Glutaminase Deficiency Caused by Short Tandem Repeat Expansion inGLS

Abstract Background Short tandem repeat (STR) expansion disorders are an important cause of human neurological disease. They have an established role in more than 40 different phenotypes including the myotonic dystrophies, Fragile X syndrome, Huntington’s disease, the hereditary cerebellar ataxias, amyotrophic lateral sclerosis and frontotemporal dementia. Main body STR expansions are difficult to detect and may explain unsolved diseases, as highlighted by recent findings including: the discovery of a biallelic intronic ‘AAGGG’ repeat in RFC1 as the cause of cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS); and the finding of ‘CGG’ repeat expansions in NOTCH2NLC as the cause of neuronal intranuclear inclusion disease and a range of clinical phenotypes. However, established laboratory techniques for diagnosis of repeat expansions (repeat-primed PCR and Southern blot) are cumbersome, low-throughput and poorly suited to parallel analysis of multiple gene regions. While next generation sequencing (NGS) has been increasingly used, established short-read NGS platforms (e.g., Illumina) are unable to genotype large and/or complex repeat expansions. Long-read sequencing platforms recently developed by Oxford Nanopore Technology and Pacific Biosciences promise to overcome these limitations to deliver enhanced diagnosis of repeat expansion disorders in a rapid and cost-effective fashion. Conclusion We anticipate that long-read sequencing will rapidly transform the detection of short tandem repeat expansion disorders for both clinical diagnosis and gene discovery.

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Genome-Wide Sequencing as a First-Tier Screening Test for Short Tandem Repeat Expansions

10.1101/2020.06.06.137356 ◽

2020 ◽

Author(s):

Indhu-Shree Rajan-Babu ◽

Junran Peng ◽

Readman Chiu ◽

Arezoo Mohajeri ◽

Egor Dolzhenko ◽

...

Keyword(s):

Decision Tree ◽

Sensitivity And Specificity ◽

Genome Sequence ◽

Tandem Repeat ◽

Short Tandem Repeat ◽

Sequence Data ◽

Repeat Expansion ◽

Full Mutation ◽

Genome Wide ◽

Short Tandem

ABSTRACTShort tandem repeat (STR) expansions cause several neurological and neuromuscular disorders. Screening for STR expansions in genome-wide (exome and genome) sequencing data can enable diagnosis, optimal clinical management/treatment, and accurate genetic counselling of patients with repeat expansion disorders. We assessed the performance of lobSTR, HipSTR, RepeatSeq, ExpansionHunter, TREDPARSE, GangSTR, STRetch, and exSTRa – bioinformatics tools that have been developed to detect and/or genotype STR expansions – on experimental and simulated genome sequence data with known STR expansions aligned using two different aligners, Isaac and BWA. We then adjusted the parameter settings to optimize the sensitivity and specificity of the STR tools and fed the optimized results into a machine-learning decision tree classifier to determine the best combination of tools to detect full mutation expansions with high diagnostic sensitivity and specificity. The decision tree model supported using ExpansionHunter’s full mutation calls with those of either STRetch or exSTRa for detection of full mutations with precision, recall, and F1-score of 90%, 100%, and 95%, respectively.We used this pipeline to screen the BWA-aligned exome or genome sequence data of 306 families of children with suspected genetic disorders for pathogenic expansions of known disease STR loci. We identified 27 samples, 17 with an apparent full-mutation expansion of the AR, ATXN1, ATXN2, ATXN8, DMPK, FXN, HTT, or TBP locus, nine with an intermediate or premutation allele in the FMR1 locus, and one with a borderline allele in the ATXN2 locus. We report the concordance between our bioinformatics findings and the clinical PCR results in a subset of these samples. Implementation of our bioinformatics workflow can improve the detection of disease STR expansions in exome and genome sequence diagnostics and enhance clinical outcomes for patients with repeat expansion disorders.

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