OCP ligation/ERCA can be used to directly probe genomic DNA for SNPs or mutations, and the entire process can be performed in a single tube. The ERCA amplification reaction is rapid, generating signal in as little as 10 minutes, and is incubated at a single temperature. These characteristics make OCP ligation/ERCA easily adaptable to high throughput automated genotyping platforms. Accurate genotyping was obtained in screens designed to detect four clinically relevant mutations, Factor V Leiden, Factor II prothrombin, Hemochromatosis C282Y and Hemochromatosis H63D.
Several improvements to the ligation/ERCA method  have increased accuracy to levels acceptable for diagnostic applications and reduced reaction time. Other reports using ERCA based genotyping require PCR amplification of the locus of interest prior to genotyping [3, 16], which is prohibitively expensive, time consuming, and more difficult to automate. We have designed ERCA primers that are optimized for minimal misamplification and artifact formation. With any exponential signal amplification method, nonspecific amplification due to exponential artifacts presents a potential problem. In ERCA as in PCR, amplification of primer-primer artifacts can mimic specific signal if primers are not selected carefully. To avoid this problem, commercially available primer design software was used to design P1 and P2 primers that are optimal for amplification. This step does not necessarily have to be repeated for each target, however, which is an advantage over PCR based methodologies. The primary amplification primer sequences are present in the OCP backbone, not in the portion of the OCP that anneals to target, allowing optimized P1 and P2 pairs, to be used for many different targets. In principle, a small collection of optimized P1/P2 pairs should contain primers that can be used for any given target.
The Q-PNA detection system  was used as a fluorescent reporter during ERCA. During ERCA, Q-PNA is rapidly displaced from the ERCA product and is physically separated from the fluor in a bimolecular reaction, resulting in detectable signal in as little as 10 minutes. By comparison, Amplifluors typically required 60–120 minutes to generate signal. The substantial difference in time to generate signal may be due to the nature of Amplifluor design. In an Ampliflour, complementary DNA sequences, fluorescent reporter, and quencher are all covalently linked on the same DNA strand. The comparative stability of the unimolecular Amplifluor hairpin is likely to hinder displacement synthesis when compared to the bimolecular Q-PNA system. In addition, the high local concentration of fluor and quencher may serve to supress signal from the Amplifluor. The Q-PNA based reporter system consistently produces signal far more rapidly than the Amplifluor based system, allowing time to result of less than an hour for the entire assay.
Secondary allele specific, nonfluorescent, primers can also be used to increase the speed and specifiCity of ERCA. These primers significantly advanced the rate of ERCA amplification, cutting the reaction time in half for the Factor V Leiden probe set (data not shown), resulting in a 20-minute assay. Although maximum fluorescent signal decreased slightly as each additional nonfluorescent primer was added, the addition of one or two more primers to the reaction did not adversely influence signal strength to the extent that genotyping was compromised.
Each of the four assays developed for this report contained two probes, one for each allele. Using both probes in a single reaction has been demonstrated to reduce the levels of nonspecific amplification due to primer dimers and misamplification of unligated probe . At least one of the probes will always be amplified, suppressing low levels of nonspecific signal.
The introduction of a hairpin into the design of the open circle probes, similar to approaches taken in molecular beacon design , provides a means to regulate the degree of ligation discrimination. A 3' and/or 5' stem-loop structure may be designed to increase specific binding to difficult sequences. The ratio of the hairpin stability to target annealing stability directly affects the overall target annealing specifiCity. By modulating the stability of the hairpin any OCP can be fine tuned for ligation specifiCity.
The OCP 3' hairpin also decreases the level of nonspecific DNA synthesis caused by misamplification of OCP sequences. Analysis of misamplified products has shown that OCP sequences are usually found in the misamplified DNA products. This means that uncircularized OCP is able to provide a template for primer-based misamplification. Removing the unligated OCP helps to reduce background amplification , but digestion of the unused OCP or purification of the ligated circles introduces time consuming and expensive steps. Designing a 3' hairpin into the OCP creates a self-priming sequence in unligated OCP. During ERCA, the polymerase will extend unligated OCP starting at the 3' end in a suicide pathway that renders the OCP double stranded and inert. This approach eliminates nonspecific amplification and improves genotyping accuracy without the introduction of separate isolation or purification steps. As demonstrated above, removal of the hairpin sequence either by deletion or point mutation of the base paired region resulted in greatly decreased genotyping accuracy for both Factor V Leiden and Hemochromatosis H63D genotyping assays.
Additional methods to improve ERCA specifiCity were integrated into the genotyping protocol. Careful design allowed the same P2 sequence to be used in the ERCA reaction for both alleles. For each set of OCPs, the P2 sequence was generic. The generic P2 was not part of the target specific portion of the probe, which allowed it to be used in both the normal and mutant OCP. Because both probes in each assay contained the same P2, the reaction kinetics could be more easily balanced, promoting uniform amplification for both alleles. Uniform amplification is especially important when the genotype is heterozygous so that both alleles are accurately represented.
Genotyping accuracy depends on using sufficient quantities of genomic DNA target. As expected, OCP ligation/ERCA results were influenced by the amount of genomic DNA used in the assay. Typically, genotyping was possible with as little as 50 ng target DNA. However, specific signal strength increased with more DNA target, up to 1000 ng, after which no further benefit was seen (data not shown). WGA DNA can be produced in milligram quantities from nanograms  of original sample allowing use of high DNA concentration for optimal signal. As a result, 1000 ng WGA DNA was used to obtain optimal genotyping reaction conditions. The results obtained for the WGA DNA agreed in every instance with the known genotypes determined by RFLP. WGA product should also be compatible with other genotyping assays where better results can be obtained using more target DNA.
Many aspects of probe design are open to manipulation, and in practice probes can be successfully designed for most target sequences of interest. Pickering et al. demonstrated a 95% success rate in designing OCPs for 99 different targets on the first attempt . Probes can be designed against either strand of genomic DNA, and the backbone portion can also be varied. Optimization of Tm parameters, and sequence allows rapid design of OCPs with a high degree of success.
The degree to which a genotyping assay needs to be optimized depends in part on the purpose of the assay. A genotyping system intended for diagnostic purposes needs to meet the highest standards of accuracy, robustness, and throughput, as compared to a system that is intended solely for research purposes. In recognition of the expectation that 100% accuracy is a requirement, even under suboptimal conditions, the assays developed for the targets in this report have undergone extensive optimization to maximize accuracy even under less than optimal conditions. As a result, the concentrations of primers, probes and polymerase vary between assays. After determining the best conditions for each individual genotyping assay, the expectation is that these conditions would be the best possible for genotyping large numbers of samples with high accuracy. The critical nature of the information derived from the output of the assay justifies the extra optimization effort. To minimize the potential for error, the accuracy for a single assay was compared to the accuray for the same assay performed in triplicate. Depending on the assay requirements, the level of accuracy can be selected by increasing or decreasing the number of repeats. The demonstration that high levels of input genomic DNA improve robustness of genotyping results is paralleled by PCR results. WGA can be used to generate sufficient DNA for genotyping using large quantities of template. The cost of performing WGA is offset by the fact that sample prep is unnecessary; WGA product can be performed directly on crude blood sample and yields enough DNA for dozens or hundreds of genotyping reactions. Under different circumstances, it may be necessary to rapidly generate assays for a large number of SNPs. For this, the emphasis could be placed on optimization of assay design. Amounts of input DNA, primers and polymerase could be standardized, rapidly yielding accurate genotyping assays but without the highest accuracy under suboptimal conditions. The process of OCP ligation followed by ERCA has been designed such that genomic DNA can be genotyped directly in less than an hour. Hundreds of individual samples were genotyped with over 99% accuracy. Accurate genotyping was demonstrated for both genomic DNA and whole genome amplified DNA. Isothermal exponential amplification produces a fluorescent signal from ligated OCP using nanomolar amounts of probe. Because OCP ligation/ ERCA does not rely on thermal cycling for amplification, amplification kinetics are not limited by cycling rate. The exponential nature of the reaction produces millions of fold amplification in as little as 20 minutes. Output can be read on a fluorescent plate reader, real time PCR instrument, fluorescent imager, or other device equipped with the ability to measure fluorescent signals. OCP ligation/ ERCA probes can be multiplexed. OCP ligation and ERCA reactions for each SNP target are performed in a single tube, and are easily scalable from 96 to 384 well formats, making OCP ligation/ ERCA ideal for high throughput screening.