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March 27, 2025  |  Rare disease

Long-read sequencing resolves the clinically relevant CYP21A2 locus, supporting a new clinical test for Congenital Adrenal Hyperplasia

Authors: Jean Monlong, Xiao Chen, Hayk Barseghyan, William J Rowell, Shloka Negi, Natalie Nokoff, Lauren Mohnach, Josephine Hirsch, Courtney Finlayson, Catherine E. Keegan, Miguel Almalvez, Seth I. Berger, Ivan de Dios, Brandy McNulty, Alex Robertson, Karen H. Miga, Phyllis W. Speiser, Benedict Paten, Eric Vilain, Emmanuèle C. Délot

Both HiFi-based and nanopore-based whole-genome long-read sequencing datasets could be mined to accurately identify pathogenic single-nucleotide variants, full gene deletions, fusions creating non-functional hybrids between the gene and pseudogene (“30-kb deletion”), as well as count the number of RCCX modules and phase the resulting multimodular haplotypes. On the Hi-Fi data set of 6 samples, the PacBio Paraphase tool was able to distinguish nine different mono-, bi-, and tri-modular haplotypes, as well as the 30-kb and whole gene deletions. To do the same on the ONT-Nanopore dataset, we designed a tool, Parakit, which creates an enriched local pangenome to represent known haplotype assemblies and map ClinVar pathogenic variants and fusions onto them. With few labels in the region, optical genome mapping was not able to reliably resolve module counts or fusions, although designing a tool to mine the dataset specifically for this region may allow doing so in the future. Both sequencing techniques yielded congruent results, matching clinically identified variants, and offered additional information above the clinical test, including phasing, count of RCCX modules, and status of the other module genes, all of which may be of clinical relevance. Thus long-read sequencing could be used to identify variants causing multiple forms of CAH in a single test.

Journal: medRxiv
DOI: 10.1101/2025.02.07.25321404
Year: 2025

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