Whole genome sequencing: interpretatie van niet-coderende variatie in patiënten met syndromale verstandelijke beperking.

Van Laere Manon, 2025
Neurodevelopmental disorders represent a significant and common category of pathologies, impacting a substantial portion of the global population. Despite increasing awareness of these disorders, only approximately 50% of affected individuals currently receive a definitive molecular diagnosis. This diagnostic gap creates considerable uncertainty for both patients and their families, often delaying appropriate interventions and exacerbating the emotional and psychological burden on their environment. Recent advancements in genomic technologies, particularly the development of whole genome sequencing (WGS), offer promising solutions to these diagnostic challenges. WGS provides a more comprehensive analysis of the genome compared to the previously employed whole exome sequencing (WES), which focuses solely on protein-coding regions. To empirically evaluate the potential benefits of WGS over WES, the national initiative BeSolveRD has been launched. The primary objective of the project is to determine whether WGS could be adopted as the new standard of care for the molecular diagnosis of rare genetic disorders. In addition to enhancing diagnostic accuracy, WGS may have the potential to transform patient care. For healthcare professionals, WGS provides a broader, more detailed view of the genome, thereby increasing the likelihood of achieving a conclusive diagnosis. For patients and their families, obtaining a molecular diagnosis can be transformative, as it opens the door to targeted therapies, informed clinical management, and access to genetic counseling services, all of which can significantly improve the quality of life and reduce uncertainties. This molecular diagnosis can also be obtained earlier, because of the faster diagnostic timelines, resulting in earlier interventions and more long-term effects. However, while WGS presents numerous potential advantages, it also introduces several significant challenges. One of the primary issues associated with WGS is the vast volume of data it generates, which complicates both analysis and interpretation. Each sequenced genome generates a substantial volume of data, complicating the management and precise identification of pathogenic variants within this information. This poses a particular challenge in clinical settings where timely and accurate diagnoses are crucial. The BeSolveRD project will systematically evaluate both the advantages and limitations of WGS. This includes examining the improved diagnostic yield and the challenges associated with data management, variant interpretation, and the potential for incidental findings. The outcomes of this evaluation will be critical in determining the feasibility of integrating WGS into routine clinical practice and its potential to become the standard diagnostic tool for neurodevelopmental and other genetic disorders. To fully leverage the diagnostic potential of WGS, specialized analytical tools are necessary. In response to this need, several analysis tools exist among which Seqr. Seqr is designed to facilitate the efficient identification of pathogenic mutations within the large datasets generated by WGS. However, despite the utility of Seqr, the task remains complex. WGS often reveals between 50 to 100 genetic variants that could be causal in a single patient's genome, many of which being either benign or of uncertain clinical significance. Identifying the causative variant among these requires advanced bioinformatics tools and expert interpretation.

Promotor Annelies Dheedene
Opleiding Geneeskunde
Domein Pediatrie