Step 1: The 5' sequences TCGTCGGCAGCGTCAGATGTGTATAAGAGACAG and GTCTCGTGGGCTCGGAGATGTGTATAAGAGACAG represent Illumina adapters associated with Nextera library preparation kits. These serve as common binding sites for PCR2 primers as well as for standard sequencing primers during Illumina sequencing (SBS).
Step 2: This implies a total primer mix concentration of 60 µM, which is in the upper range of typical PCR primer concentrations. Sometimes sensitivity can be increased by reducing primer concentrations (less primers -> less potential for off-target binding), but this was not found to be the case for the SIMPLseq assay.
Step 3: We recommend increasing template volume input when parasitemias are expected to be low. This is simply because, at low parasitemias, small aliquots (3 µl) of extracted DNA may not contain any parasites at all.
For example, let us consider a parasitemia level of ~1 p/µl in whole human blood. This likely becomes <0.2 p/µl through the course of DNA extraction. A random 4 µl extraction aliquot is expected to contain less than a single parasite on average if distribution is homogeneous; increasing the PCR1 input volume helps increase our chances of capturing at least one parasite genome.
Step 6: 29x cycles were chosen as a suitable balance between increasing PCR yield and limiting reaction artifacts. Another significant 'knob' to turn in PCR protocols is annealing temperature; at 57°C, SIMPLseq uses a relatively permissive annealing temperature and thus requires caution with >30x PCR1 cycle counts.
Steps 7-11: The ExoSap step digests/removes small fragments (predominantly <75 bp), especially primers, from PCR1 products, as visualized in the protocol. In our hands, this leads to clearer PCR2 product signal (Bioanalyzer traces). This step does not generate significant additional cost (ca. 25-50 cents per sample) but implies further plate handling (e.g., sealing/unsealing, during which contamination is always a risk) and adds another ca. 45 minutes to the protocol. The subsequent dilution step helps minimize residual components (e.g., glycerol, EDTA) but a similar PCR1 product dilution would also take place in the absence of this digestion step.
Step 14: The phosphorothioate bond within the indexing primers represents a phosphate modification that protects the 3’ end of the primer from polymerase exonuclease activity, ensuring accurate integration of index sequences during PCR2.
Step 19: Performing an additional clean-up, (i.e, using the output of 0.8x clean-up as input for another 0.8x clean-up) is more likely required when libraries include many very low (<1 p/µl) or negative samples. If you suspect this to be the case, make sure to plan out your clean-ups with respect to required input/output volumes and concentration (note that we need 2-5 nM (preferably 5 nM, see step 30) for Illumina's final 'Denature and dilute' procedure). It is not uncommon to lose >50% of the target range concentration, due to factors including incomplete initial bead binding, losses during pellet washing, excessive pellet drying, or incomplete solubilization into the elution buffer (heating helps!). Further bead cleanups may be done if primer dimers remain.
Step 28: The inclusion of additional samples (e.g., the current PhiX aliquot, libraries and PhiX from previous runs, multiple Standard 0's) is very helpful to help accurately triangulate concentration, as well as using corresponding Qubit and Bioanalyzer information. Ideally, users also keep a long-term log of quantitation results and associated sequencing performance (especially clustering density) given that one-time qPCR readings are susceptible to misinterpretation.
Steps 30-31: Please note that, because we start Illumina's 'Denature and dilute' guide with 5 nM library instead of the standard 4 nM, final output concentration becomes ca. 17.5 pM when following the guide's directions for, e.g., 14 pM.