Doctor of Philosophy

dissertationSuccessful molecular diagnosis using an exome sequence hinges on accurate association of damaging variants to the patient's phenotype. Unfortunately, many clinical scenarios (e.g., single affected or small nuclear families) have little power to confidently identify damaging alleles using sequence data alone. Today's diagnostic tools are simply underpowered for accurate diagnosis in these situations, limiting successful diagnoses. In response, clinical genetics relies on candidate-gene and variant lists to limit the search space. Despite their practical utility, these lists suffer from inherent and significant limitations. The impact of false negatives on diagnostic accuracy is considerable because candidate-genes and variants lists are assembled ad hoc, choosing alleles based upon expert knowledge. Alleles not in the list are not considered-ending hope for novel discoveries. Rational alternatives to ad hoc assemblages of candidate lists are thus badly needed. In response, I created Phevor, the Phenotype Driven Variant Ontological Re-ranking tool. Phevor works by combining knowledge resident in biomedical ontologies, like the human phenotype and gene ontologies, with the outputs of variant-interpretation tools such as SIFT, GERP+, Annovar and VAAST. Phevor can then accurately to prioritize candidates identified by third-party variant-interpretation tools in light of knowledge found in the ontologies, effectively bypassing the need for candidate-gene and variant lists. Phevor differs from tools such as Phenomizer and Exomiser, as it does not postulate a set of fixed associations between genes and phenotypes. Rather, Phevor dynamically integrates knowledge resident in multiple bio-ontologies into the prioritization process. This enables Phevor to improve diagnostic accuracy for established diseases and previously undescribed or atypical phenotypes. Inserting known disease-alleles into otherwise healthy exomes benchmarked Phevor. Using the phenotype of the known disease, and the variant interpretation tool VAAST (Variant Annotation, Analysis and Search Tool), Phevor can rank 100% of the known alleles in the top 10 and 80% as the top candidate. Phevor is currently part of the pipeline used to diagnose cases as part the Utah Genome Project. Successful diagnoses of several phenotypes have proven Phevor to be a reliable diagnostic tool that can improve the analysis of any disease-gene search

Using conceptual modeling to improve genome data management

[EN] With advances in genomic sequencing technology, a large amount of data is publicly available for the research community to extract meaningful and reliable associations among risk genes and the mechanisms of disease. However, this exponential growth of data is spread in over thousand heterogeneous repositories, represented in multiple formats and with different levels of quality what hinders the differentiation of clinically valid relationships from those that are less well-sustained and that could lead to wrong diagnosis. This paper presents how conceptual models can play a key role to efficiently manage genomic data. These data must be accessible, informative and reliable enough to extract valuable knowledge in the context of the identification of evidence supporting the relationship between DNA variants and disease. The approach presented in this paper provides a solution that help researchers to organize, store and process information focusing only on the data that are relevant and minimizing the impact that the information overload has in clinical and research contexts. A case-study (epilepsy) is also presented, to demonstrate its application in a real context.Spanish State Research Agency and the Generalitat Valenciana under the projects TIN2016-80811-P and PROMETEO/2018/176; ERDF.Pastor López, O.; León-Palacio, A.; Reyes Román, JF.; García-Simón, A.; Casamayor Rodenas, JC. (2020). Using conceptual modeling to improve genome data management. Briefings in Bioinformatics. 22(1):45-54. https://doi.org/10.1093/bib/bbaa100S4554221McCombie, W. R., McPherson, J. D., & Mardis, E. R. (2018). Next-Generation Sequencing Technologies. Cold Spring Harbor Perspectives in Medicine, 9(11), a036798. doi:10.1101/cshperspect.a036798Condit, C. M., Achter, P. J., Lauer, I., & Sefcovic, E. (2001). 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A., Botstein, D., Butler, H., Cherry, J. M., … Sherlock, G. (2000). Gene Ontology: tool for the unification of biology. Nature Genetics, 25(1), 25-29. doi:10.1038/75556Eilbeck, K., Lewis, S. E., Mungall, C. J., Yandell, M., Stein, L., Durbin, R., & Ashburner, M. (2005). Genome Biology, 6(5), R44. doi:10.1186/gb-2005-6-5-r44Vihinen, M. (2013). Variation Ontology for annotation of variation effects and mechanisms. Genome Research, 24(2), 356-364. doi:10.1101/gr.157495.113Köhler, S., Carmody, L., Vasilevsky, N., Jacobsen, J. O. B., Danis, D., Gourdine, J.-P., … McMurry, J. A. (2018). Expansion of the Human Phenotype Ontology (HPO) knowledge base and resources. Nucleic Acids Research, 47(D1), D1018-D1027. doi:10.1093/nar/gky1105Proceedings of the Eleventh International Conference on Data Engineering. (1995). Proceedings of the Eleventh International Conference on Data Engineering. doi:10.1109/icde.1995.380416Okayama, T., Tamura, T., Gojobori, T., Tateno, Y., Ikeo, K., Miyazaki, S., … Sugawara, H. (1998). Formal design and implementation of an improved DDBJ DNA database with a new schema and object-oriented library. Bioinformatics, 14(6), 472-478. doi:10.1093/bioinformatics/14.6.472Medigue, C., Rechenmann, F., Danchin, A., & Viari, A. (1999). Imagene: an integrated computer environment for sequence annotation and analysis. Bioinformatics, 15(1), 2-15. doi:10.1093/bioinformatics/15.1.2Paton, N. W., Khan, S. A., Hayes, A., Moussouni, F., Brass, A., Eilbeck, K., … Oliver, S. G. (2000). Conceptual modelling of genomic information. Bioinformatics, 16(6), 548-557. doi:10.1093/bioinformatics/16.6.548Vihinen, M., Hancock, J. M., Maglott, D. R., Landrum, M. J., Schaafsma, G. C. P., & Taschner, P. (2016). Human Variome Project Quality Assessment Criteria for Variation Databases. Human Mutation, 37(6), 549-558. doi:10.1002/humu.22976Fleuren, W. W. M., & Alkema, W. (2015). Application of text mining in the biomedical domain. Methods, 74, 97-106. doi:10.1016/j.ymeth.2015.01.015Salzberg, S. L. (2007). Genome re-annotation: a wiki solution? Genome Biology, 8(1). doi:10.1186/gb-2007-8-1-102Rigden, D. J., & Fernández, X. M. (2018). The 26th annual Nucleic Acids Research database issue and Molecular Biology Database Collection. Nucleic Acids Research, 47(D1), D1-D7. doi:10.1093/nar/gky1267Reyes Román, J. F., García, A., Rueda, U., & Pastor, Ó. (2019). GenesLove.Me 2.0: Improving the Prioritization of Genetic Variations. Evaluation of Novel Approaches to Software Engineering, 314-333. doi:10.1007/978-3-030-22559-9_14Richards, S., Aziz, N., Bale, S., Bick, D., Das, S., … Rehm, H. L. (2015). 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. Genetics in Medicine, 17(5), 405-423. doi:10.1038/gim.2015.30Kelly, M. A., Caleshu, C., Morales, A., Buchan, J., Wolf, Z., … Funke, B. (2018). Adaptation and validation of the ACMG/AMP variant classification framework for MYH7-associated inherited cardiomyopathies: recommendations by ClinGen’s Inherited Cardiomyopathy Expert Panel. Genetics in Medicine, 20(3), 351-359. doi:10.1038/gim.2017.21

Doctor of Philosophy

dissertationThe widespread use of genomic information to improve clinical care has long been a goal of clinicians, researchers, and policy-makers. With the completion of the Human Genome Project over a decade ago, the feasibility of attaining this goal on a widespread basis is becoming a greater reality. In fact, new genome sequencing technologies are bringing the cost of obtaining a patient's genomic information within reach of the general population. While this is an exciting prospect to health care, many barriers still remain to effectively use genomic information in a clinically meaningful way. These barriers, if not overcome, will limit the ability of genomic information to provide a significant impact on health care. Nevertheless, clinical decision support (CDS), which entails the provision of patient-specific knowledge to clinicians at appropriate times to enhance health care, offers a feasible solution. As such, this body of work represents an effort to develop a functional CDS solution capable of leveraging whole genome sequence information on a widespread basis. Many considerations were made in the design of the CDS solution in order to overcome the complexities of genomic information while aligning with common health information technology approaches and standards. This work represents an important advancement in the capabilities of integrating actionable genomic information within the clinical workflow using health informatics approaches

Data sharing and ontology use among agricultural genetics, genomics, and breeding databases and resources of the AgBioData Consortium

Over the last several decades, there has been rapid growth in the number and scope of agricultural genetics, genomics and breeding (GGB) databases and resources. The AgBioData Consortium (https://www.agbiodata.org/) currently represents 44 databases and resources covering model or crop plant and animal GGB data, ontologies, pathways, genetic variation and breeding platforms (referred to as 'databases' throughout). One of the goals of the Consortium is to facilitate FAIR (Findable, Accessible, Interoperable, and Reusable) data management and the integration of datasets which requires data sharing, along with structured vocabularies and/or ontologies. Two AgBioData working groups, focused on Data Sharing and Ontologies, conducted a survey to assess the status and future needs of the members in those areas. A total of 33 researchers responded to the survey, representing 37 databases. Results suggest that data sharing practices by AgBioData databases are in a healthy state, but it is not clear whether this is true for all metadata and data types across all databases; and that ontology use has not substantially changed since a similar survey was conducted in 2017. We recommend 1) providing training for database personnel in specific data sharing techniques, as well as in ontology use; 2) further study on what metadata is shared, and how well it is shared among databases; 3) promoting an understanding of data sharing and ontologies in the stakeholder community; 4) improving data sharing and ontologies for specific phenotypic data types and formats; and 5) lowering specific barriers to data sharing and ontology use, by identifying sustainability solutions, and the identification, promotion, or development of data standards. Combined, these improvements are likely to help AgBioData databases increase development efforts towards improved ontology use, and data sharing via programmatic means.Comment: 17 pages, 8 figure

The Human Phenotype Ontology in 2024: phenotypes around the world

\ua9 The Author(s) 2023. Published by Oxford University Press on behalf of Nucleic Acids Research. The Human Phenotype Ontology (HPO) is a widely used resource that comprehensively organizes and defines the phenotypic features of human disease, enabling computational inference and supporting genomic and phenotypic analyses through semantic similarity and machine learning algorithms. The HPO has widespread applications in clinical diagnostics and translational research, including genomic diagnostics, gene-disease discovery, and cohort analytics. In recent years, groups around the world have developed translations of the HPO from English to other languages, and the HPO browser has been internationalized, allowing users to view HPO term labels and in many cases synonyms and definitions in ten languages in addition to English. Since our last report, a total of 2239 new HPO terms and 49235 new HPO annotations were developed, many in collaboration with external groups in the fields of psychiatry, arthrogryposis, immunology and cardiology. The Medical Action Ontology (MAxO) is a new effort to model treatments and other measures taken for clinical management. Finally, the HPO consortium is contributing to efforts to integrate the HPO and the GA4GH Phenopacket Schema into electronic health records (EHRs) with the goal of more standardized and computable integration of rare disease data in EHRs

Expansion of the Human Phenotype Ontology (HPO) knowledge base and resources.

The Human Phenotype Ontology (HPO)-a standardized vocabulary of phenotypic abnormalities associated with 7000+ diseases-is used by thousands of researchers, clinicians, informaticians and electronic health record systems around the world. Its detailed descriptions of clinical abnormalities and computable disease definitions have made HPO the de facto standard for deep phenotyping in the field of rare disease. The HPO\u27s interoperability with other ontologies has enabled it to be used to improve diagnostic accuracy by incorporating model organism data. It also plays a key role in the popular Exomiser tool, which identifies potential disease-causing variants from whole-exome or whole-genome sequencing data. Since the HPO was first introduced in 2008, its users have become both more numerous and more diverse. To meet these emerging needs, the project has added new content, language translations, mappings and computational tooling, as well as integrations with external community data. The HPO continues to collaborate with clinical adopters to improve specific areas of the ontology and extend standardized disease descriptions. The newly redesigned HPO website (www.human-phenotype-ontology.org) simplifies browsing terms and exploring clinical features, diseases, and human genes

Resources and tools for rare disease variant interpretation

: Collectively, rare genetic disorders affect a substantial portion of the world's population. In most cases, those affected face difficulties in receiving a clinical diagnosis and genetic characterization. The understanding of the molecular mechanisms of these diseases and the development of therapeutic treatments for patients are also challenging. However, the application of recent advancements in genome sequencing/analysis technologies and computer-aided tools for predicting phenotype-genotype associations can bring significant benefits to this field. In this review, we highlight the most relevant online resources and computational tools for genome interpretation that can enhance the diagnosis, clinical management, and development of treatments for rare disorders. Our focus is on resources for interpreting single nucleotide variants. Additionally, we present use cases for interpreting genetic variants in clinical settings and review the limitations of these results and prediction tools. Finally, we have compiled a curated set of core resources and tools for analyzing rare disease genomes. Such resources and tools can be utilized to develop standardized protocols that will enhance the accuracy and effectiveness of rare disease diagnosis

The GA4GH Variation Representation Specification (VRS): a Computational Framework for the Precise Representation and Federated Identification of Molecular Variation

Maximizing the personal, public, research, and clinical value of genomic information will require that clinicians, researchers, and testing laboratories exchange genetic variation data reliably. Developed by a partnership among national information resource providers, public initiatives, and diagnostic testing laboratories under the auspices of the Global Alliance for Genomics and Health (GA4GH), the Variation Representation Specification (VRS, pronounced “verse”) is an extensible framework for the semantically precise and computable representation of variation that complements contemporary human-readable and flat file standards for variation representation. VRS objects are designed to be semantically precise representations of variation, and leverage this design to enable unique, federated identification of molecular variation. We describe the components of this framework, including the terminology and information model, schema, data sharing conventions, and a reference implementation, each of which is intended to be broadly useful and freely available for community use. The specification, documentation, examples, and community links are available at https://vrs.ga4gh.org/

The Human Phenotype Ontology in 2024: phenotypes around the world.

The Human Phenotype Ontology (HPO) is a widely used resource that comprehensively organizes and defines the phenotypic features of human disease, enabling computational inference and supporting genomic and phenotypic analyses through semantic similarity and machine learning algorithms. The HPO has widespread applications in clinical diagnostics and translational research, including genomic diagnostics, gene-disease discovery, and cohort analytics. In recent years, groups around the world have developed translations of the HPO from English to other languages, and the HPO browser has been internationalized, allowing users to view HPO term labels and in many cases synonyms and definitions in ten languages in addition to English. Since our last report, a total of 2239 new HPO terms and 49235 new HPO annotations were developed, many in collaboration with external groups in the fields of psychiatry, arthrogryposis, immunology and cardiology. The Medical Action Ontology (MAxO) is a new effort to model treatments and other measures taken for clinical management. Finally, the HPO consortium is contributing to efforts to integrate the HPO and the GA4GH Phenopacket Schema into electronic health records (EHRs) with the goal of more standardized and computable integration of rare disease data in EHRs

Resources and tools for rare disease variant interpretation

Collectively, rare genetic disorders affect a substantial portion of the world’s population. In most cases, those affected face difficulties in receiving a clinical diagnosis and genetic characterization. The understanding of the molecular mechanisms of these diseases and the development of therapeutic treatments for patients are also challenging. However, the application of recent advancements in genome sequencing/analysis technologies and computer-aided tools for predicting phenotype-genotype associations can bring significant benefits to this field. In this review, we highlight the most relevant online resources and computational tools for genome interpretation that can enhance the diagnosis, clinical management, and development of treatments for rare disorders. Our focus is on resources for interpreting single nucleotide variants. Additionally, we present use cases for interpreting genetic variants in clinical settings and review the limitations of these results and prediction tools. Finally, we have compiled a curated set of core resources and tools for analyzing rare disease genomes. Such resources and tools can be utilized to develop standardized protocols that will enhance the accuracy and effectiveness of rare disease diagnosis