Review of Automated DNA extraction systems for sequencing-based solutions for drug resistant tuberculosis detection

Abstract Robust clinical specimen nucleic acid extraction instrumentation and methods are critical to the performance of downstream molecular diagnostics for the diagnosis of drug resistant tuberculosis (DR TB). Currently there is a high level of interest in sequencing-based solutions for rapid and comprehensive DR TB testing from primary specimens (i.e. sputum). However, there is no standardized, nor fully automated sputum extraction system that has been widely implemented for use with MTBC containing sputum specimens. For sequencing-based technologies to be widely adopted in clinical laboratory settings in low- and middle-income countries (LMICs), automated extraction technologies will be important to enhance scalability, reliability, and to standardize performance of the downstream assays. Additionally, the ease of automatic technologies allows for faster uptake in laboratories currently without the expertise or infrastructure to perform manual extractions at the same automated throughput. This work is intended to provide an initial specification comparison of available automated DNA extraction systems that could serve as a front-end components for existing and future sequencing approaches and provide the framework for future evaluations.