A community-based resource for automatic exome variant-calling and annotation in Mendelian disorders

BACKGROUND: Mendelian disorders are mostly caused by single mutations in the DNA sequence of a gene, leading to a phenotype with pathologic consequences. Whole Exome Sequencing of patients can be a cost-effective alternative to standard genetic screenings to find causative mutations of genetic diseases, especially when the number of cases is limited. Analyzing exome sequencing data requires specific expertise, high computational resources and a reference variant database to identify pathogenic variants. RESULTS: We developed a database of variations collected from patients with Mendelian disorders, which is automatically populated thanks to an associated exome-sequencing pipeline. The pipeline is able to automatically identify, annotate and store insertions, deletions and mutations in the database. The resource is freely available online http://exome.tigem.it. The exome sequencing pipeline automates the analysis workflow (quality control and read trimming, mapping on reference genome, post-alignment processing, variation calling and annotation) using state-of-the-art software tools. The exome-sequencing pipeline has been designed to run on a computing cluster in order to analyse several samples simultaneously. The detected variants are annotated by the pipeline not only with the standard variant annotations (e.g. allele frequency in the general population, the predicted effect on gene product activity, etc.) but, more importantly, with allele frequencies across samples progressively collected in the database itself, stratified by Mendelian disorder. CONCLUSIONS: We aim at providing a resource for the genetic disease community to automatically analyse whole exome-sequencing samples with a standard and uniform analysis pipeline, thus collecting variant allele frequencies by disorder. This resource may become a valuable tool to help dissecting the genotype underlying the disease phenotype through an improved selection of putative patient-specific causative or phenotype-associated variations

Whole genome sequencing for mutation discovery in a single case of lysosomal storage disease (MPS type 1) in the dog.

Mucopolysaccharidosis (MPS) is a metabolic storage disorder caused by the deficiency of any lysosomal enzyme required for the breakdown of glycosaminoglycans. A 15-month-old Boston Terrier presented with clinical signs consistent with lysosomal storage disease including corneal opacities, multifocal central nervous system disease and progressively worsening clinical course. Diagnosis was confirmed at necropsy based on histopathologic evaluation of multiple organs demonstrating accumulation of mucopolysaccharides. Whole genome sequencing was used to uncover a frame-shift insertion affecting the alpha-L-iduronidase (IDUA) gene (c.19_20insCGGCCCCC), a mutation confirmed in another Boston Terrier presented 2 years later with a similar clinical picture. Both dogs were homozygous for the IDUA mutation and shared coat colors not recognized as normal for the breed by the American Kennel Club. In contrast, the mutation was not detected in 120 unrelated Boston Terriers as well as 202 dogs from other breeds. Recent inbreeding to select for recessive and unusual coat colors may have concentrated this relatively rare allele in the breed. The identification of the variant enables ante-mortem diagnosis of similar cases and selective breeding to avoid the spread of this disease in the breed. Boston Terriers carrying this variant represent a promising model for MPS I with neurological abnormalities in humans

Investigation of uncharacterized spondylocostal dysostosis using whole exome sequencing

Skeletal dysplasias and dysostoses are a genotypically and phenotypically diverse group of disorders that affect the growth, development and maintenance of cartilage and bone. General disorders of bone affecting bones and cartilage throughout the body have been referred to as skeletal dysplasias, whereas defects that selectively affect certain bones or bone groups are called skeletal dysostoses. Despite this distinction, modern molecular techniques are showing that this division is somewhat superficial, given the similarity in their underlying causes. Although the rate of disease gene discovery has grown substantially since the advent of next-generation sequencing technologies, most of the disorders have unknown molecular defects. Skeletal dysostoses are rarely observed, occurring at such low incidence levels that no comprehensive study has ascertained their frequency. The effects range from mild growth inhibition to complete absence of entire bone groups. The axial skeleton is most often involved in skeletal dysostoses with common symptoms including poorly formed cranial bones, mandible, ribs and vertebrae. Several important signaling pathways control the migration and formation of mesodermal cells, which eventually differentiate into many elements of the vertebral column. The importance of these pathways, namely the T-box transcription factors, Wnt, Notch, and Smad pathways are integrally involved in the very early stages of vertebral development. Currently, the most cost-effective method of pathogenic gene discovery for rare genetic diseases is exome sequencing. Utilizing this technology, as well as SNP arrays for identity-by-descent loci mapping, two independent skeletal dysostosis cases with similar phenotypes were studied to determine pathogenic candidate genes. Next-generation sequencing and identity-by-descent analysis revealed a possible candidate gene, PM20D2, in one proband. The gene includes peptidase dimerization, peptidase M20/M25/M40, and N-myristolylation domains based on predicted functional analysis. It is implicated in various metabolic activities, having hydrolase, protein binding, and metallopeptidase molecular functions. Further investigation into this gene, as well as further studies of these probands is needed to understand the role, if any, the defect plays in the disease

De Novo Occurrence of a Variant in ARL3 and Apparent Autosomal Dominant Transmission of Retinitis Pigmentosa.

BackgroundRetinitis pigmentosa is a phenotype with diverse genetic causes. Due to this genetic heterogeneity, genome-wide identification and analysis of protein-altering DNA variants by exome sequencing is a powerful tool for novel variant and disease gene discovery. In this study, exome sequencing analysis was used to search for potentially causal DNA variants in a two-generation pedigree with apparent dominant retinitis pigmentosa.MethodsVariant identification and analysis of three affected members (mother and two affected offspring) was performed via exome sequencing. Parental samples of the index case were used to establish inheritance. Follow-up testing of 94 additional retinitis pigmentosa pedigrees was performed via retrospective analysis or Sanger sequencing.Results and conclusionsA total of 136 high quality coding variants in 123 genes were identified which are consistent with autosomal dominant disease. Of these, one of the strongest genetic and functional candidates is a c.269A>G (p.Tyr90Cys) variant in ARL3. Follow-up testing established that this variant occurred de novo in the index case. No additional putative causal variants in ARL3 were identified in the follow-up cohort, suggesting that if ARL3 variants can cause adRP it is an extremely rare phenomenon

QueryOR: a comprehensive web platform for genetic variant analysis and prioritization

Background: Whole genome and exome sequencing are contributing to the extraordinary progress in the study of human genetic variants. In this fast developing field, appropriate and easily accessible tools are required to facilitate data analysis. Results: Here we describe QueryOR, a web platform suitable for searching among known candidate genes as well as for finding novel gene-disease associations. QueryOR combines several innovative features that make it comprehensive, flexible and easy to use. Instead of being designed on specific datasets, it works on a general XML schema specifying formats and criteria of each data source. Thanks to this flexibility, new criteria can be easily added for future expansion. Currently, up to 70 user-selectable criteria are available, including a wide range of gene and variant features. Moreover, rather than progressively discarding variants taking one criterion at a time, the prioritization is achieved by a global positive selection process that considers all transcript isoforms, thus producing reliable results. QueryOR is easy to use and its intuitive interface allows to handle different kinds of inheritance as well as features related to sharing variants in different patients. QueryOR is suitable for investigating single patients, families or cohorts. Conclusions: QueryOR is a comprehensive and flexible web platform eligible for an easy user-driven variant prioritization. It is freely available for academic institutions at http://queryor.cribi.unipd.it/

An integrated clinical program and crowdsourcing strategy for genomic sequencing and Mendelian disease gene discovery.

Despite major progress in defining the genetic basis of Mendelian disorders, the molecular etiology of many cases remains unknown. Patients with these undiagnosed disorders often have complex presentations and require treatment by multiple health care specialists. Here, we describe an integrated clinical diagnostic and research program using whole-exome and whole-genome sequencing (WES/WGS) for Mendelian disease gene discovery. This program employs specific case ascertainment parameters, a WES/WGS computational analysis pipeline that is optimized for Mendelian disease gene discovery with variant callers tuned to specific inheritance modes, an interdisciplinary crowdsourcing strategy for genomic sequence analysis, matchmaking for additional cases, and integration of the findings regarding gene causality with the clinical management plan. The interdisciplinary gene discovery team includes clinical, computational, and experimental biomedical specialists who interact to identify the genetic etiology of the disease, and when so warranted, to devise improved or novel treatments for affected patients. This program effectively integrates the clinical and research missions of an academic medical center and affords both diagnostic and therapeutic options for patients suffering from genetic disease. It may therefore be germane to other academic medical institutions engaged in implementing genomic medicine programs

DNA Sequencing Resolves Misdiagnosed and Rare Genetic Disorders

This chapter focuses on the mandatory requirement of DNA sequencing approaches for genetic diagnosis and recurrence prevention of inherited diseases. Sequencing the DNA and coded transcripts has intensely promoted our understanding of functional genomics and the fundamental importance of non-coding genomic sequences in causing heritable diseases, when mutated. Though Sanger sequencing, the first employed approach in identifying genetic mutations has been replaced nowadays in many laboratories with the highly robust massive parallel sequencing techniques, “Sanger” remains vital in countries with limited resources and also of essential importance in validating the results of large scale sequencing technologies. Next generation sequencing (NGS) enabled the parallel sequencing of the whole exome (WES) and whole genome (WGS) regions of human genome and has revolutionized the field of genetic and genomic research in human. WES and WGS have facilitated the identification of the role of previously unrecognized genes in causing neurologic phenotypes, brain structural malformation, and resolved the causal genes in puzzling and misdiagnosed genetic phenotypes. Role of fusion genes and non-coding RNA in causing neurogenetic recessive diseases has been uncovered by the application of NGS platforms, published examples are presented in this chapter. Extensive phenotypic variability that retained patients either as misdiagnosed or undiagnosed cases for years has been correctly diagnosed through NGS research applications

A Path to Implement Precision Child Health Cardiovascular Medicine.

Congenital heart defects (CHDs) affect approximately 1% of live births and are a major source of childhood morbidity and mortality even in countries with advanced healthcare systems. Along with phenotypic heterogeneity, the underlying etiology of CHDs is multifactorial, involving genetic, epigenetic, and/or environmental contributors. Clear dissection of the underlying mechanism is a powerful step to establish individualized therapies. However, the majority of CHDs are yet to be clearly diagnosed for the underlying genetic and environmental factors, and even less with effective therapies. Although the survival rate for CHDs is steadily improving, there is still a significant unmet need for refining diagnostic precision and establishing targeted therapies to optimize life quality and to minimize future complications. In particular, proper identification of disease associated genetic variants in humans has been challenging, and this greatly impedes our ability to delineate gene-environment interactions that contribute to the pathogenesis of CHDs. Implementing a systematic multileveled approach can establish a continuum from phenotypic characterization in the clinic to molecular dissection using combined next-generation sequencing platforms and validation studies in suitable models at the bench. Key elements necessary to advance the field are: first, proper delineation of the phenotypic spectrum of CHDs; second, defining the molecular genotype/phenotype by combining whole-exome sequencing and transcriptome analysis; third, integration of phenotypic, genotypic, and molecular datasets to identify molecular network contributing to CHDs; fourth, generation of relevant disease models and multileveled experimental investigations. In order to achieve all these goals, access to high-quality biological specimens from well-defined patient cohorts is a crucial step. Therefore, establishing a CHD BioCore is an essential infrastructure and a critical step on the path toward precision child health cardiovascular medicine

Next generation sequencing approaches in rare diseases: the study of four different families

The main purpose of this PhD project was to study the molecular bases of rare Mendelian diseases through Next Generation Sequencing (NGS), finding the most appropriate NGS technology and data analysis approach. To this aim, we enrolled at Umberto I General Hospital and Sapienza University of Rome four different families with a phenotype due to a supposed genetic cause, in order to find the causative gene/genes. The selection of the experimental strategy, the number of subjects to sequence (the most distant family members, trio or singleton) and the data analysis approach were dictated by considerations on the diagnostic potential of each sequencing strategy and its feasibility and cost: the diagnostic rate, the possibility to re-evaluate the NGS data periodically, the management of NGS data, the functional interpretation of coding and non coding variants and the number of secondary findings were some of the criteria driving the choice of the NGS test. The choice was also influenced by specific features of each case, e.g. the supposed mode of inheritance, the available samples and the information about the phenotype. Whole exome sequencing (WES) and clinical exome sequencing (CES) experiments were performed in our laboratory or by outer companies. We analysed sequencing data through a dedicated bioinformatic pipeline and we filtered and prioritized the variants according to several parameters, specific for each case. Then, we validated the selected variant/variants through Sanger sequencing on the proband and the other family members, to study their segregation in the family, and we investigated the functional link between the candidate variant/variants and the phenotype. To study the molecular bases of the complex phenotypes regarding canine agenesis and eruption anomalies in the family A, we performed a WES approach on three first degree cousins. Different data analyses, based on different shared genetic causes, allowed us to identify several candidate variants: two missense variants in EDARADD and COL5A1, previously associated with tooth agenesis and a syndromic phenotype including dental anomalies, respectively; three missense variants in RSPO4, T and NELL1, genes functionally related to tooth morphogenesis. The segregation analyses pointed to two different signaling pathways as responsible for the phenotypes, one of them (i.e. EDA) for the canine agenesis, and the other (i.e. WNT) for the less severe canine eruption anomalies. To find the cause of the isolated brachydactyly observed in family B, we used a WES approach on the proband and his grandfather. We identified a shared frameshift variant in the GDF5 gene, encoding for a secreted ligand of TGF-β and predominantly expressed in long bones during embryonic development. This was important for genetic counselling as it is causative of a mild phenotype in heterozygous state, but also of a very severe phenotype in homozygous state. To find the cause of the corpus callosum anomaly observed in the proband of family C, we chose a trio approach. We performed a CES, using an enrichment kit that included 171 of 180 genes reported in literature as causative of corpus callosum malformations. We identified in the proband a supposedly de novo nonsense variant in the ARX gene, critical for early development and formation of a normal brain. Segregation analysis disclosed the presence of the same variant also in the fetus of a previous pregnancy, suggesting a gonadal or gonosomal mosaicism in one of the parents. The identification of this variant was important for genetic counselling as there is an increased recurrence risk for the couple to have a child with the same disorder. It was also important for the proband’s clinical prognosis and to properly calculate the risk to transmit the mutation, which is associated with different clinical outcomes depending on the sex. To investigate the molecular bases of the recurrent Dandy- Walker malformation observed in the family D, we performed WES only of the proband. We identified a homozygous missense variant in FKTN gene, encoding a glycosyltransferase with a role in brain development. In order to test the pathogenicity of the variant, we also performed a structural modeling of FKTN. This result allowed to properly redefine the clinical diagnosis as a Muscular Dystrophy-Dystroglycanopathy Type A, with implications on recurrence risk for the couple and on reproductive choices. The adopted experimental and data analysis strategies allowed us to identify the molecular causes of phenotypes involving different systems and belonging to different clinical pictures, with significant impact on diagnosis, prognosis and genetic counselling. These results show how NGS is revolutionizing medical genetics, accelerating the research about rare-genetic diseases, facilitating clinical diagnosis and leading us to the personalized medicine