Steps in Metagenomics: Let’s Avoid Garbage in and Garbage Out

Is metagenomics a revolution or a new fad? Metagenomics is tightly associated with the availability of next-generation sequencing in all its implementations. The key feature of these new technologies, moving beyond the Sanger-based DNA sequencing approach, is the depth of nucleotide sequencing per sample.1 Knowing much more about a sample changes the traditional paradigms of “What is the most abundant?” or “What is the most significant?” to “What is present and potentially sig­nificant that might influence the situation and outcome?” Let’s take the case of identifying proper biomarkers of disease state in the context of chronic disease prevention. Prevention has been deemed as a viable option to avert human chronic diseases and to curb health­care management costs.2 The actual implementation of any effective preventive measures has proven to be rather difficult. In addition to the typically poor compliance of the general public, the vagueness of the successful validation of habit modification on the long-term risk, points to the need of defining new biomarkers of disease state. Scientists and the public are accepting the fact that humans are super-organisms, harboring both a human genome and a microbial genome, the latter being much bigger in size and diversity, and key for the health of individuals.3,4 It is time to investigate the intricate relationship between humans and their associated microbiota and how this relationship mod­ulates or affects both partners.5 These remarks can be expanded to the animal and plant kingdoms, and holistically to the Earth’s biome. By its nature, the evolution and function of all the Earth’s biomes are influenced by a myriad of interactions between and among microbes (planktonic, in biofilms or host associated) and the surrounding physical environment. The general definition of metagenomics is the cultivation-indepen­dent analysis of the genetic information of the collective genomes of the microbes within a given environment based on its sampling. It focuses on the collection of genetic information through sequencing that can target DNA, RNA, or both. The subsequent analyses can be solely fo­cused on sequence conservation, phylogenetic, phylogenomic, function, or genetic diversity representation including yet-to-be annotated genes. The diversity of hypotheses, questions, and goals to be accomplished is endless. The primary design is based on the nature of the material to be analyzed and its primary function

Combined population genomic screening for three high-risk conditions in Australia: a modelling study

BACKGROUND: No previous health-economic evaluation has assessed the impact and cost-effectiveness of offering combined adult population genomic screening for mutliple high-risk conditions in a national public healthcare system. METHODS: This modeling study assessed the impact of offering combined genomic screening for hereditary breast and ovarian cancer, Lynch syndrome and familial hypercholesterolaemia to all young adults in Australia, compared with the current practice of clinical criteria-based testing for each condition separately. The intervention of genomic screening, assumed as an up-front single cost in the first annual model cycle, would detect pathogenic variants in seven high-risk genes. The simulated population was 18–40 year-olds (8,324,242 individuals), modelling per-sample test costs ranging AU$100–$1200 (base-case AU$200) from the year 2023 onwards with testing uptake of 50 FINDINGS: Over the population lifetime (to age 80 years), the model estimated that genomic screening per-100,000 individuals would lead to 747 QALYs gained by preventing 63 cancers, 31 CHD cases and 97 deaths. In the total model population, this would translate to 31,094 QALYs gained by preventing 2612 cancers, 542 non-fatal CHD events and 4047 total deaths. At AU$200 per-test, genomic screening would require an investment of AU$832 million for screening of 50$23,926 (∼£12,050/€14,110/US$15,345) per QALY gained over the status quo. In scenario analysis with 3$4758/QALY was obtained. Sensitivity analysis for the base case indicated that combined genomic screening would be cost-effective under 70% of simulations, cost-saving under 25% and not cost-effective under 5%. Threshold analysis showed that genomic screening would be cost-effective under the AU$50,000/QALY willingness-to-pay threshold at per-test costs up to AU$325 (∼£164/€192/US$208). INTERPRETATION: Our findings suggest that offering combined genomic screening for high-risk conditions to young adults would be cost-effective in the Australian public healthcare system, at currently realistic testing costs. Other matters, including psychosocial impacts, ethical and societal issues, and implementation challenges, also need consideration. FUNDING: Australian Government, Department of Health, Medical Research Future Fund, Genomics Health Futures Mission (APP2009024). National Heart Foundation Future Leader Fellowship (102604)

Doctor of Philosophy

dissertationRapidly evolving technologies such as chip arrays and next-generation sequencing are uncovering human genetic variants at an unprecedented pace. Unfortunately, this ever growing collection of gene sequence variation has limited clinical utility without clear association to disease outcomes. As electronic medical records begin to incorporate genetic information, gene variant classification and accurate interpretation of gene test results plays a critical role in customizing patient therapy. To verify the functional impact of a given gene variant, laboratories rely on confirming evidence such as previous literature reports, patient history and disease segregation in a family. By definition variants of uncertain significance (VUS) lack this supporting evidence and in such cases, computational tools are often used to evaluate the predicted functional impact of a gene mutation. This study evaluates leveraging high quality genotype-phenotype disease variant data from 20 genes and 3986 variants, to develop gene-specific predictors utilizing a combination of changes in primary amino acid sequence, amino acid properties as descriptors of mutation severity and Naïve Bayes classification. A Primary Sequence Amino Acid Properties (PSAAP) prediction algorithm was then combined with well established predictors in a weighted Consensus sum in context of gene-specific reference intervals for known phenotypes. PSAAP and Consensus were also used to evaluate known variants of uncertain significance in the RET proto-oncogene as a model gene. The PSAAP algorithm was successfully extended to many genes and diseases. Gene-specific algorithms typically outperform generalized prediction tools. Characteristic mutation properties of a given gene and disease may be lost when diluted into genomewide data sets. A reliable computational phenotype classification framework with quantitative metrics and disease specific reference ranges allows objective evaluation of novel or uncertain gene variants and augments decision making when confirming clinical information is limited

The Ontology of Biological Attributes (OBA)-computational traits for the life sciences.

Existing phenotype ontologies were originally developed to represent phenotypes that manifest as a character state in relation to a wild-type or other reference. However, these do not include the phenotypic trait or attribute categories required for the annotation of genome-wide association studies (GWAS), Quantitative Trait Loci (QTL) mappings or any population-focussed measurable trait data. The integration of trait and biological attribute information with an ever increasing body of chemical, environmental and biological data greatly facilitates computational analyses and it is also highly relevant to biomedical and clinical applications. The Ontology of Biological Attributes (OBA) is a formalised, species-independent collection of interoperable phenotypic trait categories that is intended to fulfil a data integration role. OBA is a standardised representational framework for observable attributes that are characteristics of biological entities, organisms, or parts of organisms. OBA has a modular design which provides several benefits for users and data integrators, including an automated and meaningful classification of trait terms computed on the basis of logical inferences drawn from domain-specific ontologies for cells, anatomical and other relevant entities. The logical axioms in OBA also provide a previously missing bridge that can computationally link Mendelian phenotypes with GWAS and quantitative traits. The term components in OBA provide semantic links and enable knowledge and data integration across specialised research community boundaries, thereby breaking silos

Metagenomic sequencing for surveillance of food- and waterborne viral diseases

A plethora of viruses can be transmitted by the food- and waterborne route. However, their recognition is challenging because of the variety of viruses, heterogeneity of symptoms, the lack of awareness of clinicians, and limited surveillance efforts. Classical food- and waterborne viral disease outbreaks are mainly caused by caliciviruses, but the source of the virus is often not known and the foodborne mode of transmission is difficult to discriminate from human-to-human transmission. Atypical food- and waterborne viral disease can be caused by viruses such as hepatitis A and hepatitis E. In addition, a source of novel emerging viruses with a potential to spread via the food- and waterborne route is the repeated interaction of humans with wildlife. Wildlife-to-human adaptation may give rise to self- limiting outbreaks in some cases, but when fully adjusted to the human host can be devastating. Metagenomic sequencing has been investigated as a promising solution for surveillance purposes as it detects all viruses in a single protocol, delivers additional genomic information for outbreak tracing, and detects novel unknown viruses. Nevertheless, several issues must be addressed to apply metagenomic sequencing in surveillance. First, sample preparation is difficult since the genomic material of viruses is genera

Pharmacogenetics and the Future of Perzonalized Medications

Clinical genetic testing has grown across the globe over the past 30 decades as the causative mutations for Mendelian diseases have been pointed out, especially helped in part by the recent advances in molecular technologies. Substantially, the use of up to date tests and other strategies such as diagnostic confirmation, testing prenatally, and population-based carrier screening is offered with caution and careful consideration before implementing clinically. This may facilitate the appropriate use of brand new genetic tests available. It helps clinicians to judge and prescribe drugs more wisely. Nowadays, most of the health organizations and drug safety commissions provide revisions that include pharmacogenetic information leaflets for selected drugs. However, regardless of some pharmacogenetic associations with adverse results, rest of the proposals has been proven successfully. When compared with testing for the Mendelian diseases, pharmacogenetic testing for other manifestations may have only a negligible positive predictive value, which is one rationale for underutilization. A number of other barriers remain with implementing clinical pharmacogenetics, including lack of clinical utility, professional education, and regulatory and reimbursement issues, among others. Through this review we put forward some of the challenges and barriers faced in executing a clinical pharmacogenetic test

Identification, organisation and visualisation of complete proteomes in UniProt throughout all taxonomic ranks :|barchaea, bacteria, eukatyote and virus

Users of uniprot.org want to be able to query, retrieve and download proteome sets for an organism of their choice. They expect the data to be easily accessed, complete and up to date based on current available knowledge. UniProt release 2012_01 (25th Jan 2012) contains the proteomes of 2,923 organisms; 50% of which are bacteria, 38% viruses, 8% eukaryota and 4% archaea. Note that the term 'organism' is used in a broad sense to include subspecies, strains and isolates. Each completely sequenced organism is processed as an independent organism, hence the availability of 38 strain-specific proteomes Escherichia coli that are accessible for download. There is a project within UniProt dedicated to the mammoth task of maintaining the “Proteomes database”. This active resource is essential for UniProt to continually provide high quality proteome sets to the users. Accurate identification and incorporation of new, publically available, proteomes as well as the maintenance of existing proteomes permits sustained growth of the proteomes project. This is a huge, complicated and vital task accomplished by the activities of both curators and programmers. This thesis explains the data input and output of the proteomes database: the flow of genome project data from the nucleotide database into the proteomes database, then from each genome how a proteome is identified, augmented and made visible to uniprot.org users. Along this journey of discovery many issues arose, puzzles concerning data gathering, data integrity and also data visualisation. All were resolved and the outcome is a well-documented, actively maintained database that strives to provide optimal proteome information to its users

Presence of rare potential pathogenic variants in subjects under 65 years old with very severe or fatal COVID-19

Rare variants affecting host defense against pathogens could be involved in COVID-19 severity and may help explain fatal outcomes in young and middle-aged patients. Our aim was to report the presence of rare genetic variants in certain genes, by using whole exome sequencing, in a selected group of COVID-19 patients under 65 years who required intubation or resulting in death (n = 44). To this end, different etiopathogenic mechanisms were explored using gene prioritization-based analysis in which genes involved in immune response, immunodeficiencies or blood coagulation were studied. We detected 44 different variants of interest, in 29 different patients (66%). Some of these variants were previously described as pathogenic and were located in genes mainly involved in immune response. A network analysis, including the 42 genes with candidate variants, showed three main components, consisting of 25 highly interconnected genes related to immune response and two additional networks composed by genes enriched in carbohydrate metabolism and in DNA metabolism and repair processes. In conclusion, we have detected candidate variants that may potentially influence COVID-19 outcome in our cohort of patients. Further studies are needed to confirm the ultimate role of the genetic variants described in the present study on COVID-19 severityTis work was supported by Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation (COVID19 Research Call, COV20/00181) co-fnanced by European Development Regional Fund (FEDER, A way to achieve Europe) and contributions from Estrella de Levante S.A. and Colabora Mujer Association. CIBERer (Centro de Investigación en Red de Enfermedades Raras) is funded by Instituto de Salud Carlos III.R.L-R.and M.dP.V. are sponsored by the project COV20/00181. M.C., P.M. and B.A. are supported by the Miguel Servet (CP17/00006, CP16/00116) and Juan Rodes (JR17/00020) programs, respectively, of the Instituto de Salud Carlos III, co-fnanced by the European Regional Development Fund (FEDER). R.R. is supported by a postdoctoral fellowship of the Comunidad de Madrid (2019-T2/BMD-13714) and G.N.-M. by a contract of the Comunidad de Madrid (PEJ-2020-AI/BMD-18610

Presence of rare potential pathogenic variants in subjects under 65 years old with very severe or fatal COVID‑19.

Rare variants afecting host defense against pathogens could be involved in COVID-19 severity and may help explain fatal outcomes in young and middle-aged patients. Our aim was to report the presence of rare genetic variants in certain genes, by using whole exome sequencing, in a selected group of COVID-19 patients under 65 years who required intubation or resulting in death (n= 44). To this end, diferent etiopathogenic mechanisms were explored using gene prioritization-based analysis in which genes involved in immune response, immunodefciencies or blood coagulation were studied. We detected 44 diferent variants of interest, in 29 diferent patients (66%). Some of these variants were previously described as pathogenic and were located in genes mainly involved in immune response. A network analysis, including the 42 genes with candidate variants, showed three main components, consisting of 25 highly interconnected genes related to immune response and two additional networks composed by genes enriched in carbohydrate metabolism and in DNA metabolism and repair processes. In conclusion, we have detected candidate variants that may potentially infuence COVID-19 outcome in our cohort of patients. Further studies are needed to confrm the ultimate role of the genetic variants described in the present study on COVID-19 severitypost-print2807 K