200 would be above the acceptable limit. Discussion The hyplex® TBC PCR test is a new qualitative diagnostic NAAT system for the detection of MTBC in human specimens. Compared to most of the available commercial NAAT tests, which range from

about 20 to 35 Euro (US$ 25 to 50) per test, it represents a low-cost system. Costs of the hyplex® TBC test are estimated to ten to twelve Euro per test in industrialised countries. For developing countries, where most mTOR target of the TB occurs, significantly lower prices can be considered. In contrast to real-time assays which require precision instruments as well as capacity to maintain these instruments, the hyplex® TBC test can be applied in all laboratories with standard equipment for molecular biology techniques and, therefore, SRT1720 clinical trial allows for the application also in low-budget laboratories, particularly in developing and emerging countries. However, the low costs of equipment and reagents go along with a significant increase

in the hands-on time. Whereas highly automated tests like real-time assays may generate results within less than two hours with very low hands-on time, the hyplex® TBC test requires multiple workstations for Ion Channel Ligand Library screening specimen preparation, target amplification and amplicon detection. Including column-based DNA preparation, the assay will take up to 6 hours to perform. This is comparable to other NAAT assays which are largely performed manually like, for example, the GTMD assay [16]. Similar to other NAAT assays, the hyplex® TBC test is certainly suitable for partial automatation, for example by use of full automated systems for hybridisation and ELISA reading, which can significantly decrease the hands-on time of the test. Initially, the hyplex® TBC PCR test was validated by the manufacturer using a set of 40 clinical specimens (data not shown). In order to retrieve the highest sensitivity possible, the cut-off value was set to 0.200 in the manufacturer’s instructions. This cut-off was technically controlled using DNA of different Mycobacterium and non-mycobacterial species. None of 96 different strains of different

species other than Mycobacterium was positive (instruction for use, BAG Health Care). Out of 33 Mycobacterium strains, five MTBC strains (2 × MTB, 1 × M. africanum, 1 × M. cannettii, 1 × M. bovis) Fossariinae were positive. Twenty-eight NTM strains of 25 different species were tested and three (2 × M. kansasii, 1 × M. gadium) gave ELISA signals of about OD 0.300 that were considered positive following the instructions of the manufacturer. Thus, the “”technical”" sensitivity can theoretically be assumed 100%, while the technical specificity would be only 97.6% given a cut-off value of OD 0.200. Using the same cut-off, the sensitivity in our study set would be 92%, but the specificity would be as low as 85%, meaning that every seventh positive PCR result would be a false-positive one. However, the improved sensitivity by use of cut-off value 0.