Exome Sequencing: Applications From the Lab Bench to the Clinic.

Since the initial report of targeted-enrichment (Albert et al, 2007) we have been evolving the design and utility of capture reagents and methods, while taking advantage of the parallel advances in sequencing platforms. New exome designs target a comprehensive set of coding exons from 6 different gene databases, as well as computationally predicted coding and non-coding elements: regulatory regions, and conserved UTRs. Library automation, reduction of DNA input samples, capture hybridization multiplexing and application of faster read mapping tools such as BWA, together allow a rate of >4,300 libraries/captures per month, with >40,000 exome and regional capture libraries completed to date. In addition, a fully integrated informatics and analysis pipeline (Mercury), supports all aspects of data flow and analysis from the initial data production on the sequencing instrument to annotated variant calls (SNPs and small Indels). These laboratory methods and analysis pipelines have been production hardened at the Human Genome Sequencing Center (HGSC) and have now been applied toward clinical exome sequencing. Through a joint collaboration between the Human Genome Sequencing Center and the Medical Genetics Laboratories (MGL) of the Department of Molecular and Human Genetics, clinical exome sequencing and interpretation are now provided through the CAP/CLIA certified Whole Genome Laboratory (WGL). To date, the WGL has completed exome sequencing of 650 patient samples and final interpretation completed for over 450 patients with causative deleterious mutations identified in 25% of cases. Performance has been maintained to a high standard of 95% of the exome target bases represented at 20X coverage. Overall exome performance metrics, LIMS support, variant analysis and validation of the clinical pipeline for a CAP/CLIA environment will be presented.