RESUMO
Identifying large expansions of short tandem repeats (STRs), such as those that cause amyotrophic lateral sclerosis (ALS) and fragile X syndrome, is challenging for short-read whole-genome sequencing (WGS) data. A solution to this problem is an important step toward integrating WGS into precision medicine. We developed a software tool called ExpansionHunter that, using PCR-free WGS short-read data, can genotype repeats at the locus of interest, even if the expanded repeat is larger than the read length. We applied our algorithm to WGS data from 3001 ALS patients who have been tested for the presence of the C9orf72 repeat expansion with repeat-primed PCR (RP-PCR). Compared against this truth data, ExpansionHunter correctly classified all (212/212, 95% CI [0.98, 1.00]) of the expanded samples as either expansions (208) or potential expansions (4). Additionally, 99.9% (2786/2789, 95% CI [0.997, 1.00]) of the wild-type samples were correctly classified as wild type by this method with the remaining three samples identified as possible expansions. We further applied our algorithm to a set of 152 samples in which every sample had one of eight different pathogenic repeat expansions, including those associated with fragile X syndrome, Friedreich's ataxia, and Huntington's disease, and correctly flagged all but one of the known repeat expansions. Thus, ExpansionHunter can be used to accurately detect known pathogenic repeat expansions and provides researchers with a tool that can be used to identify new pathogenic repeat expansions.
Assuntos
Esclerose Lateral Amiotrófica/genética , Expansão das Repetições de DNA , Sequenciamento Completo do Genoma/métodos , Algoritmos , Proteína C9orf72/genética , Bases de Dados Genéticas , Humanos , Medicina de Precisão , Sensibilidade e Especificidade , SoftwareRESUMO
Complex regional pain syndrome (CRPS) is a poorly understood pain disorder presenting with predominantly neuropathic features. It is often, though not always, associated with an injury to the central or peripheral nervous systems, and in such cases may aggravate the prevailing disability. We describe a unique case of bilateral CRPS arising in a patient following traumatic spinal cord injury.