Structural and non-coding variants increase the diagnostic yield of clinical whole genome sequencing for rare diseases

BACKGROUND: Whole genome sequencing is increasingly being used for the diagnosis of patients with rare diseases. However, the diagnostic yields of many studies, particularly those conducted in a healthcare setting, are often disappointingly low, at 25-30%. This is in part because although entire genomes are sequenced, analysis is often confined to in silico gene panels or coding regions of the genome.METHODS: We undertook WGS on a cohort of 122 unrelated rare disease patients and their relatives (300 genomes) who had been pre-screened by gene panels or arrays. Patients were recruited from a broad spectrum of clinical specialties. We applied a bioinformatics pipeline that would allow comprehensive analysis of all variant types. We combined established bioinformatics tools for phenotypic and genomic analysis with our novel algorithms (SVRare, ALTSPLICE and GREEN-DB) to detect and annotate structural, splice site and non-coding variants.RESULTS: Our diagnostic yield was 43/122 cases (35%), although 47/122 cases (39%) were considered solved when considering novel candidate genes with supporting functional data into account. Structural, splice site and deep intronic variants contributed to 20/47 (43%) of our solved cases. Five genes that are novel, or were novel at the time of discovery, were identified, whilst a further three genes are putative novel disease genes with evidence of causality. We identified variants of uncertain significance in a further fourteen candidate genes. The phenotypic spectrum associated with RMND1 was expanded to include polymicrogyria. Two patients with secondary findings in FBN1 and KCNQ1 were confirmed to have previously unidentified Marfan and long QT syndromes, respectively, and were referred for further clinical interventions. Clinical diagnoses were changed in six patients and treatment adjustments made for eight individuals, which for five patients was considered life-saving.CONCLUSIONS: Genome sequencing is increasingly being considered as a first-line genetic test in routine clinical settings and can make a substantial contribution to rapidly identifying a causal aetiology for many patients, shortening their diagnostic odyssey. We have demonstrated that structural, splice site and intronic variants make a significant contribution to diagnostic yield and that comprehensive analysis of the entire genome is essential to maximise the value of clinical genome sequencing.</p

Structural and non-coding variants increase the diagnostic yield of clinical whole genome sequencing for rare diseases

Background: Whole genome sequencing is increasingly being used for the diagnosis of patients with rare diseases. However, the diagnostic yields of many studies, particularly those conducted in a healthcare setting, are often disappointingly low, at 25–30%. This is in part because although entire genomes are sequenced, analysis is often confined to in silico gene panels or coding regions of the genome. Methods: We undertook WGS on a cohort of 122 unrelated rare disease patients and their relatives (300 genomes) who had been pre-screened by gene panels or arrays. Patients were recruited from a broad spectrum of clinical specialties. We applied a bioinformatics pipeline that would allow comprehensive analysis of all variant types. We combined established bioinformatics tools for phenotypic and genomic analysis with our novel algorithms (SVRare, ALTSPLICE and GREEN-DB) to detect and annotate structural, splice site and non-coding variants. Results: Our diagnostic yield was 43/122 cases (35%), although 47/122 cases (39%) were considered solved when considering novel candidate genes with supporting functional data into account. Structural, splice site and deep intronic variants contributed to 20/47 (43%) of our solved cases. Five genes that are novel, or were novel at the time of discovery, were identified, whilst a further three genes are putative novel disease genes with evidence of causality. We identified variants of uncertain significance in a further fourteen candidate genes. The phenotypic spectrum associated with RMND1 was expanded to include polymicrogyria. Two patients with secondary findings in FBN1 and KCNQ1 were confirmed to have previously unidentified Marfan and long QT syndromes, respectively, and were referred for further clinical interventions. Clinical diagnoses were changed in six patients and treatment adjustments made for eight individuals, which for five patients was considered life-saving. Conclusions: Genome sequencing is increasingly being considered as a first-line genetic test in routine clinical settings and can make a substantial contribution to rapidly identifying a causal aetiology for many patients, shortening their diagnostic odyssey. We have demonstrated that structural, splice site and intronic variants make a significant contribution to diagnostic yield and that comprehensive analysis of the entire genome is essential to maximise the value of clinical genome sequencing.</p

Gaia data release 1. Pre-processing and source list creation

Context. The first data release from the Gaia mission contains accurate positions and magnitudes for more than a billion sources, and proper motions and parallaxes for the majority of the 2.5 million Hipparcos and Tycho-2 stars. Aims. We describe three essential elements of the initial data treatment leading to this catalogue: the image analysis, the construction of a source list, and the near real-time monitoring of the payload health. We also discuss some weak points that set limitations for the attainable precision at the present stage of the mission. Methods. Image parameters for point sources are derived from one-dimensional scans, using a maximum likelihood method, under the assumption of a line spread function constant in time, and a complete modelling of bias and background. These conditions are, however, not completely fulfilled. The Gaia source list is built starting from a large ground-based catalogue, but even so a significant number of new entries have been added, and a large number have been removed. The autonomous onboard star image detection will pick up many spurious images, especially around bright sources, and such unwanted detections must be identified. Another key step of the source list creation consists in arranging the more than 1010 individual detections in spatially isolated groups that can be analysed individually. Results. Complete software systems have been built for the Gaia initial data treatment, that manage approximately 50 million focal plane transits daily, giving transit times and fluxes for 500 million individual CCD images to the astrometric and photometric processing chains. The software also carries out a successful and detailed daily monitoring of Gaia health

Gaia data release 1. Pre-processing and source list creation

Context. The first data release from the Gaia mission contains accurate positions and magnitudes for more than a billion sources, and proper motions and parallaxes for the majority of the 2.5 million Hipparcos and Tycho-2 stars. Aims. We describe three essential elements of the initial data treatment leading to this catalogue: the image analysis, the construction of a source list, and the near real-time monitoring of the payload health. We also discuss some weak points that set limitations for the attainable precision at the present stage of the mission. Methods. Image parameters for point sources are derived from one-dimensional scans, using a maximum likelihood method, under the assumption of a line spread function constant in time, and a complete modelling of bias and background. These conditions are, however, not completely fulfilled. The Gaia source list is built starting from a large ground-based catalogue, but even so a significant number of new entries have been added, and a large number have been removed. The autonomous onboard star image detection will pick up many spurious images, especially around bright sources, and such unwanted detections must be identified. Another key step of the source list creation consists in arranging the more than 1010 individual detections in spatially isolated groups that can be analysed individually. Results. Complete software systems have been built for the Gaia initial data treatment, that manage approximately 50 million focal plane transits daily, giving transit times and fluxes for 500 million individual CCD images to the astrometric and photometric processing chains. The software also carries out a successful and detailed daily monitoring of Gaia health