Whole Genome Medical Sequencing for Genome Discovery

• Indentification of molecular etiology of genetic disorders.
  

• Determination of themes motivatiing subjects attitudes regarding the pursuit of whole genome sequencing and their interest in receipt of secondary results.
  

We aim to use whole-genome medical sequencing (WGMS) to discover causative molecular lesions for a set of rare, severe phenotypes hypothesized to be caused by either somatic mutations, germline de novo heterozygous mutations, germline inherited recessive, or germline inherited dominant mutations in currently unknown or uncharacterized genes. The goal of this research is threefold: to identify causative sequence variants for disorders whose molecular etiology was previously unknown, to apply this insight to both the rare disorders under study and more common phenotypes, and to enhance the study of mutation on a genome-wide level.

We plan to recruit approximately three to six affected individuals along with both parents for each phenotype under study. Prospectively recruited trios will be brought to the NIH Clinical Center for brief clinical evaluations and molecular evaluation. Each trio will be consented to whole genome sequencing with the option to learn clinically relevant results, that is, those that explain the disorder in question (what we refer to as the primary variant') as well as other clinically relevant findings discovered incidentally as part of the WGMS process (what we refer to as secondary variants ). Participants will be offered a return visit to NIH to learn these results, and will be asked to complete surveys and participate in interviews related to their decisions about participation in the study and to learn individual genotype results.

The NIH Intramural Sequencing Center (NISC) will screen for sequence variants that conform to the hypothesized inheritance pattern. These variants will be validated, for example by using trios for de novo phenotypes, or with additional cases. We have started developing analytic algorithms to distinguish potentially pathogenic genetic alterations from normal variation. All sequence variants deemed clinically relevant will be validated in a CLIA-certified laboratory and the results returned to that participant, should they choose to learn these findings. This protocol is being designed in a way that will provide the long-term potential for pursuing many different clinical projects.