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Next-generation sequencing using microfluidic PCR enrichment for molecular autopsy

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  • Hariharan Raju
  • James S Ware
  • Jonathan R Skinner
  • Paula L Hedley
  • Gavin Arno
  • Donald R Love
  • Christian van der Werf
  • Jacob Tfelt-Hansen
  • Bo Gregers Winkel
  • Marta C Cohen
  • Xinzhong Li
  • Shibu John
  • Sanjay Sharma
  • Steve Jeffery
  • Arthur A M Wilde
  • Michael Christiansen
  • Mary N Sheppard
  • Elijah R Behr
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BACKGROUND: We aimed to determine the mutation yield and clinical applicability of "molecular autopsy" following sudden arrhythmic death syndrome (SADS) by validating and utilizing low-cost high-throughput technologies: Fluidigm Access Array PCR-enrichment with Illumina HiSeq 2000 next generation sequencing (NGS).

METHODS: We validated and optimized the NGS platform with a subset of 46 patients by comparison with Sanger sequencing of coding exons of major arrhythmia risk-genes (KCNQ1, KCNH2, SCN5A, KCNE1, KCNE2, RYR2). A combined large multi-ethnic international SADS cohort was sequenced utilizing the NGS platform to determine overall molecular yield; rare variants identified by NGS were subsequently reconfirmed by Sanger sequencing.

RESULTS: The NGS platform demonstrated 100% sensitivity for pathogenic variants as well as 87.20% sensitivity and 99.99% specificity for all substitutions (optimization subset, n = 46). The positive predictive value (PPV) for NGS for rare substitutions was 16.0% (27 confirmed rare variants of 169 positive NGS calls in 151 additional cases). The overall molecular yield in 197 multi-ethnic SADS cases (mean age 22.6 ± 14.4 years, 68% male) was 5.1% (95% confidence interval 2.0-8.1%), representing 10 cases carrying pathogenic or likely pathogenic risk-mutations.

CONCLUSIONS: Molecular autopsy with Fluidigm Access Array and Illumina HiSeq NGS utilizing a selected panel of LQTS/BrS and CPVT risk-genes offers moderate diagnostic yield, albeit requiring confirmatory Sanger-sequencing of mutational variants.

Original languageEnglish
JournalBMC Cardiovascular Disorders
Volume19
Issue number1
Pages (from-to)174
ISSN1471-2261
DOIs
Publication statusPublished - 23 Jul 2019

ID: 59119364