Overview of Genomic Techniques in Diagnostics Flashcards

1
Q

Genomic Technologies

A
  • PCR
  • Fragment analysis
  • Sanger Sequencing
  • Fluorescence in situ hybridisation (FISH)
  • Array - comparative genomic hybridization (Array CGH)
  • Multiplex ligation-dependent probe amplification (MLPA)
  • Next-Generation sequencing
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2
Q

Polymerase Chain Reaction (PCR)

A
  • Fundamental for many DNA applications
  • PCR is used to amplify a specific region of DNA
  • Primers flank the region you want to amplify.
  • Each cycle doubles the amount of DNA copies of your target sequence
  • Amplify enough DNA molecules so that we have sufficient material for downstream applications
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3
Q

Fragment Analysis

A
  • PCR based assay
  • PCR followed by capillary electrophoresis
  • Here we are sizing the PCR product
  • Can be used to detect repeat expansions or other small size changes (up to a few hundred bp)
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4
Q

Repeat Expansion Diseases I

A
  • Huntington’s disease – severe neurodegenerative disorder
  • Caused by CAG repeat expansion in the Huntingtin (HTT) gene
  • Normal < 27 copies; Intermediate 27-35 copies; Pathogenic > 35 copies
  • Expanded protein is toxic and accumulates in neurons causing cell death
  • Diagnosed with fragment analysis
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5
Q

Sanger Sequencing pt 1.

A
  • Cycle Sequencing; based on the same principles as PCR
  • Each of the 4 DNA nucleotides has a different dye so we can determine the nucleotide sequence.
  • Up to 800bp of sequence per reaction• Good for sequencing single exons of genes
  • Slow, low-throughput and costly to perform for large numbers of samples
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6
Q

Sanger Sequencing pt 2.

A
  • Remember your FTO Gene sequencing practical ??
  • Here we are reading the dyes to obtain the DNA sequence
  • We can identify single nucleotide polymorphisms (SNPs), or mutations
  • Detection of a mutation in a family by use of Sanger Sequencing
  • R1042G mutation in gene C3 segregates with affected individuals
  • Mutation causes disease cutaneous vasculitis
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7
Q

FISH - Fluorescent in situ hybridisation intro

A
  • 1969, Gall & Pardue
  • Cultured cells, metaphase spread
  • Microscopic (5-10Mb)
  • To detect large chromosomal abnormalities
  • Extra chromosomes
  • Large deleted segments
  • Translocations
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8
Q

FISH pt2.

A
  1. Design Fluorescent probe to chromosomal region of interest
  2. Denature probe and target DNA
  3. Mix probe and target DNA (hybridisation)
  4. Probe binds to target
  5. Target fluoresces or lights up
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9
Q

Array CGH

A
  • Array comparative genomic hybridisation
  • For detection of sub-microscopic chromosomal abnormalities
  • Patient DNA labelled Green
  • Control DNA labelled Red
  • Patient array comparative genomic hybridisation profile
  • Increased green signal over a chromosomal segment in the patient DNA
  • Indicates a gain in the patient sample not present in the parents
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10
Q

MLPA pt1.

A

• Multiplex ligation-dependent probe
amplification (MLPA) is a variation of PCR that permits amplification of multiple
targets
• Each probe consists of two oligonucleotides which recognize adjacent target sites on the DNA
• We use MLPA to detect abnormal copy numbers at specific chromosomal locations
• MLPA can detect sub-microscopic (small) gene deletions/partial gene deletions
• One probe oligonucleotide contains the sequence recognized by the forward primer, the other contains the sequence recognized by the reverse primer.
• Only when both probe oligonucleotides are hybridized to their respective targets, can they be ligated into a complete probe

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11
Q

MLPA pt2.

A

• Perform fragment analysis (capillary
electrophoresis) of MLPA product
• An important use of MLPA is to determine
relative ploidy (how many chromosome
copies?) as specific locations
• For example, probes may be designed to
target various regions of chromosome of
a human cell
• The signal strengths of the probes are
compared with those obtained from a
reference DNA sample known to have

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12
Q

Next Generation Sequencing

A

• An end to sequential testing -Next Generation Sequencing has replaced Sanger sequencing for almost all sequencing tests in the lab
• Wider range of tests in a shorter time for less money
• Current strategy: Disease panels
- Enriching to sequence only the known disease genes relevant to the phenotype
- Panels expandable to include new genes as they are published
- Potentially pathogenic variants confirmed by Sanger sequencing

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13
Q

Exome Sequencing

A
  • Target enrichment
  • Capture target regions of interest with baits
  • Potential to capture several Mb genomic regions (typically 30-60 Mb
  • There are ~21,000 genes in the human genome
  • Often we are only interested in the gene protein coding exons or ‘exome’ represents 1-2% of the genome
  • Some ~80% pathogenic mutations are protein coding
  • More efficient to only sequence the bits we are interested in, rather than the entire genome
  • Costs £1,000 for a genome, but only £200-£300 for an exome
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14
Q

Whole Genome Sequencing

A

• NOT all tests will automatically move to whole genome sequencing
– Panels/single gene tests may still be more suitable for some diseases, e.g. cystic fibrosis
– Capillary-based methods: Repeat expansions, MLPA, family mutation confirmation Sanger sequencing
– Array-CGH: large sized chromosomal aberrations
Interpretation of clinical genomes currently has a substantial manual component
Whole genome sequencing is NOT trivial
diagrams

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15
Q

Exome and Genome Sequencing

A

• Result interpretation is the greatest challenge
• 20,000 genetic variants identified per coding genes ‘exome’
• 3 million variants in a whole human genome
• Ethical considerations
- Modified patient consent process
- Data analysis pathways – inspect relevant genes first
- Strategy for reporting ‘incidental’ findings
• Infrastructure and training (particularly IT and clinical
scientists)

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16
Q

Genomics England I

A
• 100,000 genomes project
• Bring direct benefit of whole genome 
sequencing and genetics to patients
• Enable new scientific discovery and 
medical insights
• Personalised medicine
17
Q

Genomics England II

A
  • England – wide collection
  • GMCs (genomic medicine centres)
  • Who/what is being sequenced?
  • Rare diseases – index cases + families
  • Cancer – germline and tumour samples
18
Q

Clinical Interpretation II

A
  • Classification of mutations by genomics England
  • Variants within virtual panel divided into three tiers
  • Expert review is required
• Tier 1 variants
Known pathogenic
Protein truncating
• Tier 2 variants 
Protein altering (missense)
Intronic (splice site)
• Tier 3 variants
Loss-of-function variants in genes not on the disease gene pane
19
Q

The NHS Diagnostic Laboratory pt1.

A
  • Accredited laboratory: ISO standard 15189 for Medical Laboratories
  • Scientific, technical and administrative staff
  • Provide clinical and laboratory diagnosis for genetic disorders
  • Liaise with clinicians, nurses and other health professionals
  • Provide genetic advice for sample referrals and results
20
Q

The NHS Diagnostic Laboratory pt2.

A

• The main role of the lab is to help Consultants reach a genetic diagnosis for individuals and families to help guide
treatment and clinical management
• Perform specific tests with proven:
– Clinical Validity: How well the test predicts the phenotype
– Clinical Utility: How the test adds to the management of the patient
• UKGTN (UK genetic testing network)-approved tests
• In-depth and up-to-date knowledge of the genetic diseases covered

21
Q

The NHS Diagnostic Laboratory pt3.

A

• Diagnostic

  • Diagnosis
  • Management and Treatment
  • Interpretation of pathogenicity

• Predictive
- Life choices, management

• Carrier (recessive)
- Life choices, management

• Diagnostic testing is available for all Consultant referrals
- Clinical Geneticists most common referrers

• Informed consent

  • Genetic counselling
  • Implications for other family members
22
Q

Diagnostic Test Outcomes

A

• Pathogenic mutation

• Normal variation
- Polymorphism
• Novel variant
- Investigations to establish clinical significance…

23
Q

How to establish if a mutation is pathogenic?

A
  • Mode of inheritance
  • Genetic databases of published and unpublished data
  • Nonsense, frameshift, splice site (exon+/-2 bp) mutations
  • Missense/intronic mutation
  • In-silico tools for missense and splicing mutations
24
Q

Interpreting Results

A
• Do not report known polymorphisms
• Conservative approach to reporting 
novel mutations of uncertain pathogenicity
– ‘Uncertain significance'
– 'Likely to be pathogenic'
• Request samples from family members
• Continue testing other genes ?
25
Q

Case Example: MFN2 pt1.

A

• Mitofusin 2 (MFN2) causes Charcot-Marie-Tooth disease type 2 (CMT2)
– Degeneration of the long nerves in legs and arms leading to muscle wasting and sensory defects.
– Onset usually in childhood
– Autosomal Dominant and Autosomal Recessive
• Two siblings with very severe early-onset CMT2.
• Parents unaffected
• MFN2 sequenced by next generation sequencing
– Apparently homozygous for c.647T>C p.(Phe216Ser) mutation
– Parents sequenced, expected them to both be heterozygous

26
Q

Case Example: MFN2 pt2.

A

c.647T>C p.(Phe216Ser)
Mutation:

sanger sequencing/ validation
father appeared homozygous WT, not heterozygous as was expected

Deletion of MFN2 Exons 7-8
MLPA of MFN2 gene exons:
• MLPA measures dosage of all MFN2 exons
• Affected children carry deletion of MFN2 exons 7-8 inherited from father

27
Q

Case Example: MFN2

A

diagram