WO 2018/213641 Al 22 November 2018 (22.11.2018) W !P O PCT
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(12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization I International Bureau (10) International Publication Number (43) International Publication Date WO 2018/213641 Al 22 November 2018 (22.11.2018) W !P O PCT (51) International Patent Classification: TR), OAPI (BF, BJ, CF, CG, CI, CM, GA, GN, GQ, GW, C12Q 1/68 (2018.01) G01N 33/531 (2006.01) KM, ML, MR, NE, SN, TD, TG). G I 24/08 (2006.01) Published: (21) International Application Number: — with international search report (Art. 21(3)) PCT/US20 18/033278 — before the expiration of the time limit for amending the (22) International Filing Date: claims and to be republished in the event of receipt of 17 May 2018 (17.05.2018) amendments (Rule 48.2(h)) — with sequence listing part of description (Rule 5.2(a)) (25) Filing Language: English (26) Publication Language: English (30) Priority Data: 62/507,642 17 May 2017 (17.05.2017) US (71) Applicant: T2 BIOSYSTEMS, INC. [US/US]; 101 Hartwell Avenue, Lexington, MA 02421 (US). (72) Inventors: MANNING, Brendan, John; 25 Adams Street, Arlington, MA 02474 (US). SNYDER, Jessica, Lee; 46 Thorndike Street, Arlington, MA 02474 (US). CHANG, Benjamin, Nguyen; 1Porter Cirlce, Cambridge, MA 02 140 (US). HIGA, Trissha, Ritsue; 365 Faneuil Street, Apt 5, Brighton, MA (US). SHIVERS, Robert, Patrick; 232 Common Street, Watertown, MA 02472 (US). WONG, Yin Shan, Cathy; 30 Burso Avenue, Maiden, MA 02148 (US). LOWERY, Thomas, Jay; 123 Winter Street, Belmont, MA 02478 (US). VED, Urvi; 325 Speen Street, Apartment 8 11, Natick, MA 01760 (US). GAMERO, Daniel; 101 Hartwell Avenue, Lexington, MA 02421 (US). (74) Agent: ELBING, Karen, L.; Clark & Elbing LLP, 101 Federal Street, 15th Floor, Boston, MA 021 10 (US). (81) Designated States (unless otherwise indicated, for every kind of national protection available): AE, AG, AL, AM, AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DJ, DK, DM, DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, HN, HR, HU, ID, IL, IN, IR, IS, JO, JP, KE, KG, KH, KN, KP, KR, KW, KZ, LA, LC, LK, LR, LS, LU, LY, MA, MD, ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, OM, PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, SC, SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, ZW. (84) Designated States (unless otherwise indicated, for every kind of regional protection available): ARIPO (BW, GH, GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, ST, SZ, TZ, UG, ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, RU, TJ, TM), European (AL, AT, BE, BG, CH, CY, CZ, DE, DK, EE, ES, FI, FR, GB, GR, HR, HU, IE, IS, IT, LT, LU, LV, MC, MK, MT, NL, NO, PL, PT, RO, RS, SE, SI, SK, SM, (54) Title: NMR METHODS AND SYSTEMS FOR THE RAPID DETECTION OF CANDIDA SPECIES (57) Abstract: The invention features methods, systems, and panels for rapid detection of Candida species (e.g., Candida auris, Candida lusitaniae, Candida haemulonii, Candida duobushaemulonii, and Candida pseudohaemulonii) in biological samples (e.g., whole blood) and environmental samples (e.g., environmental swabs, e.g., surface swabs), and for diagnosis and monitoring of diseases, including Candidiasis and sepsis. NMR METHODS AND SYSTEMS FOR THE RAPID DETECTION OF CANDIDA SPECIES SEQUENCE LISTING The instant application contains a Sequence Listing which has been submitted electronically in ASCII format and is hereby incorporated by reference in its entirety. Said ASCII copy, created on May 17 , 201 8 , is named 5071 3-1 18W02_Sequence_Listing_5. 17.1 8_ST25 and is 12,346 bytes in size. FIELD OF THE INVENTION The invention features methods, panels, and systems for detecting Candida auris and other Candida species and for diagnosing and treating diseases. BACKGROUND OF THE INVENTION Candida auris is now recognized worldwide as a virulent pathogen that is difficult to manage, resulting in high mortality rates. The majority of Candida auris isolates have exhibited resistance to one or more antifungal agents. Nosocomial infections caused by Candida auris are growing due to the increasing rate of colonization and environmental causes. The diagnostic tests available for the identification of Candida auris are limited to date. Additionally, microbiological cultures and subsequent identification of Candida species typically require 2-5 days, and have a sensitivity of approximately 50%. Accurate diagnosis of a Candida auris infection is also hampered by misidentification of C. auris as other species, commonly Candida haemulonii and Saccharomyces cerevisiae. Thus, there remains a need for rapid and sensitive methods, preferably requiring minimal or no sample preparation , for detecting the presence of Candida auris and other Candida species analytes for diagnosis and monitoring of diseases, including Candidiasis, Candidemia, and sepsis. SUMMARY OF THE INVENTION The invention features methods, panels, and systems for detecting Candida auris and other Candida species (e.g. , Candida lusitaniae, Candida haemulonii, Candida duobushaemulonii, and Candida pseudohaemulonii), and diagnosing and treating diseases, including Candidiasis, Candidemia, and sepsis. In a first aspect, the invention features a method for detecting the presence of a Candida species in a biological or environmental sample, wherein the Candida species is Candida auris, the method including : (a) providing a biological or environmental sample; (b) amplifying a Candida species target nucleic acid in the biological or environmental sample; and (c) detecting the amplified nucleic acid to determine whether Candida auris is present in the biological or environmental sample, wherein (i) the presence of Candida auris in the biological or environmental sample is determined within about 5 hours (e.g., about 1, 2 , 3 , 4 , or 5 hours) from obtaining the sample or less; (ii) the presence of Candida auris is determined directly from the biological or environmental sample without a prior culturing step; and/or (iii) the Candida auris is present in the biological or environmental sample at a concentration of about 10 cells/mL of biological or environmental sample or less (e.g., about 1, 2 , 3 , 4 , 5 , 6 , 7 , 9 , or 10 cells/mL). In some embodiments, step (c) further includes detecting the amplified nucleic acid to determine whether Candida lusitaniae is present. In some embodiments, step (c) further includes detecting the amplified nucleic acid to determine whether Candida haemulonii is present. In some embodiments, step (c) further includes detecting the amplified nucleic acid to determine whether Candida duobushaemulonii is present. In some embodiments, step (c) further includes detecting the amplified nucleic acid to determine whether Candida pseudohaemulonii is present. In some embodiments, the method detects a concentration of Candida auris of 10 cells/mL of biological or environmental sample or less (e.g. , about 1, 2 , 3 , 4 , 5 , 6 , 7 , 9 , or 10 cells/mL). In some embodiments, step (a) further includes lysing Candida cells present in the biological or environmental sample. In some embodiments, the amplified Candida species target nucleic acid is detected by sequencing (e.g. , Sanger sequencing or high-throughput sequencing (e.g. , ILLUMINA® sequencing), optical, fluorescent, mass, density, magnetic, chromatographic, and/or electrochemical measurement. In some embodiments, the amplified Candida species target nucleic acid is detected by measuring the T 2 relaxation response of the biological or environmental sample or a portion thereof following contacting the biological or environmental sample or the portion thereof with magnetic particles, wherein the magnetic particles have binding moieties on their surfaces, the binding moieties operative to alter the specific aggregation of the magnetic particles in the presence of the amplified Candida species target nucleic acid. In another aspect, the invention features a method for detecting the presence of a Candida species in a biological or environmental sample, wherein the Candida species is Candida lusitaniae, the method including : (a) providing a biological or environmental sample; (b) amplifying a Candida species target nucleic acid in the biological or environmental sample; and (c) detecting the amplified nucleic acid to determine whether Candida lusitaniae is present in the biological or environmental sample, wherein (i) the presence of Candida lusitaniae in the biological or environmental sample is determined within about 5 hours from obtaining the sample or less (e.g., about 1, 2 , 3 , 4 , or 5 hours) ; (ii) the presence of Candida lusitaniae is determined directly from the biological or environmental sample without a prior culturing step; and/or (iii) the Candida lusitaniae is present in the biological or environmental sample at a concentration of about 10 cells/mL of biological or environmental sample or less (e.g., about 1, 2 , 3 , 4 , 5 , 6 , 7 , 9 , or 10 cells/mL). In some embodiments, step (c) further includes detecting the amplified nucleic acid to determine whether Candida auris is present. In some embodiments, step (c) further includes detecting the amplified nucleic acid to determine whether Candida haemulonii is present. In some embodiments, step (c) further includes detecting the amplified nucleic acid to determine whether Candida duobushaemulonii is present. In some embodiments, step (c) further includes detecting the amplified nucleic acid to determine whether Candida pseudohaemulonii is present. In some embodiments, the method detects a concentration of Candida lusitaniae of 10 cells/mL of biological or environmental sample or less (e.g., about 1, 2 , 3 , 4 , 5 , 6 , 7 , 9 , or 10 cells/mL). In some embodiments, step (a) further includes lysing Candida cells present in the biological or environmental sample. In some embodiments, the amplified Candida species target nucleic acid is detected by sequencing (e.g. , Sanger sequencing or high-throughput sequencing (e.g., ILLUMINA® sequencing), optical, fluorescent, mass, density, magnetic, chromatographic, and/or electrochemical measurement.