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      Long-read genome sequencing and variant reanalysis increase diagnostic yield in neurodevelopmental disorders

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          Abstract

          Variant detection from long-read genome sequencing (lrGS) has proven to be considerably more accurate and comprehensive than variant detection from short-read genome sequencing (srGS). However, the rate at which lrGS can increase molecular diagnostic yield for rare disease is not yet precisely characterized. We performed lrGS using Pacific Biosciences “HiFi” technology on 96 short-read-negative probands with rare disease that were suspected to be genetic. We generated hg38-aligned variants and de novo phased genome assemblies, and subsequently annotated, filtered, and curated variants using clinical standards. New disease-relevant or potentially relevant genetic findings were identified in 16/96 (16.7%) probands, eight of which (8/96, 8.33%) harbored pathogenic or likely pathogenic variants. Newly identified variants were visible in both srGS and lrGS in nine probands (~9.4%) and resulted from changes to interpretation mostly from recent gene-disease association discoveries. Seven cases included variants that were only interpretable in lrGS, including copy-number variants, an inversion, a mobile element insertion, two low-complexity repeat expansions, and a 1 bp deletion. While evidence for each of these variants is, in retrospect, visible in srGS, they were either: not called within srGS data, were represented by calls with incorrect sizes or structures, or failed quality-control and filtration. Thus, while reanalysis of older data clearly increases diagnostic yield, we find that lrGS allows for substantial additional yield (7/96, 7.3%) beyond srGS. We anticipate that as lrGS analysis improves, and as lrGS datasets grow allowing for better variant frequency annotation, the additional lrGS-only rare disease yield will grow over time.

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          Most cited references58

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          Standards and Guidelines for the Interpretation of Sequence Variants: A Joint Consensus Recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology

          The American College of Medical Genetics and Genomics (ACMG) previously developed guidance for the interpretation of sequence variants. 1 In the past decade, sequencing technology has evolved rapidly with the advent of high-throughput next generation sequencing. By adopting and leveraging next generation sequencing, clinical laboratories are now performing an ever increasing catalogue of genetic testing spanning genotyping, single genes, gene panels, exomes, genomes, transcriptomes and epigenetic assays for genetic disorders. By virtue of increased complexity, this paradigm shift in genetic testing has been accompanied by new challenges in sequence interpretation. In this context, the ACMG convened a workgroup in 2013 comprised of representatives from the ACMG, the Association for Molecular Pathology (AMP) and the College of American Pathologists (CAP) to revisit and revise the standards and guidelines for the interpretation of sequence variants. The group consisted of clinical laboratory directors and clinicians. This report represents expert opinion of the workgroup with input from ACMG, AMP and CAP stakeholders. These recommendations primarily apply to the breadth of genetic tests used in clinical laboratories including genotyping, single genes, panels, exomes and genomes. This report recommends the use of specific standard terminology: ‘pathogenic’, ‘likely pathogenic’, ‘uncertain significance’, ‘likely benign’, and ‘benign’ to describe variants identified in Mendelian disorders. Moreover, this recommendation describes a process for classification of variants into these five categories based on criteria using typical types of variant evidence (e.g. population data, computational data, functional data, segregation data, etc.). Because of the increased complexity of analysis and interpretation of clinical genetic testing described in this report, the ACMG strongly recommends that clinical molecular genetic testing should be performed in a CLIA-approved laboratory with results interpreted by a board-certified clinical molecular geneticist or molecular genetic pathologist or equivalent.
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            Minimap2: pairwise alignment for nucleotide sequences

            Heng Li (2018)
            Recent advances in sequencing technologies promise ultra-long reads of ∼100 kb in average, full-length mRNA or cDNA reads in high throughput and genomic contigs over 100 Mb in length. Existing alignment programs are unable or inefficient to process such data at scale, which presses for the development of new alignment algorithms.
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              Integrative Genomics Viewer

              To the Editor Rapid improvements in sequencing and array-based platforms are resulting in a flood of diverse genome-wide data, including data from exome and whole genome sequencing, epigenetic surveys, expression profiling of coding and non-coding RNAs, SNP and copy number profiling, and functional assays. Analysis of these large, diverse datasets holds the promise of a more comprehensive understanding of the genome and its relation to human disease. Experienced and knowledgeable human review is an essential component of this process, complementing computational approaches. This calls for efficient and intuitive visualization tools able to scale to very large datasets and to flexibly integrate multiple data types, including clinical data. However, the sheer volume and scope of data poses a significant challenge to the development of such tools. To address this challenge we developed the Integrative Genomics Viewer (IGV), a lightweight visualization tool that enables intuitive real-time exploration of diverse, large-scale genomic datasets on standard desktop computers. It supports flexible integration of a wide range of genomic data types including aligned sequence reads, mutations, copy number, RNAi screens, gene expression, methylation, and genomic annotations (Figure S1). The IGV makes use of efficient, multi-resolution file formats to enable real-time exploration of arbitrarily large datasets over all resolution scales, while consuming minimal resources on the client computer (see Supplementary Text). Navigation through a dataset is similar to Google Maps, allowing the user to zoom and pan seamlessly across the genome at any level of detail from whole-genome to base pair (Figure S2). Datasets can be loaded from local or remote sources, including cloud-based resources, enabling investigators to view their own genomic datasets alongside publicly available data from, for example, The Cancer Genome Atlas (TCGA) 1 , 1000 Genomes (www.1000genomes.org/), and ENCODE 2 (www.genome.gov/10005107) projects. In addition, IGV allows collaborators to load and share data locally or remotely over the Web. IGV supports concurrent visualization of diverse data types across hundreds, and up to thousands of samples, and correlation of these integrated datasets with clinical and phenotypic variables. A researcher can define arbitrary sample annotations and associate them with data tracks using a simple tab-delimited file format (see Supplementary Text). These might include, for example, sample identifier (used to link different types of data for the same patient or tissue sample), phenotype, outcome, cluster membership, or any other clinical or experimental label. Annotations are displayed as a heatmap but more importantly are used for grouping, sorting, filtering, and overlaying diverse data types to yield a comprehensive picture of the integrated dataset. This is illustrated in Figure 1, a view of copy number, expression, mutation, and clinical data from 202 glioblastoma samples from the TCGA project in a 3 kb region around the EGFR locus 1, 3 . The investigator first grouped samples by tumor subtype, then by data type (copy number and expression), and finally sorted them by median copy number over the EGFR locus. A shared sample identifier links the copy number and expression tracks, maintaining their relative sort order within the subtypes. Mutation data is overlaid on corresponding copy number and expression tracks, based on shared participant identifier annotations. Several trends in the data stand out, such as a strong correlation between copy number and expression and an overrepresentation of EGFR amplified samples in the Classical subtype. IGV’s scalable architecture makes it well suited for genome-wide exploration of next-generation sequencing (NGS) datasets, including both basic aligned read data as well as derived results, such as read coverage. NGS datasets can approach terabytes in size, so careful management of data is necessary to conserve compute resources and to prevent information overload. IGV varies the displayed level of detail according to resolution scale. At very wide views, such as the whole genome, IGV represents NGS data by a simple coverage plot. Coverage data is often useful for assessing overall quality and diagnosing technical issues in sequencing runs (Figure S3), as well as analysis of ChIP-Seq 4 and RNA-Seq 5 experiments (Figures S4 and S5). As the user zooms below the ~50 kb range, individual aligned reads become visible (Figure 2) and putative SNPs are highlighted as allele counts in the coverage plot. Alignment details for each read are available in popup windows (Figures S6 and S7). Zooming further, individual base mismatches become visible, highlighted by color and intensity according to base call and quality. At this level, the investigator may sort reads by base, quality, strand, sample and other attributes to assess the evidence of a variant. This type of visual inspection can be an efficient and powerful tool for variant call validation, eliminating many false positives and aiding in confirmation of true findings (Figures S6 and S7). Many sequencing protocols produce reads from both ends (“paired ends”) of genomic fragments of known size distribution. IGV uses this information to color-code paired ends if their insert sizes are larger than expected, fall on different chromosomes, or have unexpected pair orientations. Such pairs, when consistent across multiple reads, can be indicative of a genomic rearrangement. When coloring aberrant paired ends, each chromosome is assigned a unique color, so that intra- (same color) and inter- (different color) chromosomal events are readily distinguished (Figures 2 and S8). We note that misalignments, particularly in repeat regions, can also yield unexpected insert sizes, and can be diagnosed with the IGV (Figure S9). There are a number of stand-alone, desktop genome browsers available today 6 including Artemis 7 , EagleView 8 , MapView 9 , Tablet 10 , Savant 11 , Apollo 12 , and the Integrated Genome Browser 13 . Many of them have features that overlap with IGV, particularly for NGS sequence alignment and genome annotation viewing. The Integrated Genome Browser also supports viewing array-based data. See Supplementary Table 1 and Supplementary Text for more detail. IGV focuses on the emerging integrative nature of genomic studies, placing equal emphasis on array-based platforms, such as expression and copy-number arrays, next-generation sequencing, as well as clinical and other sample metadata. Indeed, an important and unique feature of IGV is the ability to view all these different data types together and to use the sample metadata to dynamically group, sort, and filter datasets (Figure 1 above). Another important characteristic of IGV is fast data loading and real-time pan and zoom – at all scales of genome resolution and all dataset sizes, including datasets comprising hundreds of samples. Finally, we have placed great emphasis on the ease of installation and use of IGV, with the goal of making both the viewing and sharing of their data accessible to non-informatics end users. IGV is open source software and freely available at http://www.broadinstitute.org/igv/, including full documentation on use of the software. Supplementary Material 1
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                Author and article information

                Journal
                medRxiv
                MEDRXIV
                medRxiv
                Cold Spring Harbor Laboratory
                26 March 2024
                : 2024.03.22.24304633
                Affiliations
                [1 ]HudsonAlpha Institute for Biotechnology, Huntsville, AL, 35806, USA
                [2 ]Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, 35924, USA
                [3 ]Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, 35924, USA
                [4 ]Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, 35924, USA
                Author notes
                [* ] shiatt@ 123456hudsonalpha.org , gcooper@ 123456hudsonalpha.org , 601 Genome Way, Huntsville, AL, 35806, USA
                Article
                10.1101/2024.03.22.24304633
                10996728
                38585854
                d4ca435a-699d-45e5-a73d-61a0bdbc2210

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which allows reusers to copy and distribute the material in any medium or format in unadapted form only, for noncommercial purposes only, and only so long as attribution is given to the creator.

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                lrs special issue,long read sequencing,clinical sequencing,neurodevelopmental disorder,structural variation,repeat expansion

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