Singapore Undiagnosed Disease Program: Genomic Analysis aids Diagnosis and Clinical Management.

Journal: Archives Of Disease In Childhood
Published:
Abstract

Objective: Use next-generation sequencing (NGS) technology to improve our diagnostic yield in patients with suspected genetic disorders in the Asian setting.

Design: A diagnostic study conducted between 2014 and 2019 (and ongoing) under the Singapore Undiagnosed Disease Program. Date of last analysis was 1 July 2019. Setting: Inpatient and outpatient genetics service at two large academic centres in Singapore. Patients: Inclusion criteria: patients suspected of genetic disorders, based on abnormal antenatal ultrasound, multiple congenital anomalies and developmental delay. Exclusion criteria: patients with known genetic disorders, either after clinical assessment or investigations (such as karyotype or chromosomal microarray). Interventions: Use of NGS technology-whole exome sequencing (WES) or whole genome sequencing (WGS). Main outcome measures: (1) Diagnostic yield by sequencing type, (2) diagnostic yield by phenotypical categories, (3) reduction in time to diagnosis and (4) change in clinical outcomes and management.

Results: We demonstrate a 37.8% diagnostic yield for WES (n=172) and a 33.3% yield for WGS (n=24). The yield was higher when sequencing was conducted on trios (40.2%), as well as for certain phenotypes (neuromuscular, 54%, and skeletal dysplasia, 50%). In addition to aiding genetic counselling in 100% of the families, a positive result led to a change in treatment in 27% of patients.

Conclusion: Genomic sequencing is an effective method for diagnosing rare disease or previous 'undiagnosed' disease. The clinical utility of WES/WGS is seen in the shortened time to diagnosis and the discovery of novel variants. Additionally, reaching a diagnosis significantly impacts families and leads to alteration in management of these patients.

Authors
Neha Bhatia, Jiin Lim, Carine Bonnard, Jyn-ling Kuan, Maggie Brett, Heming Wei, Breana Cham, Huilin Chin, Celia Bosso Lefevre, Perumal Dharuman, Nathalie Escande Beillard, Arun Devasia, Chew Yin Goh, Sylvia Kam, Wendy Liew, Woei Liew, Grace Lin, Kanika Jain, Alvin Ng, Deepa Subramanian, Min Xie, Yuen-ming Tan, Nilesh Tawari, Zenia Tiang, Teck Ting, Sumanty Tohari, Cheuk Tong, Alexander Lezhava, Sarah Ng, Hai Law, Byrappa Venkatesh, Swati Tomar, Raman Sethi, Grace Tan, Arthi Shanmugasundaram, Denise Goh, Poh Lai, Angeline Lai, Ee Tan, Ivy Ng, Bruno Reversades, Ene Tan, Roger Foo, Saumya Jamuar
Relevant Conditions

HIV/AIDS