100,000 genomes project and its potential for rare disease research

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100,000 Genomes Project and its potential for rare disease research

Eamonn Sheridan

Professor of Clinical Genetics

University of Leeds

100,000 genomes project

• Launched 2012 by the Prime Minister

• Genomes England (DoH owned) will sequence 100,000 whole genomes by 2017

• Aims

– Create ethical and transparent programme based on consent

– Benefit patients and set up a genomic medicine service for the NHS

– Enable new scientific discovery and medical insights

– Kick start the development of a UK genomics industry

Rare diseases

• 50,000 genomes

– Three per patient • (proband + two relatives)

• Genome sequence not exome

• Deliver clinically meaningful results

– Analytical challenge

• Store data

– 200GB per genome

– Total 10-20 petabytes

– 30000-50000 CDs –tower 250-500m high

– Facebook 300PB!!

• Research in the 100,000 genomes project

– Genomics England Clinical Interpretation Partnerships (GeCIP)

– bring together researchers, clinicians and trainees from academia and the NHS

– main focus of GeCIP is on clinical interpretation • research will also be undertaken

Now with added:

Paed sepsis

Inherited cancer

Hepatology!!!!

Serum and plasma for proteomics and

metabolomics.

Cell free serum for circulating tumour

DNA and to assess tumour

recurrence.

Germ-line RNA for transcriptomics.

Lymphocyte DNA for epigenetics.

Tumour for RNA expression profiles,

tumour epigenetics and proteomics.

How is all this going to help research?

• Traditional approach to gene discovery

– Targetted at patients with pre-existing clinical diagnoses

– Eg De novo dominant Mutations in ARID1B cause Coffin Siris syndrome • Developmental delay, Absent speech,

Coarse facies, hypertrichosis, fingernail abnormalities, ACC

• Includes three patients with deletions of 6q25 including ARID1B

– Haploinsufficiency is the disease mechanism

Santen et al 2012

The ARID1B phenotype: What we have learned so far

American Journal of Medical Genetics Part C: Seminars in Medical Genetics Volume 166, Issue 3, pages 276-289, 28 AUG 2014 DOI: 10.1002/ajmg.c.31414 http://onlinelibrary.wiley.com/doi/10.1002/ajmg.c.31414/full#ajmgc31414-fig-0001

Clinical Features Developmental delay ACC Not much in common with CSS Although mechanism of haploinsufficiency is the same

ARID1B

• Subsequently reported in DDD as cause of 1% of delay in recruits

– Much broader phenotype in these patients

• Core CSS phenotype still valid predictor of mutations in ARID1B

– CSS is also caused by mutations in SMARCB1

The International Journal of Biochemistry & Cell Biology, Volume 52, 2014, 83–93

What about going beyond diagnosis?

Genome wide analysis of modifiers

100,000 genomes

• Promiscuous approach to mutation discovery

• Linked to very deep phenotyping

– May broaden phenotypes

– Better identification of core components

– Better data on natural history • Presently often a snapshot

• All patients have detailed genome sequence available

• Can be re-interrogated in light of subsequent knowledge

– Technology

– Disease

– Natural history

– Pathogenetic pathways

100,000 genomes

• Serum and plasma for proteomics and

metabolomics.

• Cell free serum for circulating tumour

DNA and to assess tumour recurrence.

• Germ-line RNA for transcriptomics.

• Lymphocyte DNA for epigenetics.

• Tumour for RNA expression profiles,

tumour epigenetics and proteomics.

100,000 genome – trio sampling strategy

100,000 genome – trio sampling strategy

100,000 genomes – biological insight

• MPPH syndrome

• Early overgrowth (brain > somatic tissues)

• Progressive megalencephaly

• Ventriculomegaly/Hydrocephalus

• Cerebellar tonsillar ectopia

• Mega-corpus callosum

• Polymicrogyria

Distal limb anomalies

• Postaxial polydactyly

• Familial recurrences rare

Megalencephaly-Polymicrogyria-Polydactyly-Hydrocephalus Syndrome

(MPPH)

• No recurrence in all reported families. • Exome sequencing of one trio:

• 5,980 heterozygous ‘functional’ variants identified in proband

• 5 candidate de novo variants • 4 true de novo variants validated by Sanger

sequencing

Potential Denovos

GLG1: c.1229A>G p.H410R

Confirmed

CCND2: c.838A>G p.T280A

Confirmed

JT144

11/5 JT145

15/0 JT146

18/0

JT144

34/17 JT145

46/0 JT146

55/1

Additional MPPH Patients

JT210 CCND2: c.842C>G

p.P281R

JT232 CCND2: c.839C>A

p.T280N

JT238 CCND2: c.851T>G

p.V280G

CCND2 Mutations in MPPH Patients

Cyclin D2 Regulates G1-S Cell-Cycle Transition

CDK4/6

P

P

RB1

E2F

E2F

RB1

P

G1 S

CCND2

Cell Cycle

P

CCND2 CCND2

P

P

GSK3B

Ubiquitin-mediated

degradation

Proliferation

T280A prevents phosphorylation of CCND2

Genetic data allows you generate hypotheses and answer those questions

But you still have to get on with stuff

HyperActive

P CCND2 CCND2

P

GSK3B

Ubiquitin-mediated

degradation

P

GSK3B

P

AKT3

P

Proliferation

P

P P P P

Active

Inactive

Active

PI3K hyper-activation and CCND2 Stabilisation

PIK3CA

PIK3R2

P

AKT3

P

P

P

(PI3K)

Inactive

P P

P P

P P

HyperActive Active

PIP2

PIP3

Summary

• 100000 genomes will provide basic genetic data on large numbers of patients

• This will allow the generation of novel disease hypotheses

• It is up to us to further investigate those

• Provide new disease paradigms

July 2015, 30× coverage $1363 = £888

Array CGH

qPCR

FISH

Karyotype

Conventional PCR/Sanger sequence

[Custom]

[Custom]

Long PCR NGS

Targetted panel NGS

MLPA

Array CGH

qPCR

FISH

Karyotype

Conventional PCR/sequence

Exome

[Virtual panels] Exome

Academia

PCD

× 24

diag

× 10

gene

× 2

DNAH8

Array CGH

qPCR

FISH

Karyotype

[Custom]

[Custom]

Conventional PCR/sequence

Exome

Conventional PCR/sequence

Exome

Array CGH

qPCR

FISH

Karyotype

CNVseq

66 kb

76.8 kb

Chromosome 7

Array CGH

qPCR

FISH Karyotype

CNVseq

Conventional PCR/sequence

Exome

[Custom]

[Custom]

?

Array CGH

Karyotype FISH

CNVseq

WGS Breakpoints

Dosage

Conventional PCR/sequence

Exome

WGS Dosage Breakpoints

Array Karyotype

FISH

Conventional PCR/sequence

Exome

100,000 genomes

• Radically alter NHS provision of genomic services

• Single platform

• Common workflows

• Deep phenotyping

• Clinically relevant results

• Qucikly!

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