Rare germline structural variants increase risk for pediatric solid tumors.

Pediatric solid tumors are rare malignancies that represent a leading cause of death by disease among children in developed countries. The early age-of-onset of these tumors suggests that germline genetic factors are involved, yet conventional germline testing for short coding variants in established predisposition genes only identifies pathogenic events in 10-15% of patients. Here, we examined the role of germline structural variants (SVs)-an underexplored form of germline variation-in pediatric extracranial solid tumors using germline genome sequencing of 1,766 affected children, their 943 unaffected relatives, and 6,665 adult controls. We discovered a sex-biased association between very large (>1 megabase) germline chromosomal abnormalities and a four-fold increased risk of solid tumors in male children. The overall impact of germline SVs was greatest in neuroblastoma, where we revealed burdens of ultra-rare SVs that cause loss-of-function of highly expressed, mutationally intolerant, neurodevelopmental genes, as well as noncoding SVs predicted to disrupt three-dimensional chromatin domains in neural crest-derived tissues. Collectively, our results implicate rare germline SVs as a predisposing factor to pediatric solid tumors that may guide future studies and clinical practice.

Validation of Claims-Based Algorithm for Lyme Disease, Massachusetts, USA.

Compared with notifiable disease surveillance, claims-based algorithms estimate higher Lyme disease incidence, but their accuracy is unknown. We applied a previously developed Lyme disease algorithm (diagnosis code plus antimicrobial drug prescription dispensing within 30 days) to an administrative claims database in Massachusetts, USA, to identify a Lyme disease cohort during July 2000-June 2019. Clinicians reviewed and adjudicated medical charts from a cohort subset by using national surveillance case definitions. We calculated positive predictive values (PPVs). We identified 12,229 Lyme disease episodes in the claims database and reviewed and adjudicated 128 medical charts. The algorithm's PPV for confirmed, probable, or suspected cases was 93.8% (95% CI 88.1%-97.3%); the PPV was 66.4% (95% CI 57.5%-74.5%) for confirmed and probable cases only. In a high incidence setting, a claims-based algorithm identified cases with a high PPV, suggesting it can be used to assess Lyme disease burden and supplement traditional surveillance data.

Systematic evaluation of genome sequencing for the diagnostic assessment of autism spectrum disorder and fetal structural anomalies.

Short-read genome sequencing (GS) holds the promise of becoming the primary diagnostic approach for the assessment of autism spectrum disorder (ASD) and fetal structural anomalies (FSAs). However, few studies have comprehensively evaluated its performance against current standard-of-care diagnostic tests: karyotype, chromosomal microarray (CMA), and exome sequencing (ES). To assess the clinical utility of GS, we compared its diagnostic yield against these three tests in 1,612 quartet families including an individual with ASD and in 295 prenatal families. Our GS analytic framework identified a diagnostic variant in 7.8% of ASD probands, almost 2-fold more than CMA (4.3%) and 3-fold more than ES (2.7%). However, when we systematically captured copy-number variants (CNVs) from the exome data, the diagnostic yield of ES (7.4%) was brought much closer to, but did not surpass, GS. Similarly, we estimated that GS could achieve an overall diagnostic yield of 46.1% in unselected FSAs, representing a 17.2% increased yield over karyotype, 14.1% over CMA, and 4.1% over ES with CNV calling or 36.1% increase without CNV discovery. Overall, GS provided an added diagnostic yield of 0.4% and 0.8% beyond the combination of all three standard-of-care tests in ASD and FSAs, respectively. This corresponded to nine GS unique diagnostic variants, including sequence variants in exons not captured by ES, structural variants (SVs) inaccessible to existing standard-of-care tests, and SVs where the resolution of GS changed variant classification. Overall, this large-scale evaluation demonstrated that GS significantly outperforms each individual standard-of-care test while also outperforming the combination of all three tests, thus warranting consideration as the first-tier diagnostic approach for the assessment of ASD and FSAs.

Genome-Wide Analysis of Structural Variants in Parkinson Disease.

OBJECTIVE: Identification of genetic risk factors for Parkinson disease (PD) has to date been primarily limited to the study of single nucleotide variants, which only represent a small fraction of the genetic variation in the human genome. Consequently, causal variants for most PD risk are not known. Here we focused on structural variants (SVs), which represent a major source of genetic variation in the human genome. We aimed to discover SVs associated with PD risk by performing the first large-scale characterization of SVs in PD. METHODS: We leveraged a recently developed computational pipeline to detect and genotype SVs from 7,772 Illumina short-read whole genome sequencing samples. Using this set of SV variants, we performed a genome-wide association study using 2,585 cases and 2,779 controls and identified SVs associated with PD risk. Furthermore, to validate the presence of these variants, we generated a subset of matched whole-genome long-read sequencing data. RESULTS: We genotyped and tested 3,154 common SVs, representing over 412 million nucleotides of previously uncatalogued genetic variation. Using long-read sequencing data, we validated the presence of three novel deletion SVs that are associated with risk of PD from our initial association analysis, including a 2 kb intronic deletion within the gene LRRN4. INTERPRETATION: We identified three SVs associated with genetic risk of PD. This study represents the most comprehensive assessment of the contribution of SVs to the genetic risk of PD to date. ANN NEUROL 2023;93:1012-1022.

Factors associated with prolonged duration of viral clearance in non-severe SARS-CoV-2 patients in Osaka, Japan.

BACKGROUND: We investigated factors associated with prolonged viral clearance of SARS-CoV-2 among non-severe adult patients in Osaka, Japan. A total of 706 laboratory-confirmed COVID-19 patients were enrolled in this longitudinal observational study between 29 January 2020 and 31 May 2020, across 62 hospitals and three non-hospital recuperation facilities. METHODS: Logistic regression analysis was performed to investigate the factors associated with prolonged (29 days: upper 25% in duration) viral clearance of SARS-CoV-2. Linear regression analysis was conducted to assess these factors 14 days after symptom onset. RESULTS: The median duration of viral clearance was 22 days from symptom onset. After adjustment for sex, age, symptoms, comorbidity, and location of recuperation, comorbidities were associated with prolonged duration: (OR, 1.77 [95% CI, 1.11-2.82]) for one, (OR, 2.47 [95% CI, 1.32-4.61]) for two or more comorbidities. Viral clearance 14 days after symptom onset was 3 days longer for one comorbidity and 4 days longer for two or more comorbidities compared to clearance when there was no comorbidity. CONCLUSION: The presence of comorbidity was a robust factor associated with a longer duration of viral clearance, extending by 3 to 4 days compared to patients with no comorbidity.

Landscape of multi-nucleotide variants in 125,748 human exomes and 15,708 genomes.

Multi-nucleotide variants (MNVs), defined as two or more nearby variants existing on the same haplotype in an individual, are a clinically and biologically important class of genetic variation. However, existing tools typically do not accurately classify MNVs, and understanding of their mutational origins remains limited. Here, we systematically survey MNVs in 125,748 whole exomes and 15,708 whole genomes from the Genome Aggregation Database (gnomAD). We identify 1,792,248 MNVs across the genome with constituent variants falling within 2 bp distance of one another, including 18,756 variants with a novel combined effect on protein sequence. Finally, we estimate the relative impact of known mutational mechanisms - CpG deamination, replication error by polymerase zeta, and polymerase slippage at repeat junctions - on the generation of MNVs. Our results demonstrate the value of haplotype-aware variant annotation, and refine our understanding of genome-wide mutational mechanisms of MNVs.

The mutational constraint spectrum quantified from variation in 141,456 humans.

Genetic variants that inactivate protein-coding genes are a powerful source of information about the phenotypic consequences of gene disruption: genes that are crucial for the function of an organism will be depleted of such variants in natural populations, whereas non-essential genes will tolerate their accumulation. However, predicted loss-of-function variants are enriched for annotation errors, and tend to be found at extremely low frequencies, so their analysis requires careful variant annotation and very large sample sizes1. Here we describe the aggregation of 125,748 exomes and 15,708 genomes from human sequencing studies into the Genome Aggregation Database (gnomAD). We identify 443,769 high-confidence predicted loss-of-function variants in this cohort after filtering for artefacts caused by sequencing and annotation errors. Using an improved model of human mutation rates, we classify human protein-coding genes along a spectrum that represents tolerance to inactivation, validate this classification using data from model organisms and engineered human cells, and show that it can be used to improve the power of gene discovery for both common and rare diseases.

ASC-1 Is a Cell Cycle Regulator Associated with Severe and Mild Forms of Myopathy.

OBJECTIVE: Recently, the ASC-1 complex has been identified as a mechanistic link between amyotrophic lateral sclerosis and spinal muscular atrophy (SMA), and 3 mutations of the ASC-1 gene TRIP4 have been associated with SMA or congenital myopathy. Our goal was to define ASC-1 neuromuscular function and the phenotypical spectrum associated with TRIP4 mutations. METHODS: Clinical, molecular, histological, and magnetic resonance imaging studies were made in 5 families with 7 novel TRIP4 mutations. Fluorescence activated cell sorting and Western blot were performed in patient-derived fibroblasts and muscles and in Trip4 knocked-down C2C12 cells. RESULTS: All mutations caused ASC-1 protein depletion. The clinical phenotype was purely myopathic, ranging from lethal neonatal to mild ambulatory adult patients. It included early onset axial and proximal weakness, scoliosis, rigid spine, dysmorphic facies, cutaneous involvement, respiratory failure, and in the older cases, dilated cardiomyopathy. Muscle biopsies showed multiminicores, nemaline rods, cytoplasmic bodies, caps, central nuclei, rimmed fibers, and/or mild endomysial fibrosis. ASC-1 depletion in C2C12 and in patient-derived fibroblasts and muscles caused accelerated proliferation, altered expression of cell cycle proteins, and/or shortening of the G0/G1 cell cycle phase leading to cell size reduction. INTERPRETATION: Our results expand the phenotypical and molecular spectrum of TRIP4-associated disease to include mild adult forms with or without cardiomyopathy, associate ASC-1 depletion with isolated primary muscle involvement, and establish TRIP4 as a causative gene for several congenital muscle diseases, including nemaline, core, centronuclear, and cytoplasmic-body myopathies. They also identify ASC-1 as a novel cell cycle regulator with a key role in cell proliferation, and underline transcriptional coregulation defects as a novel pathophysiological mechanism. ANN NEUROL 2020;87:217-232.

Characterization and spatial distribution of organic-contaminated sediment derived from historical industrial effluents.

Organic sediment contaminants [polychlorinated dibenzo-p-dioxins, polychlorinated dibenzofurans (PCDD/Fs), and polycyclic aromatic hydrocarbons (PAHs)] were assessed using secondary monitoring data from a former tidal estuary (Boat Harbour) impacted by historical industrial effluents. Spatiotemporal characterization of PCDD/Fs and PAHs in sediments was conducted to inform a sediment remediation program designed to return this contaminated aquatic site back to a tidal lagoon. Spatiotemporal variations of sediment PCDD/F and PAH concentrations across Boat Harbour and off-site reference locations were assessed using secondary monitoring data collected between 1992 and 2015. Sediment PCDD/F toxic equivalency (TEQ) and PAH concentrations were compared to sediment quality guidelines. Sediment PCDD/F concentrations exceeded the highest effect thresholds posing severe ecological health risks. High sediment PCDD/F concentrations have persisted in Boat Harbour despite implementation of Pulp and Paper Mill Effluent Chlorinated Dioxins and Furans Regulations in 1992. PAH concentrations varied greatly. Five individual PAH compounds frequently exceeded severe effect thresholds, in contrast to total PAHs, which were below severe effect thresholds. Forensic analysis using PAH diagnostic ratios suggests pyrogenic PAHs derived from wood processes or coal combustion were likely sources. Twenty-five years of monitoring data revealed large data gaps in our understanding of sediment characteristics in Boat Harbour. Gaps included spatial (vertical and horizontal) and temporal variations, presenting challenges for remediation to accurately delineate sediment contaminants. Deeper horizons were poorly characterized compared to shallow sediments (0-15 cm). Historical secondary monitoring data showed that spatial coverage across Boat Harbour was inadequate. Due to severe ecological health risks associated with high sediment PCDD/F concentrations, remediation of the entire sediment inventory is recommended. Detailed vertical and horizontal sampling within Boat Harbour, establishment of local baseline concentrations, and additional sampling in down-gradient-receiving environments for a suite of contaminants are required to better characterize sediments prior to remediation.

Managing Psychosocial Distress: Lessons Learned in Optimizing Screening Program Implementation.

The estimated prevalence of psychosocial distress in cancer patients is 29.6% to 43.4%. Psychosocial distress is associated with depression, a common comorbidity in cancer patients. Untreated distress can contribute to early morbidity and mortality and can worsen other comorbidities. In 2012, the American College of Surgeons (ACoS) Commission on Cancer (CoC) required accredited cancer centers to integrate psychosocial distress screening into cancer care by the end of 2015. Uptake of screening has been minimal, with only 47% to 73% of eligible patients being screened. The Screening for Psychosocial Distress Program (SPDP) is a 2-year educational and implementation-support program designed to help cancer care clinicians meet the ACoS CoC mandate. Through the SPDP, we have trained cancer care clinicians on how to optimize the distress screening process to increase the likelihood that patients' distress will be detected, evaluated, and triaged. We report here on our "lessons learned" and the optimal strategies to promote institutions' adoption of distress screening.

Pilot study investigating ambient air toxics emissions near a Canadian kraft pulp and paper facility in Pictou County, Nova Scotia.

Air toxics are airborne pollutants known or suspected to cause cancer or other serious health effects, including certain volatile organic compounds (VOCs), prioritized by the US Environmental Protection Agency (EPA). While several EPA-designated air toxics are monitored at a subset of Canadian National Air Pollution Surveillance (NAPS) sites, Canada has no specific "air toxics" control priorities. Although pulp and paper (P&P) mills are major industrial emitters of air pollutants, few studies quantified the spectrum of air quality exposures. Moreover, most NAPS monitoring sites are in urban centers; in contrast, rural NAPS sites are sparse with few exposure risk records. The objective of this pilot study was to investigate prioritized air toxic ambient VOC concentrations using NAPS hourly emissions data from a rural Pictou, Nova Scotia Kraft P&P town to document concentration levels, and to determine whether these concentrations correlated with wind direction at the NAPS site (located southwest of the mill). Publicly accessible Environment and Climate Change Canada data (VOC concentrations [Granton NAPS ID: 31201] and local meteorological conditions [Caribou Point]) were examined using temporal (2006-2013) and spatial analytic methods. Results revealed several VOCs (1,3-butadiene, benzene, and carbon tetrachloride) routinely exceeded EPA air toxics-associated cancer risk thresholds. 1,3-Butadiene and tetrachloroethylene were significantly higher (p < 0.05) when prevailing wind direction blew from the northeast and the mill towards the NAPS site. Conversely, when prevailing winds originated from the southwest towards the mill, higher median VOC air toxics concentrations at the NAPS site, except carbon tetrachloride, were not observed. Despite study limitations, this is one of few investigations documenting elevated concentrations of certain VOCs air toxics to be associated with P&P emissions in a community. Findings support the need for more research on the extent to which air toxics emissions exist in P&P towns and contribute to poor health in nearby communities.

Spatiotemporal assessment (quarter century) of pulp mill metal(loid) contaminated sediment to inform remediation decisions.

A bleached kraft pulp mill in Nova Scotia has discharged effluent wastewater into Boat Harbour, a former tidal estuary within Pictou Landing First Nation since 1967. Fifty years of effluent discharge into Boat Harbour has created >170,000 m3 of unconsolidated sediment, impacted by inorganic and organic contaminants, including metal[loid]s, polycyclic aromatic hydrocarbons (PAHs), dioxins, and furans. This study aimed to characterize metal(loid)-impacted sediments to inform decisions for a $89 million CAD sediment remediation program. The remediation goals are to return this impacted aquatic site to pre-mill tidal conditions. To understand historical sediment characteristics, spatiotemporal variation covering ~quarter century, of metal(loid) sediment concentrations across 103 Boat Harbour samples from 81 stations and four reference locations, were assessed by reviewing secondary data from 1992 to 2015. Metal(loid) sediment concentrations were compared to current Canadian freshwater and marine sediment quality guidelines (SQGs). Seven metal(loid)s, As, Cd, Cr, Cu, Pb, Hg, and Zn, exceeded low effect freshwater and marine SQGs; six, As, Cd, Cr, Pb, Hg, and Zn, exceeded severe effect freshwater SQGs; and four, Cd, Cu, Hg, and Zn, exceeded severe effect marine SQGs. Metal(loid) concentrations varied widely across three distinct temporal periods. Significantly higher Cd, Cu, Pb, Hg, and Zn concentrations were measured between 1998 and 2000, compared to earlier, 1992-1996 and more recent 2003-2015 data. Most samples, 69%, were shallow (0-15 cm), leaving deeper horizons under-characterized. Geographic information system (GIS) techniques also revealed inadequate spatial coverage, presenting challenges for remedy decisions regarding vertical and horizontal delineation of contaminants. Review of historical monitoring data revealed that gaps still exist in our understanding of sediment characteristics in Boat Harbour, including spatial, vertical and horizontal, and temporal variation of sediment contamination. To help return Boat Harbour to a tidal estuary, more detailed sampling is required to better characterize these sediments and to establish appropriate reference (background) concentrations to help develop cost-effective remediation approaches for this decades-old problem.

Analysis of protein-coding genetic variation in 60,706 humans.

Large-scale reference data sets of human genetic variation are critical for the medical and functional interpretation of DNA sequence changes. Here we describe the aggregation and analysis of high-quality exome (protein-coding region) DNA sequence data for 60,706 individuals of diverse ancestries generated as part of the Exome Aggregation Consortium (ExAC). This catalogue of human genetic diversity contains an average of one variant every eight bases of the exome, and provides direct evidence for the presence of widespread mutational recurrence. We have used this catalogue to calculate objective metrics of pathogenicity for sequence variants, and to identify genes subject to strong selection against various classes of mutation; identifying 3,230 genes with near-complete depletion of predicted protein-truncating variants, with 72% of these genes having no currently established human disease phenotype. Finally, we demonstrate that these data can be used for the efficient filtering of candidate disease-causing variants, and for the discovery of human 'knockout' variants in protein-coding genes.

A Modified Wire Hanging Apparatus for Small Animal Muscle Function Testing.

Wire hang tests are simple and cheap methods to assess muscle performance in small rodents, but do not always yield consistent results. We describe a simple wire hang apparatus that comprises a continuous rolling loop. Wire hang times measured using the rolling wire provide consistent and reliable data that more accurately reflect the output of a continuous physical effort. As such data obtained in mice using a rolling wire are more representative of the physical changes in the mouse muscle and less susceptible to individual mouse behaviour and differences in animal handling.

Assessment of public perception and environmental compliance at a pulp and paper facility: a Canadian case study.

Communities across Canada rely heavily on natural resources for their livelihoods. One such community in Pictou County, Nova Scotia, has both benefited and suffered, because of its proximity to a pulp and paper mill (currently owned by Northern Pulp). Since production began in 1967, there have been increasing impacts to the local environment and human health. Environmental reports funded by the mill were reviewed and compared against provincial and federal regulatory compliance standards. Reports contrasted starkly to societal perceptions of local impacts and independent studies. Most environmental monitoring reports funded by the mill indicate some levels of compliance in atmospheric and effluent emissions, but when compliance targets were not met, there was a lack of regulatory enforcement. After decades of local pollution impacts and lack of environmental compliance, corporate social responsibility initiatives need implementing for the mill to maintain its social licence to operate.

The male sex pheromone darcin stimulates hippocampal neurogenesis and cell proliferation in the subventricular zone in female mice.

The integration of newly generated neurons persists throughout life in the mammalian olfactory bulb and hippocampus, regions involved in olfactory and spatial learning. Social cues can be potent stimuli for increasing adult neurogenesis; for example, odors from dominant but not subordinate male mice increase neurogenesis in both brain regions of adult females. However, little is known about the role of neurogenesis in social recognition or the assessment of potential mates. Dominant male mice scent-mark territories using urine that contains a number of pheromones including darcin (MUP20), a male-specific major urinary protein that stimulates rapid learned attraction to the spatial location and individual odor signature of the scent owner. Here we investigate whether exposure to darcin stimulates neurogenesis in the female brain. Hippocampal neurons and cellular proliferation in the lateral ventricles that supply neurons to the olfactory bulbs increased in females exposed for 7 days to male urine containing at least 0.5 µg/µl darcin. Darcin was effective whether presented alone or in the context of male urine, but other information in male urine appeared to modulate the proliferative response. When exposed to urine from wild male mice, hippocampal proliferation increased only if urine was from the same individual over 7 days, suggesting that consistency of individual scent signatures is important. While 7 days exposure to male scent initiated the first stages of increased neurogenesis, this caused no immediate increase in female attraction to the scent or in the strength or robustness of spatial learning in short-term conditioned place preference tests. The reliable and consistent stimulation of neurogenesis by a pheromone important in rapid social learning suggests that this may provide an excellent model to explore the relationship between the integration of new neurons and plasticity in spatial and olfactory learning in a socially-relevant context.