °C temperature and can amplify target DNA in as little as 10 minutes. The enzyme is highly resistant to inhibitors in complex samples, so plant tissue, blood, urine, or saliva can be assayed with minimal processing.

Another enzyme often used for LAMP is Bsm DNA polymerase, a portion of DNA polymerase of Bacillus smithii, and an equivalent to Bst DNA polymerase Large Fragment. Bsm has strong strand displacement activity and an optimum temperature of 60 °C. Amplification is very efficient with DNA being copied a billion-fold in as little as 15 minutes. The enzyme is highly resistant to inhibitors in complex samples, so plant tissue, blood, urine, or saliva can be assayed with minimal processing.

phi29 DNA Polymerase is the main enzyme choice for MDA-WGA and RCA technologies. This enzyme is derived from Bacillus subtilis phage phi29 (Φ29) and is a highly processive polymerase featuring strong strand displacement activity. phi29 DNA Polymerase possesses a 3'→5' exonuclease (proofreading) activity but lacks 5´→3´ exonuclease activity. Because of its proofreading activity, exo-resistant random primers are recommended [5].

phi29-type polymerases can replicate DNA from minute starting amounts without dissociating from the genomic DNA template (the average product length is greater than 10 kb). This feature makes it a great candidate for single-cell whole genome amplification. The larger the amount of DNA, and therefore the copy number of the genome, the more likely a specific locus will be detected after whole genome amplification.


Key benefits of isothermal amplifications

Isothermal amplification methods offer essential alternatives to lab-based methods that depend on expensive equipment and protocols for sequential cycling to amplify a target of interest. Among some of the more common or well-studied isothermal amplification methods (Table 1), LAMP and WGA have an increasingly important role in scientific research expanding our toolbox beyond PCR-based methods in the lab to critical analytical work in the field. Table 2 summarizes the advantages of LAMP over PCR.

Differences between LAMP and PCR

Table 2. Comparison of PCR and LAMP.

PropertiesPCRLAMP
AmplificationCycles through 3 temperature steps:
  • denaturation at 95 °C,
  • primer annealing at ~60 °C,
  • polymerization at 72 °C
Works under a constant temperature usually between 60-65 °C
DenaturationHigh temperature required for separation of strands, enabling primer bindingDenaturation step is performed by strand displacing polymerase
EquipmentRequires thermocyclerDoesn’t require dedicated thermocycler; can use a simple water bath
Reaction timeAt least 90 minutes to resultsResults are typically ready in less than 30 minutes
SensitivityDetects targets starting at nanogram levelsDetects targets starting at femtogram levels
SpecificityRequires careful primer design to avoid primer dimer or non-specific amplificationTolerates (works well with) multiple primer combinations for greater specificity
DNA visualizationDNA visualization only possible after gel electrophoresisImmediate visualization of DNA by colorimetry/visual turbidity
DNA template preparationRequires purification or special handling for high sensitivity and specificityTolerates inherent impurities and inhibitors common to field samples with highest sensitivity and specificity

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