WO2013052557A2 - Procédés pour diagnostic génétique préimplantatoire par séquençage - Google Patents

Procédés pour diagnostic génétique préimplantatoire par séquençage Download PDF

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Publication number
WO2013052557A2
WO2013052557A2 PCT/US2012/058578 US2012058578W WO2013052557A2 WO 2013052557 A2 WO2013052557 A2 WO 2013052557A2 US 2012058578 W US2012058578 W US 2012058578W WO 2013052557 A2 WO2013052557 A2 WO 2013052557A2
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Prior art keywords
chromosome
dna
loci
interest
sequencing
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PCT/US2012/058578
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English (en)
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WO2013052557A3 (fr
Inventor
Matthew Rabinowitz
Matthew Hill
Bernhard Zimmermann
Johan Baner
Allison Ryan
George Gemelos
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Natera, Inc.
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Priority claimed from US13/300,235 external-priority patent/US10017812B2/en
Application filed by Natera, Inc. filed Critical Natera, Inc.
Priority to PCT/US2013/028378 priority Critical patent/WO2013130848A1/fr
Publication of WO2013052557A2 publication Critical patent/WO2013052557A2/fr
Publication of WO2013052557A3 publication Critical patent/WO2013052557A3/fr
Priority to US14/225,356 priority patent/US20140206552A1/en
Priority to US14/877,925 priority patent/US20170051355A1/en
Priority to US14/918,544 priority patent/US10316362B2/en
Priority to US16/140,298 priority patent/US20190010543A1/en
Priority to US16/288,022 priority patent/US10597723B2/en
Priority to US16/353,636 priority patent/US10655180B2/en
Priority to US16/399,268 priority patent/US10538814B2/en
Priority to US16/399,947 priority patent/US10793912B2/en
Priority to US16/399,103 priority patent/US10557172B2/en
Priority to US16/412,331 priority patent/US10526658B2/en
Priority to US16/412,353 priority patent/US20190309365A1/en
Priority to US16/734,814 priority patent/US20200123612A1/en
Priority to US16/743,724 priority patent/US10731220B2/en
Priority to US16/747,833 priority patent/US11312996B2/en
Priority to US16/777,700 priority patent/US11332793B2/en
Priority to US16/817,117 priority patent/US20200208221A1/en
Priority to US16/829,133 priority patent/US11525162B2/en
Priority to US16/856,924 priority patent/US20200318191A1/en
Priority to US16/934,407 priority patent/US11519035B2/en
Priority to US17/018,966 priority patent/US11939634B2/en
Priority to US17/061,877 priority patent/US11111545B2/en
Priority to US17/196,822 priority patent/US11286530B2/en
Priority to US17/196,722 priority patent/US20210198743A1/en
Priority to US17/196,659 priority patent/US20210198742A1/en
Priority to US17/505,588 priority patent/US20220033909A1/en
Priority to US17/545,881 priority patent/US20220098667A1/en
Priority to US17/842,118 priority patent/US20220356526A1/en
Priority to US17/868,238 priority patent/US20230053752A1/en
Priority to US17/868,141 priority patent/US20220411875A1/en
Priority to US18/111,804 priority patent/US20240158855A1/en
Priority to US18/126,344 priority patent/US20230383348A1/en
Priority to US18/243,593 priority patent/US20240068031A1/en

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    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
    • C12Q1/00—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions
    • C12Q1/68—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions involving nucleic acids
    • C12Q1/6844—Nucleic acid amplification reactions
    • C12Q1/6858—Allele-specific amplification
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16B—BIOINFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR GENETIC OR PROTEIN-RELATED DATA PROCESSING IN COMPUTATIONAL MOLECULAR BIOLOGY
    • G16B20/00—ICT specially adapted for functional genomics or proteomics, e.g. genotype-phenotype associations
    • G16B20/20—Allele or variant detection, e.g. single nucleotide polymorphism [SNP] detection
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
    • C12Q1/00—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions
    • C12Q1/68—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions involving nucleic acids
    • C12Q1/6876—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes
    • C12Q1/6883—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes for diseases caused by alterations of genetic material
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16B—BIOINFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR GENETIC OR PROTEIN-RELATED DATA PROCESSING IN COMPUTATIONAL MOLECULAR BIOLOGY
    • G16B20/00—ICT specially adapted for functional genomics or proteomics, e.g. genotype-phenotype associations
    • G16B20/10—Ploidy or copy number detection
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
    • C12Q2600/00—Oligonucleotides characterized by their use
    • C12Q2600/156—Polymorphic or mutational markers
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16B—BIOINFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR GENETIC OR PROTEIN-RELATED DATA PROCESSING IN COMPUTATIONAL MOLECULAR BIOLOGY
    • G16B20/00—ICT specially adapted for functional genomics or proteomics, e.g. genotype-phenotype associations

Definitions

  • the present disclosure relates generally to methods for preimplantation genetic diagnosis in the context of in vitro fertilization.
  • the process of PGD during IVF currently involves extracting a single cell from the roughly eight cells of an early-stage embryo for analysis. Isolation of single cells from human embryos, while highly technical, is now routine in IVF clinics. Both polar bodies and blastomeres have been isolated with success. The most common technique is to remove single blastomeres from day 3 embryos (6 or 8 cell stage). Embryos are transferred to a special cell culture medium (standard culture medium lacking calcium and magnesium), and a hole is introduced into the zona pellucida using an acidic solution, laser, or mechanical techniques. The technician then uses a biopsy pipette to remove a single blastomere with a visible nucleus. Features of the DNA of the single (or occasionally multiple) blastomere are measured using a variety of techniques. Since only a single copy of the DNA is available from one cell, direct measurements of the DNA are highly error-prone, or noisy. There is a great need for a technique that can correct, or make more accurate, these noisy genetic measurements.
  • chromosomes normal humans have two sets of 23 chromosomes in every diploid cell, with one copy coming from each parent.
  • Aneuploidy the state of a cell with extra or missing chromosome(s), and uniparental disomy, the state of a cell with two of a given chromosome which both originate from one parent, are believed to be responsible for a large percentage of failed implantations and miscarriages, and some genetic diseases.
  • Detection of chromosomal abnormalities can identify individuals or embryos with conditions such as Down syndrome, Klinefelter' s syndrome, and Turner syndrome, among others, in addition to increasing the chances of a successful pregnancy.
  • chromosomal abnormalities is especially important as the age of a potential mother increases: between the ages of 35 and 40 it is estimated that between 40% and 50% of the embryos are abnormal, and above the age of 40, more than half of the embryos are like to be abnormal.
  • the main cause of aneuploidy is nondisjunction during meiosis. Maternal nondisjunction constitutes approxiamtely 88% of all nondisjunction of which about 65% occurs in meiosis I and 23% in meiosis II.
  • Common types of human aneuploidy include trisomy from meiosis I nondisjunction, monosomy, and uniparental disomy.
  • M2 trisomy In a particular type of trisomy that arises in meiosis II nondisjunction, or M2 trisomy, an extra chromosome is identical to one of the two normal chromosomes. M2 trisomy is particularly difficult to detect. There is a great need for a better method that can detect many or all types of aneuploidy at most or all of the chromosomes efficiently and with high accuracy, including a method that can differentiate not only euploidy from aneuploidy, but also that can differentiate different types of aneuploidy from one another.
  • FISH fluorescent in situ hybridization
  • FISH FISH has a low level of specificity. Roughly seventy- five percent of PGD today measures high-level chromosomal abnormalities such as aneuploidy using FISH with error rates on the order of 10-15%. There is a great demand for an aneuploidy screening method that has a higher throughput, lower cost, and greater accuracy.
  • a method for determining a ploidy state of an embryo at a chromosome of interest includes: obtaining a genetic sample from the embryo; preparing the genetic sample for sequencing; sequencing the genetic sample to give sequencing data; counting the number of sequence reads in the sequence data associated with each of a plurality of loci on the
  • the genetic sample is one, two, three to five, six to ten, eleven to twenty, twenty one to fifty, or fifty one to one hundred cells biopsied from an embryo.
  • the genetic sample is prepared for sequencing by performing amplification or universal amplification of the DNA in the genetic sample.
  • the method includes preferentially enriching the DNA in the genetic sample at a plurality of polymorphic loci.
  • the step of preferentially enriching the DNA includes performing targeted PCR amplification of the DNA in the genetic sample at a plurality of polymorphic loci.
  • the step of preferentially enriching the DNA comprises: obtaining a forward probe such that the 3' end of the forward probe is designed to hybridize to the region of DNA immediately upstream from the polymorphic region, and separated from the polymorphic region by a small number of bases, where the small number is selected from the group consisting of 1 , 2, 3, 4, 5, 6 to 10, and 11 to 20; obtaining a reverse probe such that the 3 ' end of the reverse probe is designed to hybridize to the region of DNA immediately downstream from the polymorphic region, and separated from the polymorphic region by a small number of bases, where the small number is selected from the group consisting of 1, 2, 3, 4, 5, 6 to 10, and 11 to 20; hybridizing the two probes to DNA in the first sample of DNA; and amplifying the DNA using the polymerase chain reaction.
  • preferentially enriching the DNA results in average degree of allelic bias between the second sample and the first sample of a factor selected from the group consisting of no more than a factor of 2, no more than a factor of 1.5, no more than a factor of 1.2, no more than a factor of 1.1 , no more than a factor of 1.05, no more than a factor of 1.02, no more than a factor of 1.01 , no more than a factor of 1.005, no more than a factor of 1.002, no more than a factor of 1.001 and no more than a factor of 1.0001.
  • the sequencing is performed using a high throughput sequencer.
  • the method includes using maximum likelihood estimates to select the ploidy state corresponding to a hypothesis with the greatest probability.
  • determining the most likely ploidy state of the chromosome includes: counting the number of sequence reads in the sequence data associated with each of a plurality of loci on one or more reference chromosomes; and comparing the number of sequence reads associated with each of the plurality of loci on the chromosome of interest to the number of sequence reads associated with each of a plurality of targeted loci at one or a plurality of reference chromosomes where the reference chromosome(s) is assumed to be disomic.
  • the method further includes counting the number of sequence reads in the sequence data associated with each of a plurality of loci on one or more reference chromosomes, wherein: the ploidy state of the chromosome of interest is determined to be trisomy where the number of sequence reads associated with each of the plurality of loci at the chromosome of interest is about 50% greater than the number of sequence reads associated with each of a plurality of loci at one or a plurality of reference chromosomes; the ploidy state of the chromosome of interest is determined to be disomy where the number of sequence reads associated with each of the plurality of loci at the chromosome of interest is about the same as the number of sequence reads associated with each of a plurality of loci at one or a plurality of reference chromosomes; and the ploidy state of the chromosome of interest is determined to be monosomy where the number of sequence reads associated with each of the plurality of loci at the chromosome
  • the loci are single nucleotide polymorphisms.
  • the method includes comparing the number of sequence reads associated with each of the alleles at the plurality of loci on the chromosome of interest, where certain allele ratios are associated with certain ploidy states.
  • the ploidy state of the chromosome of interest is determined to be trisomy when the ratios of the number of sequence reads associated with each of the alleles at a plurality of polymorphic loci on the chromosome of interest are about 100%, 67%, 33% or 0%; the ploidy state of the chromosome of interest is determined to be disomy when the ratios of the number of sequence reads associated with each of the alleles at a plurality of polymorphic loci on the chromosome of interest are about 100%, 50% or 0%; and the ploidy state of the chromosome of interest is determined to be monosomy when the ratios of the number of sequence reads associated with each of the alleles at a plurality of polymorphic loci on the chromosome of interest are about 100% or 0%.
  • the method includes calculating a confidence estimate for a called ploidy state. In an embodiment, the method includes producing a report stating the called ploidy state of the embryo at that chromosome. In an embodiment, the method includes taking a clinical action based on the determined ploidy state of the embryo, wherein the clinical action is to transfer or not transfer the embryo into the uterus of the mother.
  • a method for determining a ploidy state of an embryo at a chromosome includes: obtaining a genetic sample from the embryo; amplifying the DNA present in the genetic sample by targeted PCR; sequencing the amplified DNA using a high throughput sequencer to give sequencing data; counting the number of sequence reads in the sequence data associated with each allele at a plurality of single nucleotide polymorphisms on the chromosome; calculating the allele ratios between the alleles at the plurality of single nucleotide
  • a method for determining a ploidy state of an embryo at a chromosome of interest includes: obtaining a genetic sample from the embryo; amplifying the DNA present in the genetic sample by targeted PCR where the targeted PCR targets a plurality of loci on the chromosome of interest and on one or more reference chromosomes; sequencing the amplified DNA using a high throughput sequencer to give sequencing data; counting the number of sequence reads in the sequence data associated with each targeted locus on the chromosome of interest and on one or more reference chromosomes; determining the most likely ploidy state of the chromosome of interest given the ratio between the sequence read count associated with each targeted locus on the target chromosome and the sequence read count associated with each targeted allele on the reference chromosome(s
  • FIG. 1 shows allele ratio data from a genomic sample from an individual with a 47,XY +13 karyotype, graphed for a plurality of SNPs on chromosomes 1, 2, 13, 18, 21 and X.
  • FIG. 2 shows allele ratio data from a genomic sample from an individual with a 47,XX +18 karyotype, graphed for a plurality of SNPs on chromosomes 1, 2, 13, 18, 21 and X.
  • FIG. 3 shows allele ratio data from a genomic sample from an individual with a 47,XX
  • +21 karyotype graphed for a plurality of SNPs on chromosomes 1, 2, 13, 18, 21 and X.
  • FIG. 4 shows allele ratio data from a three-cell sample from an individual with a 47,XX +21 karyotype, graphed for a plurality of SNPs on chromosomes 1, 21 and X.
  • FIG. 5 shows allele ratio data from a three-cell sample from an individual with a 47,XX +21 karyotype, graphed for a plurality of SNPs on chromosomes 1, 21 and X. Only SNPs where the mother is heterozygous are shown.
  • FIG. 6 shows allele ratio data from a three-cell sample from an individual with a 47,XX +21 karyotype, graphed for a plurality of SNPs on chromosomes 1, 21 and X. Only SNPs where the mother is homozygous are shown.
  • FIG. 7 shows depth of read data for three cells from the same individual, run separately. Only heterozygous SNPs are shown.
  • FIG. 8 shows allele ratio data from a single-cell sample from an individual with a 47,XX +21 karyotype, graphed for a plurality of SNPs on chromosomes 1, 2, 13, 18, 21 and X. Only SNPs where the mother is homozygous are shown.
  • FIG. 9 shows allele ratio data from a single-cell sample from an individual with a 47,XX +21 karyotype, graphed for a plurality of SNPs on chromosomes 1, 21 and X.
  • FIG. 10 shows allele ratio data from a single-cell sample from an individual with a 47,XX +21 karyotype, graphed for a plurality of SNPs on chromosomes 1, 21 and X.
  • FIG. 1 1 shows allele ratio data from a single-cell sample from an individual with a
  • FIG. 12 shows allele ratio data from a single-cell sample from an individual with a 47,XX +21 karyotype, graphed for a plurality of SNPs on chromosomes 1, 21 and X.
  • FIG. 13 shows allele ratio data from a single-cell sample from an individual with a 46,XY karyotype, graphed for a plurality of SNPs on chromosomes 1, 21 and X.
  • FIG. 14 shows allele ratio data from a single-cell sample from an individual with a 46,XX karyotype, graphed for a plurality of SNPs on chromosomes 1, 21 and X.
  • a method for determining a ploidy state of an embryo at a chromosome of interest includes obtaining a genetic sample from the embryo.
  • the genetic sample may be obtained from the embryo by any suitable method.
  • the genetic sample is one or more cells biopsied from an embryo.
  • the genetic sample is a plurality of cells biopsied from an embryo.
  • the genetic sample is one, two, three to five, six to ten, eleven to twenty, twenty one to fifty, or fifty one to one hundred cells biopsied from an embryo.
  • the method also includes preparing the genetic sample for sequencing. Any suitable method may be used to prepare the genetic sample for sequencing.
  • the genetic sample is prepared for sequencing by amplification or universal amplification of the DNA present in the genetic sample.
  • the method also includes sequencing the genetic sample to give sequencing data such as by using a high throughput next generation sequencer or any other suitable method.
  • the method includes counting the number of sequence reads in the sequence data associated with each of a plurality of loci on the chromosome of interest.
  • the polymorphic loci may be single nucleotide polymorphisms.
  • the method includes determining the most likely ploidy state of the chromosome given the sequence read count associated with each allele at a plurality of polymorphic loci on the chromosome of interest.
  • the most likely ploidy state of the chromosome may be determined using a computer.
  • determining the most likely ploidy state includes calculating the allele ratios at the plurality of polymorphic loci, where certain allele ratios are associated with certain ploidy states.
  • the method disclosed herein involves comparing the observed allele measurements to theoretical hypotheses corresponding to possible fetal genetic states.
  • the method includes performing a maximum likelihood calculation for a plurality of hypotheses where the hypotheses correspond to the sequencing measurements that are expected for a plurality of ploidy states. In an embodiment, the method includes determining the most likely ploidy state using maximum likelihood estimates to select the ploidy state corresponding to a hypothesis with the greatest probability. In an embodiment, the method for calling the ploidy state comprises a quantitative analysis of the number of sequence reads associated with a plurality of loci at the chromosome of interest.
  • the ploidy state for a chromosome of interest is called as trisomy when the number of sequence reads associated with each of the plurality of loci at the chromosome of interest is approximately 50% greater than the number of sequence reads associated with each of a plurality of targeted loci at one or a plurality of reference chromosomes where the reference chromosome(s) is assumed to be disomic.
  • the ploidy state for a chromosome of interest is called as disomy when the number of sequence reads associated with each of the plurality of loci at the chromosome of interest is approximately the same as the number of sequence reads associated with each of a plurality of targeted loci at one or a plurality of reference chromosomes where the reference chromosome(s) is assumed to be disomic.
  • the ploidy state for a chromosome of interest is called as monosomy when the number of sequence reads associated with each of the plurality of loci at the chromosome of interest is approximately 50% less than the number of sequence reads associated with each of a plurality of targeted loci at one or a plurality of reference chromosomes where the reference chromosome(s) is assumed to be disomic.
  • the method for calling the ploidy state comprises an analysis of the ratios of the number of reads associated with the possible alleles for a plurality of polymorphic loci on the chromosome of interest.
  • the ploidy state for a chromosome of interest is called as trisomy when the relative ratios of the number of sequence reads associated with the two observed alleles at a plurality of loci on the chromosome of interest tend to be about 100%, 61%, 33%) or 0%.
  • the ploidy state for a chromosome of interest is called as disomy when the relative ratios of the number of sequence reads associated with the two observed alleles at a plurality of loci on the chromosome of interest tend to be about 100%>, 50%) or 0%).
  • the ploidy state for a chromosome of interest is called as monosomy when the relative ratios of the number of sequence reads associated with the two observed alleles at a plurality of loci on the chromosome of interest tend to be about 100% or 0%.
  • determining the most likely ploidy state of the chromosome includes: counting the number of sequence reads in the sequence data associated with each of a plurality of loci on one or more reference chromosomes; and comparing the number of sequence reads associated with each of the plurality of loci on the chromosome of interest to the number of sequence reads associated with each of a plurality of targeted loci at one or a plurality of reference chromosomes where the reference chromosome(s) is assumed to be disomic.
  • the method further includes counting the number of sequence reads in the sequence data associated with each of a plurality of loci on one or more reference chromosomes, wherein: the ploidy state of the chromosome of interest is determined to be trisomy where the number of sequence reads associated with each of the plurality of loci at the chromosome of interest is about 50% greater than the number of sequence reads associated with each of a plurality of loci at one or a plurality of reference chromosomes; the ploidy state of the chromosome of interest is determined to be disomy where the number of sequence reads associated with each of the plurality of loci at the chromosome of interest is about the same as the number of sequence reads associated with each of a plurality of loci at one or a plurality of reference chromosomes; and the ploidy state of the chromosome of interest is determined to be monosomy where the number of sequence reads associated with each of the plurality of loci at the chromosome
  • the loci are polymorphic loci
  • the method includes counting the number of sequence reads in the sequence data associated with each of the possible alleles at the plurality of loci on the chromosome of interest. In an embodiment, the method includes comparing the number of sequence reads associated with each of the alleles at a plurality of polymorphic loci on the chromosome of interest.
  • the ploidy state of the chromosome of interest is determined to be trisomy when the ratios of the number of sequence reads associated with each of the alleles at a plurality of polymorphic loci on the chromosome of interest are about 100%», 67%, 33% or 0%; the ploidy state of the chromosome of interest is determined to be disomy when the ratios of the number of sequence reads associated with each of the alleles at a plurality of polymorphic loci on the chromosome of interest are about 100%, 50% or 0%; and the ploidy state of the chromosome of interest is determined to be monosomy when the ratios of the number of sequence reads associated with each of the alleles at a plurality of polymorphic loci on the chromosome of interest are about 100%» or 0%.
  • a method for determining a ploidy state of an embryo at a chromosome includes: obtaining a genetic sample from the embryo; amplifying the DNA present in the genetic sample by targeted PCR; sequencing the amplified DNA using a high throughput next generation sequencer to give sequencing data; counting the number of sequence reads in the sequence data associated with each allele at a plurality of single nucleotide polymorphisms on the chromosome; and determining the most likely ploidy state of the chromosome given the sequence read count associated with each allele.
  • a method for determining a ploidy state of an embryo at a chromosome of interest includes: obtaining a genetic sample from the embryo; amplifying the DNA present in the genetic sample by targeted PCR; sequencing the amplified DNA to give sequencing data; counting the number of sequence reads in the sequence data associated with each targeted locus on the chromosome of interest and on one or more reference chromosomes; determining the most likely ploidy state of the chromosome of interest given the ratio between the sequence read count associated with each targeted locus on the target chromosome and the sequence read count associated with each targeted allele on the reference chromosome(s), where certain ratios are associated with certain ploidy states.
  • the method may include calculating a confidence estimate for a called ploidy state.
  • a report may be produced stating the called ploidy state of the embryo at that chromosome.
  • a clinical action may be taken based on the determined ploidy state of the embryo. For example, the clinical action may be to transfer or not to transfer the embryo into the uterus of the mother.
  • the fetal or embryonic genomic data can be used to detect if the cell is aneuploid, that is, where the wrong number of a chromosome is present in a cell, or if the wrong number of sexual chromosomes are present in the cell.
  • the genetic data can also be used to detect for uniparental disomy, a condition in which two of a given chromosome are present, both of which originate from one parent. This is done by creating a set of hypotheses about the potential states of the DNA, and testing to see which hypothesis has the highest probability of being true given the measured data.
  • the use of high throughput genotyping data for screening for aneuploidy enables a single blastomere from each embryo to be used both to measure multiple disease-linked loci as well as to screen for aneuploidy.
  • the direct measurements of the amount of genetic material, amplified or unamplified, present at a plurality of loci can be used to detect for monosomy, uniparental disomy, matched trisomy, unmatched trisomy, tetrasomy, and other aneuploidy states.
  • One embodiment of the present disclosure takes advantage of the fact that under some conditions, the average level of amplification and measurement signal output is invariant across the chromosomes, and thus the average amount of genetic material measured at a set of neighboring loci will be proportional to the number of homologous chromosomes present, and the ploidy state may be called in a statistically significant fashion.
  • different alleles have a statistically different characteristic amplification profiles given a certain parent context and a certain ploidy state; these characteristic differences can be used to determine the ploidy state of the chromosome.
  • the present disclosure provides methods for determining the ploidy status of an embryo at a chromosome from a sample of DNA from an embryo.
  • the ploidy state is determined by sequencing the DNA from one or more cells biopsied from the embryo, and analyzing the relative amounts of each allele at a plurality of polymorphic loci on the chromosome.
  • the ploidy state is determined by comparing the observed allele ratios to the expected allele ratios for different ploidy states.
  • the DNA is selectively amplified at a plurality of polymorphic loci by targeted sequencing.
  • the mixed sample of DNA may be preferentially enriched at a plurality of polymorphic loci in a way that minimizes the allelic bias.
  • the disclosed method enables the reconstruction of incomplete or noisy genetic data, including the determination of the identity of individual alleles, haplotypes, sequences, insertions, deletions, repeats, and the determination of chromosome copy number on a target individual, all with high fidelity, using secondary genetic data as a source of information.
  • the use of this method may facilitate diagnoses focusing on inheritable diseases, chromosome copy number predictions, increased likelihoods of defects or abnormalities, as well as making predictions of susceptibility to various disease-and non-disease phenotypes for individuals to enhance clinical and lifestyle decisions.
  • PARENTAL SUPPORTTM is an informatics based approach that can be used to analyze genetic data. In some embodiments, the methods disclosed herein may be considered as part of the PARENTAL SUPPORTTM method.
  • the PARENTAL SUPPORTTM method is a collection of methods that may be used to determine the genetic data, with high accuracy, of one or a small number of cells, specifically to determine disease-related alleles, other alleles of interest, and/or the ploidy state of the cell(s). PARENTAL SUPPORTTM may refer to any of these methods. PARENTAL SUPPORTTM is an example of an informatics based method.
  • the PARENTAL SUPPORTTM method makes use of known parental genetic data, i.e. haplotypic and/or diploid genetic data of the mother and/or the father, together with the knowledge of the mechanism of meiosis and the imperfect measurement of the target DNA, and possible of one or more related individuals, in order to reconstruct, in silico, the genotype at a plurality of alleles, and/or the ploidy state of an embryo or of any target cell(s), and the target DNA at the location of key loci with a high degree of confidence.
  • the PARENTAL SUPPORTTM method can reconstruct not only single nucleotide polymorphisms (SNPs) that were measured poorly, but also insertions and deletions, and SNPs or whole regions of DNA that were not measured at all. Furthermore, the PARENTAL SUPPORTTM method can both measure multiple disease-linked loci as well as screen for aneuploidy, from a single cell. In some embodiments, the PARENTAL SUPPORTTM method may be used to characterize one or more cells from embryos biopsied during an IVF cycle to determine the genetic condition of the one or more cells.
  • the PARENTAL SUPPORTTM method allows the cleaning of noisy genetic data. This may be done by inferring the correct genetic alleles in the target genome (embryo) using the genotype of related individuals (parents) as a reference. PARENTAL SUPPORT may be particularly relevant where only a small quantity of genetic material is available (e.g. PGD) and where direct measurements of the genotypes are inherently noisy due to the limited amounts of genetic material.
  • the PARENTAL SUPPORTTM method is able to reconstruct highly accurate ordered diploid allele sequences on the embryo, together with copy number of chromosomes segments, even though the conventional, unordered diploid measurements may be characterized by high rates of allele dropouts, drop-ins, variable amplification biases and other errors.
  • the method may employ both an underlying genetic model and an underlying model of measurement error.
  • the genetic model may determine both allele probabilities at each SNP and crossover probabilities between SNPs. Allele probabilities may be modeled at each SNP based on data obtained from the parents and model crossover probabilities between SNPs based on data obtained from the HapMap database, as developed by the International HapMap Project. Given the proper underlying genetic model and measurement error model, maximum a posteriori (MAP) estimation may be used, with modifications for computationally efficiency, to estimate the correct, ordered allele values at each SNP in the embryo.
  • MAP maximum a posteriori
  • One aspect of the PARENTAL SUPPORTTM technology is a chromosome copy number calling algorithm that in some embodiments uses parental genotype contexts.
  • the algorithm may use the phenomenon of locus dropout (LDO) combined with distributions of expected embryonic genotypes. During whole genome amplification, LDO necessarily occurs. LDO rate is concordant with the copy number of the genetic material from which it is derived, i.e., fewer chromosome copies result in higher LDO, and vice versa. As such, it follows that loci with certain contexts of parental genotypes behave in a characteristic fashion in the embryo, related to the probability of allelic contributions to the embryo.
  • LDO locus dropout
  • the embryo should never have AB or AA states. In this case, measurements on the A detection channel are expected to have a distribution determined by background noise and various interference signals, but no valid genotypes. Conversely, if both parents have homozygous AA states, then the embryo should never have AB or BB states, and measurements on the A channel are expected to have the maximum intensity possible given the rate of LDO in a particular whole genome amplification.
  • loci corresponding to the specific parental contexts behave in a predictable fashion, based on the additional allelic content that is contributed by, or is missing from, one of the parents. This allows the ploidy state at each chromosome, or chromosome segment, to be determined. The details of one embodiment of this method are described elsewhere in this disclosure.
  • the techniques outlined above are able to determine the genotype of an individual given a very small amount of DNA originating from that individual. This could be the DNA from one or a small number of cells, or it could be from an even smaller amount of DNA, for example, DNA found in maternal blood.
  • the techniques described above may not be sufficient to determine the genotype and/or the ploidy state, or the partial genotype or partial ploidy state (meaning the genetic state of a subset of alleles or chromosomes) of an individual. This may be especially true when the DNA of the target individual is found in maternal blood, and the amount of maternal DNA present in the sample may be greater than the amount of DNA from the target individual. In other cases, the amount of maternal DNA present in the sample may be in a sufficiently great amount of DNA that it makes the determination of the genetic state of the target individual difficult.
  • Single Nucleotide Polymorphism refers to a single nucleotide that may differ between the genomes of two members of the same species. The usage of the term should not imply any limit on the frequency with which each variant occurs.
  • Sequence refers to a DNA sequence or a genetic sequence. It refers to the primary, physical structure of the DNA molecule or strand in an individual. It refers to the sequence of nucleotides found in that DNA molecule, or the complementary strand to the DNA molecule.
  • Locus refers to a particular region of interest on the DNA of an individual, which may refer to a SNP, the site of a possible insertion or deletion, or the site of some other relevant genetic variation.
  • Disease-linked SNPs may also refer to disease-linked loci.
  • Polymorphic Allele also "Polymorphic Locus,” refers to an allele or locus where the genotype varies between individuals within a given species. Some examples of polymorphic alleles include single nucleotide polymorphisms, short tandem repeats, deletions, duplications, and inversions. Allele refers to the genes that occupy a particular locus.
  • To Clean Genetic Data refers to the act of taking imperfect genetic data and correcting some or all of the errors or fill in missing data at one or more loci. In the presently disclosed embodiments, this may involve using the genetic data of related individuals and the method described herein.
  • Genotypic Data refers to the data describing aspects of the genome of one or more individuals. It may refer to one or a set of loci, partial or entire sequences, partial or entire chromosomes, or the entire genome. It may refer to the identity of one or a plurality of nucleotides; it may refer to a set of sequential nucleotides, or nucleotides from different locations in the genome, or a combination thereof. Genotypic data is typically in silico, however, it is also possible to consider physical nucleotides in a sequence as chemically encoded genetic data. Genotypic Data may be said to be “on,” “of,” “at,” “from” or “on” the individual(s). Genotypic Data may refer to output measurements from a genotyping platform where those measurements are made on genetic material.
  • Genetic Sample refers to physical matter, such as tissue or blood, from one or more individuals containing DNA or RNA
  • Imperfect Genetic Data refers to genetic data with any of the following: allele dropouts, uncertain base pair measurements, incorrect base pair measurements, missing base pair measurements, uncertain measurements of insertions or deletions, uncertain measurements of chromosome segment copy numbers, spurious signals, missing measurements, other errors, or combinations thereof.
  • Confidence refers to the statistical likelihood that the called SNP, allele, set of alleles, ploidy call, or determined number of chromosome segment copies correctly represents the real genetic state of the individual.
  • Ploidy Calling also "Chromosome Copy Number Calling,” or “Copy Number Calling” (CNC) refers to the act of determining the quantity and chromosomal identity of one or more chromosomes present in a cell.
  • Aneuploidy refers to the state where the wrong number of chromosomes is present in a cell.
  • a somatic human cell it refers to the case where a cell does not contain 22 pairs of autosomal chromosomes and one pair of sex chromosomes.
  • a human gamete it refers to the case where a cell does not contain one of each of the 23 chromosomes.
  • a single chromosome it refers to the case where more or less than two homologous but non-identical chromosomes are present, and where each of the two chromosomes originate from a different parent.
  • Ploidy State refers to the quantity and chromosomal identity of one or more chromosomes in a cell.
  • Chromosomal Identity refers to the referent chromosome number. Normal humans have 22 types of numbered autosomal chromosomes, and two types of sex chromosomes. It may also refer to the parental origin of the chromosome. It may also refer to a specific chromosome inherited from the parent. It may also refer to other identifying features of a chromosome.
  • the State of the Genetic Material or simply "Genetic State” refers to the identity of a set of SNPs on the DNA, to the phased haplotypes of the genetic material, and to the sequence of the DNA, including insertions, deletions, repeats and mutations. It may also refer to the ploidy state of one or more chromosomes, chromosomal segments, or set of chromosomal segments.
  • Allelic Data refers to a set of genotypic data concerning a set of one or more alleles. It may refer to the phased, haplotypic data. It may refer to SNP identities, and it may refer to the sequence data of the DNA, including insertions, deletions, repeats and mutations. It may include the parental origin of each allele.
  • Allelic State refers to the actual state of the genes in a set of one or more alleles. It may refer to the actual state of the genes described by the allelic data.
  • Allelic Ratio refers to the ratio between the amount of each allele at a locus that is present in a sample or in an individual.
  • the allele ratio may refer to the ratio of sequence reads that map to each allele at the locus.
  • the allele ratio may refer to the ratio of the amounts of each allele present at that locus as estimated by the measurement method.
  • Allele Count refers to the number of sequences that map to a particular locus, and if that locus is polymorphic, it refers to the number of sequences that map to each of the alleles. If each allele is counted in a binary fashion, then the allele count will be whole number. If the alleles are counted probabilistically, then the allele count can be a fractional number.
  • Allele Count Probability refers to the number of sequences that are likely to map to a particular locus or a set of alleles at a polymorphic locus, combined with the probability of the mapping. Note that allele counts are equivalent to allele count probabilities where the probability of the mapping for each counted sequence is binary (zero or one).
  • Allelic Distribution refers to the relative amount of each allele that is present for each locus in a set of loci.
  • An allelic distribution can refer to an individual, to a sample, or to a set of measurements made on a sample. In the context of sequencing, the allelic distribution may refer to the number or probable number of reads that map to a particular allele for each allele at a set of polymorphic loci.
  • the allele measurements may be treated probabilistically, that is, the likelihood that a given allele is present for a give sequence read is a fraction between 0 and 1, or they may be treated in a binary fashion, that is, any given read is considered to be exactly zero or one copies of a particular allele.
  • Allelic Distribution Pattern refers to a set of different allele distributions for different parental contexts. Certain allelic disribution patterns may be indicative of certain ploidy states.
  • Allelic Bias refers to the degree to which the measured ratio of alleles at a heterozygous locus is different to the ratio that was present in the original sample of DNA.
  • the degree of allelic bias at a particular locus is equal to the observed allelelic ratio at that locus, as measured, divided by the ratio of alleles in the original DNA sample at that locus.
  • Allelic bias may be defined to be greater than one, such that if the calculation of the degree of allelic bias returns a value, x, that is less than 1, then the degree of allelic bias may be restated as 1/x.
  • Matched Copy Error also "Matching Chromosome Aneuploidy" (MCA) refers to a state of aneuploidy where one cell contains two identical or nearly identical chromosomes. This type of aneuploidy may arise during the formation of the gametes in mitosis, and may be referred to as a mitotic non-disjunction error.
  • Matching trisomy may refer to the case where three copies of a given chromosome are present in an individual and two of the copies are identical.
  • Unmatched Copy Error also "Unique Chromosome Aneuploidy" (UCA) refers to a state of aneuploidy where one cell contains two chromosomes that are from the same parent, and that may be homologous but not identical. This type of aneuploidy may arise during meiosis, and may be referred to as a meiotic error. Unmatching trisomy may refer to the case where three copies of a given chromosome are present in an individual and two of the copies are from the same parent, and are homologous, but are not identical.
  • Homologous Chromosomes refers to chromosomes that contain the same set of genes that normally pair up during meiosis.
  • Identical Chromosomes refers to chromosomes that contain the same set of genes, and for each gene they have the same set of alleles that are identical, or nearly identical.
  • Allele Drop Out refers to the situation where one of the base pairs in a set of base pairs from homologous chromosomes at a given allele is not detected.
  • Locus Drop Out refers to the situation where both base pairs in a set of base pairs from homologous chromosomes at a given allele are not detected.
  • Homozygous refers to having similar alleles as corresponding chromosomal loci.
  • Heterozygous refers to having dissimilar alleles as corresponding chromosomal loci.
  • Heterozygosity Rate refers to the rate of individuals in the population having heterozygous alleles at a given locus.
  • the heterozygosity rate may also refer to the expected or measured ratio of alleles, at a given locus in an individual, or a sample of DNA.
  • HISNP Highly Informative Single Nucleotide Polymorphism
  • Chromosomal Region refers to a segment of a chromosome, or a full chromosome.
  • Segment of a Chromosome refers to a section of a chromosome that can range in size from one base pair to the entire chromosome.
  • Chromosome refers to either a full chromosome, or also a segment or section of a chromosome. Copies refers to the number of copies of a chromosome segment, to identical copies, or to non- identical, homologous copies of a chromosome segment wherein the different copies of the chromosome segment contain a substantially similar set of loci, and where one or more of the alleles are different. Note that in some cases of aneuploidy, such as the M2 copy error, it is possible to have some copies of the given chromosome segment that are identical as well as some copies of the same chromosome segment that are not identical. Haplotype refers to a combination of alleles at multiple loci that are transmitted together on the same chromosome.
  • Haplotype may refer to as few as two loci or to an entire chromosome depending on the number of recombination events that have occurred between a given set of loci. Haplotype can also refer to a set of single nucleotide polymorphisms (SNPs) on a single chromatid that are statistically associated.
  • SNPs single nucleotide polymorphisms
  • Haplotypic Data also "Phased Data” or “Ordered Genetic Data,” refers to data from a single chromosome in a diploid or polyploid genome, i.e., either the segregated maternal or paternal copy of a chromosome in a diploid genome.
  • Phasing refers to the act of determining the haplotypic genetic data of an individual given unordered, diploid (or polyploidy) genetic data. It may refer to the act of determining which of two genes at an allele, for a set of alleles found on one chromosome, are associated with each of the two homologous chromosomes in an individual.
  • Phased Data refers to genetic data where the haplotype has been determined.
  • Hypothesis refers to a set of possible ploidy states at a given set of chromosomes, or a set of possible allelic states at a given set of loci.
  • the set of possibilities may contain one or more elements.
  • Copy Number Hypothesis also "Ploidy State Hypothesis,” refers to a hypothesis concerning the number of copies of a particular chromosome in an individual. It may also refer to a hypothesis concerning the identity of each of the chromosomes, including the parent of origin of each chromosome, and which of the parent's two chromosomes are present in the individual. It may also refer to a hypothesis concerning which chromosomes, or chromosome segments, if any, from a related individual correspond genetically to a given chromosome from an individual.
  • Target Individual refers to the individual whose genetic data is being determined. In one context, only a limited amount of DNA is available from the target individual. In one context, the target individual is a fetus. In some embodiments, there may be more than one target individual. In some embodiments, each fetus that originated from a pair of parents may be considered to be target individuals. In one embodiment, the genetic data that is being determined is one or a set of allele calls. In one embodiment, the genetic data that is being determined is a ploidy call.
  • the related individual refers to any individual who is genetically related to, and thus shares haplotype blocks with, the target individual.
  • the related individual may be a genetic parent of the target individual, or any genetic material derived from a parent, such as a sperm, a polar body, an embryo, a fetus, or a child. It may also refer to a sibling, parent or a grandparent.
  • Sibling refers to any individual whose parents are the same as the individual in question. In some embodiments, it may refer to a born child, an embryo, or a fetus, or one or more cells originating from a born child, an embryo, or a fetus. A sibling may also refer to a haploid individual that originates from one of the parents, such as a sperm, a polar body, or any other set of haplotypic genetic matter. An individual may be considered to be a sibling of itself.
  • Fetal refers to "of the fetus,” but it also may refer to "of the placenta”. In a pregnant woman, some portion of the placenta is genetically similar to the fetus, and the free floating fetal
  • DNA found in maternal blood may have originated from the portion of the placenta with a genotype that matches the fetus. Note that the genetic information in half of the chromosomes in a fetus were inherited from the mother of the fetus. In some embodiments, the DNA from these maternally inherited chromosomes that came from a fetal cell are considered to be "of fetal origin,” not "of maternal origin.”
  • DNA of Fetal Origin refers to DNA that was originally part of a cell whose genotype was essentially equivalent to that of the fetus.
  • DNA of Maternal Origin refers to DNA that was originally part of a cell whose genotype was essentially equivalent to that of the mother.
  • Child is used interchangeably with the terms embryo, blastomere, and fetus. Note that in the presently disclosed embodiments, the concepts described apply equally well to individuals who are a born child, a fetus, an embryo or a set of cells therefrom. The use of the term child may simply be meant to connote that the individual referred to as the child is the genetic offspring of the parents.
  • Parent refers to the genetic mother or father of an individual. An individual typically has two parents, a mother and a father. A parent may be considered to be an individual.
  • Parental Context refers to the genetic state of a given SNP, on each of the two relevant chromosomes for each of the two parents of the target.
  • “Develop Normally” refers to a viable embryo implanting in a uterus and resulting in a pregnancy. It may also refer to the pregnancy continuing and resulting in a live birth. It may also refer to the born child being free of chromosomal abnormalities. It may also refer to the born child being free of other undesired genetic conditions such as disease-linked genes.
  • the term “develop as desired” encompasses anything that may be desired by parents or healthcare facilitators. In some cases, “develop as desired” may refer to an unviable or viable embryo that is useful for medical research or other purposes.
  • Insertion Into a Uterus refers to the process of transferring an embryo into the uterine cavity in the context of in vitro fertilization.
  • Clinical Decision refers to any decision to take or not take an action that has an outcome that affects the health or survival of an individual.
  • a clinical decision refers to a decision to abort or not abort a fetus.
  • a clinical decision may also refer to a decision to conduct further testing, to take actions to mitigate an undesireable phenotype, or to take actions to prepare for the birth of a child with abnormalities.
  • Informatics Based Method refers to a method designed to determine the ploidy state at one or more chromosomes or the allelic state at one or more alleles by statistically inferring the most likely state, rather than by directly physically measuring the state.
  • the informatics based technique may be one disclosed in this patent. In one embodiment of the present disclosure it may be PARENTAL SUPPORTTM.
  • Non-Invasive Prenatal Diagnosis or also “Non-Invasive Prenatal Screening” (NPS) refers to a method of determining the genetic state of a fetus that is gestating in a mother using genetic material found in the mother's blood, where the genetic material is obtained by drawing the mother's intravenous blood.
  • Preferential Enrichment of DNA that corresponds to a locus refers to any method that results in the percentage of molecules of DNA in a post-enrichment DNA mixture that correspond to the locus being higher than the percentage of molecules of DNA in the pre-enrichment DNA mixture that correspond to the locus.
  • the method may involve selective amplification of DNA molecules that correspond to a locus.
  • the method may involve removing DNA molecules that do not correspond to the locus.
  • the method may involve a combination of methods.
  • the degree of enrichment is defined as the percentage of molecules of DNA in the post-enrichment mixture that correspond to the locus divided by the percentage of molecules of DNA in the pre-enrichment mixture that correspond to the locus.
  • Preferential enrichment may be carried out at a plurality of loci. In some embodiments of the present disclosure, the degree of enrichment is greater than 20. In some embodiments of the present disclosure, the degree of enrichment is greater than 200. When preferential enrichment is carried out at a plurality of loci, the degree of enrichment may refer to the average degree of enrichment of all of the loci in the set of loci.
  • Universal Amplification refers to a method of amplification where all DNA in the mixture is amplified in a manner that is indiscriminant, and/or not sequence specific.
  • Amplification refers to a method that increases the number of copies of a molecule of DNA.
  • Selective Amplification refers to a method that increases the number of copies of a particular molecule of DNA, or molecules of DNA that correspond to a particular region of DNA. It may also refer to a method that increases the number of copies of a particular targeted molecule of DNA, or targeted region of DNA more than it increases non-targeted molecules or regions of DNA. Selective amplification may be a method of preferential enrichment.
  • Targeting refers to a method used to preferentially enrich those molecules of DNA that correspond to a set of loci, in a mixture of DNA.
  • Joint Distribution Model refers to a model that defines the probability of events defined in terms of multiple random variables, given a plurality of random variables defined on the same probability space, where the probabilities of the variable are linked.
  • any of the embodiments disclosed herein may be implemented in digital electronic circuitry, integrated circuitry, specially designed ASICs (application-specific integrated circuits), computer hardware, firmware, software, or in combinations thereof.
  • Apparatus of the presently disclosed embodiments can be implemented in a computer program product tangibly embodied in a machine-readable storage device for execution by a programmable processor; and method steps of the presently disclosed embodiments can be performed by a programmable processor executing a program of instructions to perform functions of the presently disclosed embodiments by operating on input data and generating output.
  • the presently disclosed embodiments can be implemented advantageously in one or more computer programs that are executable and/or interpretable on a programmable system including at least one programmable processor, which may be special or general purpose, coupled to receive data and instructions from, and to transmit data and instructions to, a storage system, at least one input device, and at least one output device.
  • Each computer program can be implemented in a high-level procedural or object- oriented programming language or in assembly or machine language if desired; and in any case, the language can be a compiled or interpreted language.
  • a computer program may be deployed in any form, including as a stand-alone program, or as a module, component, subroutine, or other unit suitable for use in a computing environment.
  • a computer program may be deployed to be executed or interpreted on one computer or on multiple computers at one site, or distributed across multiple sites and interconnected by a communication network.
  • Computer readable storage media refers to physical or tangible storage (as opposed to signals) and includes without limitation volatile and non-volatile, removable and non-removable media implemented in any method or technology for the tangible storage of information such as computer-readable instructions, data structures, program modules or other data.
  • Computer readable storage media includes any type of non-transitory computer readable medium including, but not limited to, RAM, ROM, EPROM, EEPROM, flash memory or other solid state memory technology, CD-ROM, DVD, or other optical storage, magnetic cassettes, magnetic tape, magnetic disk storage or other magnetic storage devices, or any other physical or material medium which can be used to tangibly store the desired information or data or instructions and which can be accessed by a computer or processor.
  • any of the methods described herein may include the output of data in a physical format, such as on a computer screen, or on a paper printout.
  • the described methods may be combined with the output of the actionable data in a format that can be acted upon by a physician.
  • the described methods may be combined with the actual execution of a clinical decision that results in a clinical treatment, or the execution of a clinical decision to make no action.
  • Some of the embodiments described in the document for determining genetic data pertaining to a target individual may be combined with the decision to select one or more embryos for transfer in the context of IVF, optionally combined with the process of transferring the embryo to the womb of the prospective mother.
  • Some of the embodiments described in the document for determining genetic data pertaining to a target individual may be combined with the notification of a potential chromosomal abnormality, or lack thereof, with a medical professional, optionally combined with the decision to abort, or to not abort, a fetus in the context of prenatal diagnosis. Some of the embodiments described herein may be combined with the output of the actionable data, and the execution of a clinical decision that results in a clinical treatment, or the execution of a clinical decision to make no action.
  • a hypothesis may refer to a possible genetic state. It may refer to a possible ploidy state. It may refer to a possible allelic state.
  • a set of hypotheses refers to a set of possible genetic states. In some embodiments, a set of hypotheses may be designed such that one hypothesis from the set will correspond to the actual genetic state of any given individual. In some embodiments, a set of hypotheses may be designed such that every possible genetic state may be described by at least one hypothesis from the set. In some embodiments of the present disclosure, one aspect of the method is to determine which hypothesis corresponds to the actual genetic state of the individual in question.
  • one step involves creating a hypothesis.
  • it may be a copy number hypothesis.
  • it may involve a hypothesis concerning which segments of a chromosome from each of the related individuals correspond genetically to which segments, if any, of the other related individuals.
  • Creating a hypothesis may refer to the act of setting the limits of the variables such that the entire set of possible genetic states that are under consideration are encompassed by those variables.
  • a "copy number hypothesis,” also called a “ploidy hypothesis,” or a “ploidy state hypothesis,” may refer to a hypothesis concerning a possible ploidy state for a given chromosome, or section of a chromosome, in the target individual. It may also refer to the ploidy state at more than one of the chromosomes in the individual.
  • a set of copy number hypotheses may refer to a set of hypotheses where each hypothesis corresponds to a different possible ploidy state in an individual.
  • a set of hypotheses may concern a set of possible ploidy states, a set of possible parental haplotypes contributions, a set of possible fetal DNA percentages in the mixed sample, or combinations thereof.
  • a normal individual contains one of each chromosome from each parent. However, due to errors in meiosis and mitosis, it is possible for an individual to have 0, 1, 2, or more of a given chromosome from each parent. In practice, it is rare to see more that two of a given chromosomes from a parent. In this disclosure, the embodiments only consider the possible hypotheses where 0, 1, or 2 copies of a given chromosome come from a parent. In some embodiments, for a given chromosome, there are nine possible hypotheses: the three possible hypothesis concerning 0, 1, or 2 chromosomes of maternal origin, multiplied by the three possible hypotheses concerning 0, 1, or 2 chromosomes of paternal origin.
  • (m,f) refer to the hypothesis where m is the number of a given chromosome inherited from the mother, and f is the number of a given chromosome inherited from the father. Therefore, the nine hypotheses are (0,0), (0,1), (0,2), (1,0), (1,1), (1,2), (2,0), (2,1), and (2,2). These may also be written as H 00 , Hoi, Ho 2 , Hio, Hi2, 3 ⁇ 4 ⁇ , H 2 i, and H 22 . The different hypotheses correspond to different ploidy states.
  • (1 ,1) refers to a normal disomic chromosome
  • (2,1) refers to a maternal trisomy
  • (0,1) refers to a paternal monosomy.
  • the case where two chromosomes are inherited from one parent and one chromosome is inherited from the other parent may be further differentiated into two cases: one where the two chromosomes are identical (matched copy error), and one where the two chromosomes are homologous but not identical (unmatched copy error).
  • there are sixteen possible hypotheses there are sixteen possible hypotheses. It should be understood that it is possible to use other sets of hypotheses, and a different number of hypotheses.
  • the ploidy hypothesis may refer to a hypothesis concerning which chromosome from other related individuals correspond to a chromosome found in the target individual's genome.
  • a key to the method is the fact that related individuals can be expected to share haplotype blocks, and using measured genetic data from related individuals, along with a knowledge of which haplotype blocks match between the target individual and the related individual, it is possible to infer the correct genetic data for a target individual with higher confidence than using the target individual's genetic measurements alone.
  • the ploidy hypothesis may concern not only the number of chromosomes, but also which chromosomes in related individuals are identical, or nearly identical, with one or more chromosomes in the target individual.
  • the algorithms when the algorithms operate on the input genetic data, they may output a determined statistical probability for each of the hypotheses under consideration.
  • the probabilities of the various hypotheses may be determined by mathematically calculating, for each of the various hypotheses, the value that the probability equals, as stated by one or more of the expert techniques, algorithms, and/or methods described elsewhere in this disclosure, using the relevant genetic data as input.
  • the probabilities of the different hypotheses may be combined. This may entail, for each hypothesis, multiplying the probabilities as determined by each technique. The product of the probabilities of the hypotheses may be normalized. Note that one ploidy hypothesis refers to one possible ploidy state for a chromosome.
  • the two probabilities that are associated with that hypothesis, as determined by the two expert methods, are multiplied together, and the corresponding product is the output probability.
  • This process may be expanded to any number of expert techniques. If only one expert technique is used, then the output probabilities are the same as the input probabilities. If more than two expert techniques are used, then the relevant probabilities may be multiplied at the same time.
  • the products may be normalized so that the probabilities of the hypotheses in the set of hypotheses sum to 100%. In some embodiments, if the combined probabilities for a given hypothesis are greater than the combined probabilities for any of the other hypotheses, then it may be considered that that hypothesis is determined to be the most likely.
  • a hypothesis may be determined to be the most likely, and the ploidy state, or other genetic state, may be called if the normalized probability is greater than a threshold. In one embodiment, this may mean that the number and identity of the chromosomes that are associated with that hypothesis may be called as the ploidy state. In one embodiment, this may mean that the identity of the alleles that are associated with that hypothesis may be called as the allelic state.
  • the threshold may be between about 50% and about 80%. In some embodiments the threshold may be between about 80% and about 90%. In some embodiments the threshold may be between about 90% and about 95%. In some embodiments the threshold may be between about 95% and about 99%. In some embodiments the threshold may be between about 99% and about 99.9%. In some embodiments the threshold may be above about 99.9%. Parental Contexts
  • the parental context may refer to the genetic state of a given SNP, on each of the two relevant chromosomes for each of the two parents of the target. Note that in one embodiment, the parental context does not refer to the allelic state of the target, rather, it refers to the allelic state of the parents.
  • the parental context for a given SNP may consist of four base pairs, two paternal and two maternal; they may be the same or different from one another. It is typically written as "mini2
  • the parental context may be written as "f 1 f 2
  • a and B are often used to generically represent base pair identities; A or B could equally well represent C (cytosine), G (guanine), A (adenine) or T (thymine).
  • C cytosine
  • G guanine
  • A adenine
  • T thymine
  • any of the four possible nucleotides could occur at a given allele, and thus it is possible, for example, for the mother to have a genotype of AT, and the father to have a genotype of GC at a given allele.
  • empirical data indicate that in most cases only two of the four possible base pairs are observed at a given allele.
  • the discussion assumes that only two possible base pairs will be observed at a given allele, although the embodiments disclosed herein could be modified to take into account the cases where this assumption does not hold.
  • a "parental context” may refer to a set or subset of target SNPs that have the same parental context. For example, if one were to measure 1000 alleles on a given chromosome on a target individual, then the context AA
  • AB BA
  • the parental data is phased, and thus AB ⁇ BA
  • the set of SNPs wherein the parental context for one parent is heterozygous may be referred to as the heterozygous context.
  • Non-invasive prenatal diagnosis is an important technique that can be used to determine the genetic state of a fetus from genetic material that is obtained in a non-invasive manner, for example from a blood draw on the pregnant mother.
  • the blood could be separated and the plasma isolated, and size selection could also be used to isolate the DNA of the appropriate length.
  • This isolated DNA can then be measured by a number of means, such as by hybridizing to a genotyping array and measuring the fluorescence, or by sequencing on a high throughput sequencer.
  • sequencing is used for ploidy calling of a fetus in the context of non-invasive prenatal diagnosis, there are a number of ways to use the sequence data.
  • sequence data The most common way one could use the sequence data is to simply count the number of reads that map to a given chromosome. For example, imagine if you are trying to figure out the ploidy state of chromosome 21 on the fetus. Further imagine that the DNA in the sample is comprised of 10% DNA of fetal origin, and 90% DNA of maternal origin. In this case, you could look at the average number of reads on a chromosome which can be expected to be disomic, for example chromosome 3, and compare that to the number of read on chromosome 21, where the reads are adjusted for the number of base pairs on that chromosome that are part of a unique sequence.
  • the fetus were euploid, one would expect the amount of DNA per unit of genome to be about equal at all locations (subject to stochastic variations). On the other hand, if the fetus were trisomic at chromosome 21, then one would expect there to be more slightly more DNA per genetic unit from chromosome 21 than the other locations on the genome. Specifically one would expect there to be about 5% more DNA from chromosome 21 in the mixture. When sequencing is used to measure the DNA, one would expect about 5% more uniquely mappable reads from chromosome 21 per unique segment than from the other chromosomes.
  • Another method that may be used to detect aneuploidy is similar to that above, except that parental contexts could be taken into account.
  • a method for determining a ploidy state of an embryo at a chromosome includes obtaining a genetic sample from the embryo and preparing the genetic sample for sequencing.
  • preparing the genetic sample for sequencing may involve amplifying DNA present in the genetic sample.
  • preparing the genetic sample for sequencing includes universal amplification of the DNA in the genetic sample.
  • preparing the genetic sample for sequencing comprises preferentially enriching the DNA in the genetic sample at a plurality of polymorphic loci such as by performing targeted PCR amplification of the DNA in the genetic sample at a plurality of polymorphic loci.
  • preferentially enriching the DNA includes: obtaining a forward probe such that the 3' end of the forward probe is designed to hybridize to the region of DNA immediately upstream from the polymorphic region, and separated from the polymorphic region by a small number of bases, where the small number is selected from the group consisting of 1, 2, 3, 4, 5, 6 to 10, and 11 to 20; obtaining a reverse probe such that the 3' end of the reverse probe is designed to hybridize to the region of DNA immediately downstream from the polymorphic region, and separated from the polymorphic region by a small number of bases, where the small number is selected from the group consisting of 1 , 2, 3, 4, 5, 6 to 10, and 11 to 20; hybridizing the two probes to DNA in the first sample of DNA; and amplifying the DNA using the poly
  • preferential enrichment results in average degree of allelic bias between the second sample and the first sample of a factor selected from the group consisting of no more than a factor of 2, no more than a factor of 1.5, no more than a factor of 1.2, no more than a factor of 1.1 , no more than a factor of 1.05, no more than a factor of 1.02, no more than a factor of 1.01 , no more than a factor of 1.005, no more than a factor of 1.002, no more than a factor of 1.001 and no more than a factor of 1.0001.
  • PCR polymerase chain reaction
  • WGA whole genome amplification
  • LM-PCR ligation-mediated PCR
  • DOP-PCR degenerate oligonucleotide primer PCR
  • MDA multiple displacement amplification
  • LM-PCR short DNA sequences called adapters are ligated to blunt ends of DNA.
  • adapters contain universal amplification sequences, which are used to amplify the DNA by PCR.
  • DOP-PCR random primers that also contain universal amplification sequences are used in a first round of annealing and PCR.
  • MDA uses the phi-29 polymerase, which is a highly processive and non-specific enzyme that replicates DNA and has been used for single-cell analysis.
  • the major limitations to amplification of material from a single cell are (1) necessity of using extremely dilute DNA concentrations or extremely small volume of reaction mixture, and (2) difficulty of reliably dissociating DNA from proteins across the whole genome. Regardless, single-cell whole genome amplification has been used successfully for a variety of applications for a number of years. There are other methods of amplifying DNA from a sample of DNA. There are numerous difficulties in using DNA amplification in these contexts.
  • Amplification of single-cell DNA (or DNA from a small number of cells, or from smaller amounts of DNA) by PCR can fail completely, as reported in 5-10% of the cases. This is often due to contamination of the DNA, the loss of the cell, its DNA, or accessibility of the DNA during the PCR reaction.
  • Other sources of error that may arise in measuring the fetal DNA by amplification and microarray analysis include transcription errors introduced by the DNA polymerase where a particular nucleotide is incorrectly copied during PCR, and microarray reading errors due to imperfect hybridization on the array.
  • ADO allele drop-out
  • ADO can affect up to more than 40%> of amplifications and has already caused PGD misdiagnoses.
  • ADO becomes a health issue especially in the case of a dominant disease, where the failure to amplify can lead to implantation of an affected embryo.
  • the need for more than one set of primers per each marker (in heterozygotes) complicate the PCR process. Therefore, more reliable PCR assays are being developed based on understanding the ADO origin. Reaction conditions for single-cell amplifications are under study. The amplicon size, the amount of DNA degradation, freezing and thawing, and the PCR program and conditions can each influence the rate of ADO.
  • PCR-based techniques include whole genome amplification (WGA) techniques such as multiple displacement amplification (MDA), and Molecular Inversion Probes (MIPS) that perform genotyping using multiple tagged oligonucleotides that may then be amplified using PCR with a single pair of primers.
  • WGA whole genome amplification
  • MDA multiple displacement amplification
  • MIPS Molecular Inversion Probes
  • PCR can be used to target specific locations of the genome.
  • the original DNA is highly fragmented (typically less than 500 bp, with an average length less than 200 bp).
  • both forward and reverse primers must anneal to the same fragment to enable amplification. Therefore, if the fragments are short, the PCR assays must amplify relatively short regions as well.
  • the polymorphic positions are too close the polymerase binding site, it could result in biases in the amplification from different alleles.
  • PCR primers that target polymorphic regions are typically designed such that the 3' end of the primer will hybridize to the base immediately adjacent to the polymorphic base or bases.
  • the 3' ends of both the forward and reverse PCR primers are designed to hybridize to bases that are one or a few positions away from the variant positions (polymorphic sites) of the targeted allele.
  • the number of bases between the polymorphic site (SNP or otherwise) and the base to which the 3 ' end of the primer is designed to hybridize may be one base, it may be two bases, it may be three bases, it may be four bases, it may be five bases, it may be six bases, it may be seven to ten bases, it may be eleven to fifteen bases, or it may be sixteen to twenty bases.
  • the forward and reverse primers may be designed to hybridize a different number of bases away from the polymorphic site.
  • PCR assay can be generated in large numbers, however, the interactions between different PCR assays makes it difficult to multiplex them beyond about one hundred assays.
  • Various complex molecular approaches can be used to increase the level of multiplexing, but it may still be limited to fewer than 100, perhaps 200, or possibly 500 assays per reaction.
  • Samples with large quantities of DNA can be split among multiple sub-reactions and then recombined before sequencing. For samples where either the overall sample or some subpopulation of DNA molecules is limited, splitting the sample would introduce statistical noise.
  • a small or limited quantity of DNA may refer to an amount below 10 pg, between 10 and 100 pg, between 100 pg and 1 ng, between 1 and 10 ng, or between 10 and 100 ng.
  • this method is particularly useful on small amounts of DNA where other methods that involve splitting into multiple pools can cause significant problems related to introduced stochastic noise, this method still provides the benefit of minimizing bias when it is run on samples of any quantity of DNA.
  • a universal pre-amplification step may be used to increase the overall sample quantity.
  • this pre-amplification step should not appreciably alter the allelic distributions.
  • a method of the present disclosure can generate PCR products that are specific to a large number of targeted loci, specifically 1,000 to 5,000 loci, 5,000 to 10,000 loci or more than 10,000 loci, for genotyping by sequencing or some other genotyping method, from limited samples such as single cells or DNA from body fluids.
  • PCR products that are specific to a large number of targeted loci, specifically 1,000 to 5,000 loci, 5,000 to 10,000 loci or more than 10,000 loci, for genotyping by sequencing or some other genotyping method, from limited samples such as single cells or DNA from body fluids.
  • primer side products such as primer dimers, and other artifacts.
  • primer dimers and other artifacts may be ignored, as these are not detected.
  • n targets of a sample greater than 50, greater than 100, greater than 500, or greater than 1,000
  • FLUIDIGM ACCESS ARRAY 48 reactions per sample in microfluidic chips
  • DROPLET PCR by RAIN DANCE TECHNOLOGY
  • Described here is a method to effectively and efficiently amplify many PCR reactions that is applicable to cases where only a limited amount of DNA is available.
  • the method may be applied for analysis of single cells, body fluids, mixtures of DNA such as the free floating DNA foundin maternal plasma, biopsies, environmental and/or forensic samples.
  • the targeted sequencing may involve one, a plurality, or all of the following steps, a) Generate and amplify a library with adaptor sequences on both ends of DNA fragments, b) Divide into multiple reactions after library amplification, c) Generate and optionally amplify a library with adaptor sequences on both ends of DNA fragments, d) Perform 1000- to 10,000-plex amplification of selected targets using one target specific "Forward" primer per target and one tag specific primer, e) Perform a second amplification from this product using "Reverse" target specific primers and one (or more) primer specific to a universal tag that was introduced as part of the target specific forward primers in the first round, f) Perform a 1000-plex preamplification of selected target for a limited number of cycles, g) Divide the product into multiple aliquots and amplify subpools of targets in individual reactions (for example, 50 to 500- plex, though this can be used all the way down to singleplex. h) Pool products of parallel subpool
  • the amplified sample may be relatively free of primer dimer products and have low allelic bias at target loci. If during or after amplification the products are appended with sequencing compatible adaptors, analysis of these products can be performed by sequencing.
  • One solution is to split the 5000-plex reaction into several lower-plexed amplifications, e.g. one hundred 50-plex or fifty 100-plex reactions, or to use microfluidics or even to split the sample into individual PCR reactions.
  • the sample DNA is limited, such as in noninvasive prenatal diagnostics from pregnancy plasma, dividing the sample between multiple reactions should be avoided as this will result in bottlenecking.
  • a method of the present disclosure can be used for preferentially enriching a DNA mixture at a plurality of loci, the method comprising one or more of the following steps: generating and amplifying a library from a mixture of DNA where the molecules in the library have adaptor sequences ligated on both ends of the DNA fragments, dividing the amplified library into multiple reactions, performing a first round of multiplex amplification of selected targets using one target specific "forward" primer per target and one or a plurality of adaptor specific universal "reverse" primers.
  • a method of the present disclosure further includes performing a second amplification using "reverse" target specific primers and one or a plurality of primers specific to a universal tag that was introduced as part of the target specific forward primers in the first round.
  • the method may involve a fully nested, hemi-nested, semi-nested, one sided fully nested, one sided hemi-nested, or one sided semi-nested PCR approach.
  • a method of the present disclosure is used for preferentially enriching a DNA mixture at a plurality of loci, the method comprising performing a multiplex preamplification of selected targets for a limited number of cycles, dividing the product into multiple aliquots and amplifying subpools of targets in individual reactions, and pooling products of parallel subpools reactions. Note that this approach could be used to perform targeted amplification in a manner that would result in low levels of allelic bias for 50-500 loci, for 500 to 5,000 loci, for 5,000 to 50,000 loci, or even for 50,000 to 500,000 loci.
  • the primers carry partial or full length sequencing compatible tags.
  • the workflow may entail (1) extracting plasma DNA, (2) preparing fragment library with universal adaptors on both ends of fragments, (3) amplifying the library using universal primers specific to the adaptors, (4) dividing the amplified sample "library” into multiple aliquots, (5) performing multiplex (e.g. about 100-plex, 1,000, or 10,000-plex with one target specific primer per target and a tag-specific primer) amplifications on aliquots, (6) pooling aliquots of one sample, (7) barcoding the sample, (8) mixing the samples and adjusting the concentration, (9) sequencing the sample.
  • the workflow may comprise multiple sub-steps that contain one of the listed steps (e.g.
  • step (2) of preparing the library step could entail three enzymatic steps (blunt ending, dA tailing and adaptor ligation) and three purification steps). Steps of the workflow may be combined, divided up or performed in different order (e.g. bar coding and pooling of samples).
  • PCR assays can have the tags, for example sequencing tags, (usually a truncated form of 15-25 bases). After multiplexing, PCR multiplexes of a sample are pooled and then the tags are completed (including bar coding) by a tag-specific PCR (could also be done by ligation).
  • the full sequencing tags can be added in the same reaction as the multiplexing.
  • targets may be amplified with the target specific primers, subsequently the tag-specific primers take over to complete the SQ-adaptor sequence.
  • the PCR primers may carry no tags.
  • the sequencing tags may be appended to the amplification products by ligation.
  • highly multiplex PCR followed by evaluation of amplified material by clonal sequencing may be used to detect fetal aneuploidy.
  • traditional multiplex PCRs evaluate up to fifty loci simultaneously
  • the approach described herein may be used to enable simultaneous evaluation of more than 50 loci simultaneously, more than 100 loci simultaneously, more than 500 loci simultaneously, more than 1,000 loci simultaneously, more than 5,000 loci simultaneously, more than 10,000 loci simultaneously, more than 50,000 loci simultaneously, and more than 100,000 loci simultaneously.
  • up to, including and more than 10,000 distinct loci can be evaluated simultaneously, in a single reaction, with sufficiently good efficiency and specificity to make non-invasive prenatal aneuploidy diagnoses and/or copy number calls with high accuracy.
  • Assays may be combined in a single reaction with the entirety of a cfDNA sample isolated from maternal plasma, a fraction thereof, or a further processed derivative of the cfDNA sample.
  • the cfDNA or derivative may also be split into multiple parallel multiplex reactions.
  • the optimum sample splitting and multiplex is determined by trading off various performance specifications. Due to the limited amount of material, splitting the sample into multiple fractions can introduce sampling noise, handling time, and increase the possibility of error. Conversely, higher multiplexing can result in greater amounts of spurious amplification and greater inequalities in amplification both of which can reduce test performance.
  • LM-PCR ligation mediated PCR
  • MDA multiple displacement amplification
  • DOP-PCR random priming is used to amplify the original material DNA.
  • Each method has certain characteristics such as uniformity of amplification across all represented regions of the genome, efficiency of capture and amplification of original DNA, and amplification performance as a function of the length of the fragment.
  • LM-PCR may be used with a single heteroduplexed adaptor having a 3-prime tyrosine.
  • the heteroduplexed adaptor enables the use of a single adaptor molecule that may be converted to two distinct sequences on 5-prime and 3-prime ends of the original DNA fragment during the first round of PCR.
  • sample DNA Prior to ligation, sample DNA may be blunt ended, and then a single adenosine base is added to the 3-prime end.
  • the DNA Prior to ligation the DNA may be cleaved using a restriction enzyme or some other cleavage method.
  • the 3-prime adenosine of the sample fragments and the complementary 3-prime tyrosine overhang of adaptor can enhance ligation efficiency.
  • the extension step of the PCR amplification may be limited from a time standpoint to reduce amplification from fragments longer than about 200 bp, about 300 bp, about 400 bp, about 500 bp or about 1,000 bp. Since longer DNA found in the maternal plasma is nearly exclusively maternal, this may result in the enrichment of fetal DNA by 10-50% and improvement of test performance.
  • a number of reactions were run using conditions as specified by commercially available kits; the resulted in successful ligation of fewer than 10% of sample DNA molecules. A series of optimizations of the reaction conditions for this improved ligation to approximately 70%.
  • mini-PCR assays Fetal cfDNA in maternal serum is highly fragmented and the fragment sizes are distributed in approximately a Gaussian fashion with a mean of 160 bp, a standard deviation of 15 bp, a minimum size of about 100 bp, and a maximum size of about 220 bp.
  • mini-PCR may equally well refer to normal PCR with no additional restrictions or limitations.
  • telomere length L is the distance between the 5-prime ends of the forward and reverse priming sites.
  • Amplicon length that is shorter than typically used by those known in the art may result in more efficient measurements of the desired polymorphic loci by only requiring short sequence reads.
  • a substantial fraction of the amplicons should be less than 100 bp, less than 90 bp, less than 80 bp, less than 70 bp, less than 65 bp, less than 60 bp, less than 55 bp, less than 50 bp, or less than 45 bp.
  • the 3 ' end of the inner forward and reverse primers are designed to hybridize to a region of DNA upstream from the polymorphic site, and separated from the polymorphic site by a small number of bases.
  • the number of bases may be between 6 and 10 bases, but may equally well be between 4 and 15 bases, between three and 20 bases, between two and 30 bases, or between 1 and 60 bases, and achieve substantially the same end.
  • Multiplex PCR may involve a single round of PCR in which all targets are amplified or it may involve one round of PCR followed by one or more rounds of nested PCR or some variant of nested PCR.
  • Nested PCR consists of a subsequent round or rounds of PCR amplification using one or more new primers that bind internally, by at least one base pair, to the primers used in a previous round.
  • Nested PCR reduces the number of spurious amplification targets by amplifying, in subsequent reactions, only those amplification products from the previous one that have the correct internal sequence. Reducing spurious amplification targets improves the number of useful measurements that can be obtained, especially in sequencing.
  • Nested PCR typically entails designing primers completely internal to the previous primer binding sites, necessarily increasing the minimum DNA segment size required for amplification.
  • the larger assay size reduces the number of distinct cfDNA molecules from which a measurement can be obtained.
  • a multiplex pool of PCR assays are designed to amplify potentially heterozygous SNP or other polymorphic or non-polymorphic loci on one or more chromosomes and these assays are used in a single reaction to amplify DNA.
  • the number of PCR assays may be between 50 and 200 PCR assays, between 200 and 1,000 PCR assays, between 1,000 and 5,000 PCR assays, or between 5,000 and 20,000 PCR assays (50 to 200-plex, 200 to 1,000-plex, 1,000 to 5,000-plex, 5,000 to 20,000-plex, more than 20,000-plex respectively).
  • a multiplex pool of about 10,000 PCR assays are designed to amplify potentially heterozygous SNP loci on chromosomes X, Y, 13, 18, and 21 and 1 or 2 and these assays are used in a single reaction to amplify cfDNA obtained from a material plasma sample, chorion villus samples, amniocentesis samples, single or a small number of cells, other bodily fluids or tissues, cancers, or other genetic matter.
  • the SNP frequencies of each locus may be determined by clonal or some other method of sequencing of the amplicons.
  • Statistical analysis of the allele frequency distributions or ratios of all assays may be used to determine if the sample contains a trisomy of one or more of the chromosomes included in the test.
  • the original cfDNA samples is split into two samples and parallel 5,000-plex assays are performed.
  • the original cfDNA samples is split into n samples and parallel ( ⁇ 10,000/n)-plex assays are performed where n is between 2 and 12, or between 12 and 24, or between 24 and 48, or between 48 and 96. Data is collected and analyzed in a similar manner to that already described. Note that this method is equally well applicable to detecting translocations, deletions, duplications, and other chromosomal abnormalities.
  • tails with no homology to the target genome may also be added to the 3-prime or 5-prime end of any of the primers. These tails facilitate subsequent manipulations, procedures, or measurements.
  • the tail sequence can be the same for the forward and reverse target specific primers.
  • different tails may used for the forward and reverse target specific primers.
  • a plurality of different tails may be used for different loci or sets of loci. Certain tails may be shared among all loci or among subsets of loci. For example, using forward and reverse tails corresponding to forward and reverse sequences required by any of the current sequencing platforms can enable direct sequencing following amplification.
  • the tails can be used as common priming sites among all amplified targets that can be used to add other useful sequences.
  • the inner primers may contain a region that is designed to hybridize either upstream or downstream of the targeted polymorphic locus.
  • the primers may contain a molecular barcode.
  • the primer may contain a universal priming sequence designed to allow PCR amplification.
  • a 10,000-plex PCR assay pool is created such that forward and reverse primers have tails corresponding to the required forward and reverse sequences required by a high throughput sequencing instrument such as the HISEQ, GAIIX, or MYSEQ available from ILLUMINA.
  • a high throughput sequencing instrument such as the HISEQ, GAIIX, or MYSEQ available from ILLUMINA.
  • included 5 -prime to the sequencing tails is an additional sequence that can be used as a priming site in a subsequent PCR to add nucleotide barcode sequences to the amplicons, enabling multiplex sequencing of multiple samples in a single lane of the high throughput sequencing instrument.
  • a 10,000-plex PCR assay pool is created such that reverse primers have tails corresponding to the required reverse sequences required by a high throughput sequencing instrument.
  • a subsequent PCR amplification may be performed using a another 10,000-plex pool having partly nested forward primers (e.g. 6-bases nested) for all targets and a reverse primer corresponding to the reverse sequencing tail included in the first round.
  • This subsequent round of partly nested amplification with just one target specific primer and a universal primer limits the required size of the assay, reducing sampling noise, but greatly reduces the number of spurious amplicons.
  • the sequencing tags can be added to appended ligation adaptors and/or as part of PCR probes, such that the tag is part of the final amplicon.
  • Fetal fraction affects performance of the test. There are a number of ways to enrich the fetal fraction of the DNA found in maternal plasma. Fetal fraction can be increased by the previously described LM-PCR method already discussed as well as by a targeted removal of long maternal fragments.
  • an additional multiplex PCR reaction may be carried out to selectively remove long and largely maternal fragments corresponding to the loci targeted in the subsequent multiplex PCR. Additional primers are designed to anneal a site a greater distance from the polymorphism than is expected to be present among cell free fetal DNA fragments. These primers may be used in a one cycle multiplex PCR reaction prior to multiplex PCR of the target polymorphic loci.
  • These distal primers are tagged with a molecule or moiety that can allow selective recognition of the tagged pieces of DNA.
  • these molecules of DNA may be covalently modified with a biotin molecule that allows removal of newly formed double stranded DNA comprising these primers after one cycle of PCR. Double stranded DNA formed during that first round is likely maternal in origin. Removal of the hybrid material may be accomplish by the used of magnetic streptavidin beads. There are other methods of tagging that may work equally well.
  • size selection methods may be used to enrich the sample for shorter strands of DNA; for example those less than about 800 bp, less than about 500 bp, or less than about 300 bp. Amplification of short fragments can then proceed as usual.
  • the mini-PCR method described in this disclosure enables highly multiplexed amplification and analysis of hundreds to thousands or even millions of loci in a single reaction, from a single sample.
  • the detection of the amplified DNA can be multiplexed; tens to hundreds of samples can be multiplexed in one sequencing lane by using barcoding PCR.
  • This multiplexed detection has been successfully tested up to 49-plex, and a much higher degree of multiplexing is possible. In effect, this allows hundreds of samples to be genotyped at thousands of SNPs in a single sequencing run.
  • the method allows determination of genotype and heterozygosity rate and simultaneously determination of copy number, both of which may be used for the purpose of aneuploidy detection.
  • This method is particularly useful in detecting aneuploidy of a gestating fetus from the free floating DNA found in maternal plasma.
  • This method may be used as part of a method for sexing a fetus, and/or predicting the paternity of the fetus. It may be used as part of a method for mutation dosage.
  • This method may be used for any amount of DNA or RNA, and the targeted regions may be SNPs, other polymorphic regions, non-polymorphic regions, and combinations thereof.
  • ligation mediated universal-PCR amplification of fragmented DNA may be used.
  • the ligation mediated universal-PCR amplification can be used to amplify plasma DNA, which can then be divided into multiple parallel reactions. It may also be used to preferentially amplify short fragments, thereby enriching fetal fraction.
  • the addition of tags to the fragments by ligation can enable detection of shorter fragments, use of shorter target sequence specific portions of the primers and/or annealing at higher temperatures which reduces unspecific reactions.
  • the methods described herein may be used for a number of purposes where there is a target set of DNA that is mixed with an amount of contaminating DNA.
  • the target DNA and the contaminating DNA may be from individuals who are genetically related.
  • genetic abnormalities in a fetus (target) may be detected from maternal plasma which contains fetal (target) DNA and also maternal (contaminating) DNA; the abnormalities include whole chromosome abnormalities (e.g. aneuploidy) partial chromosome abnormalities (e.g. deletions, duplications, inversions, translocations), polynucleotide polymorphisms (e.g. STRs), single nucleotide polymorphisms, and/or other genetic abnormalities or differences.
  • whole chromosome abnormalities e.g. aneuploidy
  • partial chromosome abnormalities e.g. deletions, duplications, inversions, translocations
  • polynucleotide polymorphisms e.g.
  • the target and contaminating DNA may be from the same individual, but where the target and contaminating DNA are different by one or more mutations, for example in the case of cancer, (see e.g. H. Mamon et al. Preferential Amplification of Apoptotic DNA from Plasma: Potential for Enhancing Detection of Minor DNA Alterations in Circulating DNA. Clinical Chemistry 54:9 (2008).
  • the DNA may be found in cell culture (apoptotic) supernatant.
  • it is possible to induce apoptosis in biological samples e.g. blood
  • biological samples e.g. blood
  • the target DNA may originate from single cells, from samples of
  • DNA consisting of less than one copy of the target genome, from low amounts of DNA, from DNA from mixed origin (e.g. pregnancy plasma: placental and maternal DNA; cancer patient plasma and tumors: mix between healthy and cancer DNA, transplantation etc), from other body fluids, from cell cultures, from culture supernatants, from forensic samples of DNA, from ancient samples of DNA (e.g. insects trapped in amber), from other samples of DNA, and combinations thereof.
  • mixed origin e.g. pregnancy plasma: placental and maternal DNA
  • cancer patient plasma and tumors mix between healthy and cancer DNA, transplantation etc
  • DNA consisting of less than one copy of the target genome, from low amounts of DNA, from DNA from mixed origin (e.g. pregnancy plasma: placental and maternal DNA; cancer patient plasma and tumors: mix between healthy and cancer DNA, transplantation etc), from other body fluids, from cell cultures, from culture supernatants, from forensic samples of DNA, from ancient samples of DNA (e.g. insects trapped in amber), from other samples of DNA, and combinations thereof.
  • a short amplicon size may be used. Short amplicon sizes are especially suited for fragmented DNA (see e.g. A. Sikora, et si. Detection of increased amounts of cell-free fetal DNA with short PCR amplicons. Clin Chem. 2010 Jan;56(l): 136-8.)
  • Short amplicon sizes may result in some significant benefits. Short amplicon sizes may result in optimized amplification efficiency. Short amplicon sizes typically produce shorter products, therefore there is less chance for nonspecific priming. Shorter products can be clustered more densely on sequencing flow cell, as the clusters will be smaller. Note that the methods described herein may work equally well for longer PCR amplicons. Amplicon length may be increased if necessary, for example, when sequencing larger sequence stretches. Experiments with 146-plex targeted amplification with assays of 100 bp to 200 bp length as first step in a nested-PCR protocol were run on single cells and on genomic DNA with positive results.
  • the methods described herein may be used to amplify and/or detect SNPs, copy number, nucleotide methylation, mRNA levels, other types of RNA expression levels, other genetic and/or epigenetic features.
  • the mini-PCR methods described herein may be used along with next-generation sequencing; it may be used with other downstream methods such as microarrays, counting by digital PCR, real-time PCR, Mass- spectrometry analysis etc.
  • the mini-PCR amplification methods described herein may be used as part of a method for accurate quantification of minority populations. It may be used for absolute quantification using spike calibrators. It may be used for mutation / minor allele quantification through very deep sequencing, and may be run in a highly multiplexed fashion. It may be used for standard paternity and identity testing of relatives or ancestors, in human, animals, plants or other creatures. It may be used for forensic testing. It may be used for rapid genotyping and copy number analysis (CN), on any kind of material, e.g. amniotic fluid and CVS, sperm, product of conception (POC). It may be used for single cell analysis, such as genotyping on samples biopsied from embryos. It may be used for rapid embryo analysis (within less than one, one, or two days of biopsy) by targeted sequencing using min-PCR.
  • CN genotyping and copy number analysis
  • tumor biopsies are often a mixture of health and tumor cells.
  • Targeted PCR allows deep sequencing of SNPs and loci with close to no background sequences. It may be used for copy number and loss of heterozygosity analysis on tumor DNA.
  • Said tumor DNA may be present in many different body fluids or tissues of tumor patients. It may be used for detection of tumor recurrence, and/or tumor screening. It may be used for quality control testing of seeds. It may be used for breeding, or fishing purposes. Note that any of these methods could equally well be used targeting non- polymorphic loci for the purpose of ploidy calling.
  • Some literature describing some of the fundamental methods that underlie the methods disclosed herein include: (1) Wang HY, Luo M, Tereshchenko IV, Frikker DM, Cui X, Li JY, Hu G, Chu Y, Azaro MA, Lin Y, Shen L, Yang Q, Kambouris ME, Gao R, Shih W, Li H. Genome Res. 2005 Feb;15(2):276-83. Department of Molecular Genetics, Microbiology and Immunology /The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903, USA. (2) High-throughput genotyping of single nucleotide polymorphisms with high sensitivity.
  • Highly multiplexed PCR can often result in the production of a very high proportion of product DNA that results from unproductive side reactions such as primer dimer formation.
  • the particular primers that are most likely to cause unproductive side reactions may be removed from the primer library to give a primer library that will result in a greater proportion of amplified DNA that maps to the genome.
  • the step of removing problematic primers, that is, those primers that are particularly likely to firm dimers has unexpectedly enabled extremely high PCR multiplexing levels for subsequent analysis by sequencing. In systems such as sequencing, where performance significantly degrades by primer dimers and/or other mischief products, greater than 10, greater than 50, and greater than 100 times higher multiplexing than other described multiplexing has been achieved.
  • primers for a library There are a number of ways to choose primers for a library where the amount of non- mapping primer-dimer or other primer mischief products are minimized.
  • Empirical data indicate that a small number of 'bad' primers are responsible for a large amount of non-mapping primer dimer side reactions. Removing these 'bad' primers can increase the percent of sequence reads that map to targeted loci.
  • One way to identify the 'bad' primers is to look at the sequencing data of DNA that was amplified by targeted amplification; those primer dimers that are seen with greatest frequnecy can be removed to give a primer library that is significantly less likely to result in side product DNA that does not map to the genome.
  • primers can be designed it is possible to attempt to identify primer pairs likely to form spurious products by evaluating the likelihood of spurious primer duplex formation between all possible pairs of primers using published thermodynamic parameters for DNA duplex formation.
  • Primer interactions may be ranked by a scoring function related to the interaction and primers with the worst interaction scores are eliminated until the number of primers desired is met.
  • SNPs likely to be heterozygous are most useful, it is possible to also rank the list of assays and select the most heterozygous compatible assays. Experiments have validated that primers with high interaction scores are most likely to form primer dimers.
  • analysis of a pool of DNA that has been amplified using a non- optimized set of primers may be sufficient to determine problematic primers. For example, analysis may be done using sequencing, and those dimers which are present in the greatest number are determined to be those most likely to form dimers, and may be removed.
  • the method of primer design may be used in combination with the mini-PCR method described elsewhere in this document.
  • the primer design method may be used as part of a massive multiplexed PCR method.
  • Tag-primers can be used to shorten necessary target-specific sequence to below 20, below 15, below 12, and even below 10 base pairs. This can be serendipitous with standard primer design when the target sequence is fragmented within the primer binding site or, or it can be designed into the primer design. Advantages of this method include: it increases the number of assays that can be designed for a certain maximal amplicon length, and it shortens the "non- informative" sequencing of primer sequence. It may also be used in combination with internal tagging (see elsewhere in this document).
  • the relative amount of nonproductive products in the multiplexed targeted PCR amplification can be reduced by raising the annealing temperature.
  • the annealing temperature can be increased in comparison to the genomic DNA as the tags will contribute to the primer binding.
  • the annealing times may be longer than 10 minutes, longer than 20 minutes, longer than 30 minutes, longer than 60 minutes, longer than 120 minutes, longer than 240 minutes, longer than 480 minutes, and even longer than 960 minutes.
  • longer annealing times are used than in previous reports, allowing lower primer concentrations.
  • the primer concentrations are as low as 50 nM, 20 nM, 10 nM, 5 nM, 1 nM, and lower than 1 uM. This surprisingly results in robust performance for highly multiplexed reactions, for example 1,000-plex reactions, 2,000-plex reactions, 5,000-plex reactions, 10,000- plex reactions, 20,000-plex reactions, 50,000-plex reactions, and even 100,000-plex reactions.
  • the amplification uses one, two, three, four or five cycles run with long annealing times, followed by PCR cycles with more usual annealing times with tagged primers.
  • the DNA in the sample may have ligation adapters, often referred to as library tags or ligation adaptor tags (LTs), appended, where the ligation adapters contain a universal priming sequence, followed by a universal amplification. In an embodiment, this may be done using a standard protocol designed to create sequencing libraries after fragmentation.
  • the DNA sample can be blunt ended, and then an A can be added at the 3' end.
  • a Y-adaptor with a T-overhang can be added and ligated.
  • other sticky ends can be used other than an A or T overhang.
  • other adaptors can be added, for example looped ligation adaptors.
  • the adaptors may have tag designed for PCR amplification.
  • STA Specific Target Amplification
  • STA Pre-amplification of hundreds to thousands to tens of thousands and even hundreds of thousands of targets may be multiplexed in one reaction. STA is typically run from 10 to 30 cycles, though it may be run from 5 to 40 cycles, from 2 to 50 cycles, and even from 1 to 100 cycles. Primers may be tailed, for example for a simpler workflow or to avoid sequencing of a large proportion of dimers. Note that typically, dimers of both primers carrying the same tag will not be amplified or sequenced efficiently.
  • between 1 and 10 cycles of PCR may be carried out; in some embodiments between 10 and 20 cycles of PCR may be carried out; in some embodiments between 20 and 30 cycles of PCR may be carried out; in some embodiments between 30 and 40 cycles of PCR may be carried out; in some embodiments more than 40 cycles of PCR may be carried out.
  • the amplification may be a linear amplification.
  • the number of PCR cycles may be optimized to result in an optimal depth of read (DOR) profile. Different DOR profiles may be desirable for different purposes.
  • a more even distribution of reads between all assays is desirable; if the DOR is too small for some assays, the stochastic noise can be too high for the data to be too useful, while if the depth of read is too high, the marginal usefulness of each additional read is relatively small.
  • Primer tails may improve the detection of fragmented DNA from universally tagged libraries. If the library tag and the primer-tails contain a homologous sequence, hybridization can be improved (for example, melting temperature (TM) is lowered) and primers can be extended if only a portion of the primer target sequence is in the sample DNA fragment. In some embodiments, 13 or more target specific base pairs may be used. In some embodiments, 10 to 12 target specific base pairs may be used. In some embodiments, 8 to 9 target specific base pairs may be used. In some embodiments, 6 to 7 target specific base pairs may be used. In some embodiments, STA may be performed on pre-amplified DNA, e.g. MDA, RCA, other whole genome amplifications, or adaptor-mediated universal PCR. In some embodiments, STA may be performed on samples that are enriched or depleted of certain sequences and populations, e.g. by size selection, target capture, directed degradation.
  • TM melting temperature
  • full nesting, semi-nesting, hemi-nesting, and/or subdividing into parallel reactions of smaller assay pools are all techniques that may be used to increase specificity.
  • splitting a sample into three 400-plex reactions resulted in product DNA with greater specificity than one 1,200-plex reaction with exactly the same primers.
  • splitting a sample into four 2,400-plex reactions resulted in product DNA with greater specificity than one 9,600-plex reaction with exactly the same primers.
  • a DNA sample (dilution, purified or otherwise) produced by an STA reaction using tag-specific primers and "universal amplification", i.e. to amplify many or all pre-amplified and tagged targets.
  • Primers may contain additional functional sequences, e.g. barcodes, or a full adaptor sequence necessary for sequencing on a high throughput sequencing platform. These methods may be used for analysis of any sample of DNA, and are especially useful when the sample of DNA is particularly small, or when it is a sample of DNA where the DNA originates from more than one individual, such as in the case of maternal plasma.
  • DNA samples such as a single or small number of cells, genomic DNA, plasma DNA, amplified plasma libraries, amplified apoptotic supernatant libraries, or other samples of mixed DNA.
  • these methods may be used in the case where cells of different genetic constitution may be present in a single individual, such as with cancer or transplants.
  • Protocol variants variants and/or additions to the workflow above
  • Direct multiplexed mini-PCR In some embodiments, specific target amplification
  • STA of a plurality of target sequences with tagged primers.
  • 101 denotes double stranded DNA with a polymorphic locus of interest at X.
  • 102 denotes the double stranded DNA with ligation adaptors added for universal amplification.
  • 103 denotes the single stranded DNA that has been universally amplified with PCR primers hybridized.
  • 104 denotes the final PCR product.
  • STA may be done on more than 100, more than 200, more than 500, more than 1,000, more than 2,000, more than 5,000, more than 10,000, more than 20,000, more than 50,000, more than 100,000 or more than 200,000 targets.
  • tag-specific primers amplify all target sequences and lengthen the tags to include all necessary sequences for sequencing, including sample indexes.
  • primers may not be tagged or only certain primers may be tagged.
  • Sequencing adaptors may be added by conventional adaptor ligation.
  • the initial primers may carry the tags.
  • primers are designed so that the length of DNA amplified is unexpectedly short.
  • Prior art demonstrates that ordinary people skilled in the art typically design 100+ bp amplicons.
  • the amplicons may be designed to be less than 80 bp.
  • the amplicons may be designed to be less than 70 bp.
  • the amplicons may be designed to be less than 60 bp.
  • the amplicons may be designed to be less than 50 bp.
  • the amplicons may be designed to be less than 45 bp.
  • the amplicons may be designed to be less than 40 bp.
  • the amplicons may be designed to be less than 35 bp.
  • the amplicons may be designed to be between 40 and 65 bp.
  • Sequential PCR After STA1 multiple aliquots of the product may be amplified in parallel with pools of reduced complexity with the same primers. The first amplification can give enough material to split. This method is especially good for small samples, for example those that are about 6-100 pg, about 100 pg to 1 ng, about 1 ng to 10 ng, or about 10 ng to 100 ng.
  • the protocol was performed with 1200-plex into three 400-plexes. Mapping of sequencing reads increased from around 60 to 70 % in the 1200-plex alone to over 95%.
  • the congenital disorder is a malformation, neural tube defect, chromosome abnormality, Down syndrome (or trisomy 21), Trisomy 18, spina bifida, cleft palate, Tay Sachs disease, sickle cell anemia, thalassemia, cystic fibrosis, Huntington's disease, and/or fragile x syndrome.
  • Chromosome abnormalities include, but are not limited to, Down syndrome (extra chromosome 21), Turner Syndrome (45X0) and Klinefelter's syndrome (a male with 2 X chromosomes).
  • the malformation is a limb malformation.
  • Limb malformations include, but are not limited to, amelia, ectrodactyly, phocomelia, polymelia, Polydactyly, syndactyly, polysyndactyly, oligodactyly, brachydactyly, achondroplasia, congenital aplasia or hypoplasia, amniotic band syndrome, and cleidocranial dysostosis.
  • the malformation is a congenital malformation of the heart.
  • Congenital malformations of the heart include, but are not limited to, patent ductus arteriosus, atrial septal defect, ventricular septal defect, and tetralogy of fallot.
  • the malformation is a congenital malformation of the nervous system.
  • Congenital malformations of the nervous system include, but are not limited to, neural tube defects (e.g., spina bifida, meningocele, meningomyelocele, encephalocele and anencephaly), Arnold-Chiari malformation, the Dandy- Walker malformation, hydrocephalus, microencephaly, megencephaly, lissencephaly, polymicrogyria, holoprosencephaly, and agenesis of the corpus callosum.
  • neural tube defects e.g., spina bifida, meningocele, meningomyelocele, encephalocele and anencephaly
  • Arnold-Chiari malformation e.g., the Dandy- Walker malformation
  • hydrocephalus e.g., microencephaly, megencephaly, lissencephaly, polymicrogyria,
  • the malformation is a congenital malformation of the gastrointestinal system.
  • Congenital malformations of the gastrointestinal system include, but are not limited to, stenosis, atresia, and imperforate anus.
  • the systems, methods, and techniques of the present disclosure are used in methods to increase the probability of implanting an embryo obtained by in vitro fertilization that is at a reduced risk of carrying a predisposition for a genetic disease.
  • the genetic disease is either monogenic or multigenic.
  • Genetic diseases include, but are not limited to, Bloom Syndrome, Canavan Disease, Cystic fibrosis, Familial Dysautonomia, Riley-Day syndrome, Fanconi Anemia (Group C), Gaucher Disease, Glycogen storage disease la, Maple syrup urine disease, Mucolipidosis IV, Niemann- Pick Disease, Tay-Sachs disease, Beta thalessemia, Sickle cell anemia, Alpha thalessemia, Beta thalessemia, Factor XI Deficiency, Friedreich's Ataxia, MCAD, Parkinson disease- juvenile, Connexin26, SMA, Rett syndrome, Phenylketonuria, Becker Muscular Dystrophy, Duchennes Muscular Dystrophy, Fragile X syndrome, Hemophilia A, Alzheimer dementia- early onset, Breast/Ovarian cancer, Colon cancer, Diabetes/MODY, Huntington disease, Myotonic Muscular Dystrophy, Parkinson Disease-
  • the method may further comprise administering prenatal or postnatal treatments for the congenital disorder. In some embodiments, the method may further comprise determining whether the fetus is likely to be afflicted with a malformation. In some embodiments, the method may further comprise administering prenatal or post-natal treatments for the malformation. In some embodiments, the method may further comprise determining whether the fetus is likely to be afflicted with a genetic disease. In some embodiments, the method may further comprise administering prenatal or post-natal treatments for the genetic disease. In some embodiments, the prenatal or post-natal treatment is taken from the group comprising pharmaceutical based intervention, surgery, genetic therapy, nutritional therapy, or combinations thereof.
  • the method may further comprise generating a report containing information pertaining to the determination.
  • the report may contain information pertaining to the determination as determined in any preceding or subsequent claim.
  • the method may further comprise generating a report containing the likelihood of a fetus displaying a phenotype, wherein the likelihood of the fetus displaying the phenotype was estimated using the determination as determined in any preceding or subsequent claim.
  • the method may further comprise performing a pregnancy termination.
  • DNA that originated from cancer that is living in a host can be found in the blood of the host.
  • genetic diagnoses can equally well be made from the measurement of mixed DNA found in host blood.
  • the genetic diagnoses may include aneuploidy states, or gene mutations. Any claim in that patent that reads on determining the ploidy state or genetic state of a fetus from the measurements made on maternal blood can equally well read on determining the ploidy state or genetic state of a cancer from the measurements on host blood.
  • the method may allow one to determine the ploidy status of a cancer, the method comprising obtaining a mixed sample that contains genetic material from the host, and genetic material from the cancer, measuring the DNA in the mixed sample, calculating the fraction of DNA that is of cancer origin in the mixed sample, and determining the ploidy status of the cancer using the measurements made on the mixed sample and the calculated fraction.
  • the method may further comprise administering a cancer therapeutic based on the determination of the ploidy state of the cancer.
  • the method may further comprise administering a cancer therapeutic based on the determination of the ploidy state of the cancer, wherein the cancer therapeutic is taken from the group comprising a pharmaceutical, a biologic therapeutic, and antibody based therapy and combination thereof.
  • a method for determining the ploidy state of one or more chromosome in a target individual may include any of the following steps, and combinations thereof:
  • Amplification of the DNA a process which transforms a small amount of genetic material to a larger amount of genetic material that contains a similar set of genetic data, can be done by a wide variety of methods, including, but not limited to, Polymerase Chain Reaction (PCR), ligand mediated PCR, degenerative oligonucleotide primer PCR, Multiple Displacement Amplification, allele-specific amplification techniques, Molecular Inversion Probes (MIP), padlock probes, other circularizing probes, and combination thereof. Many variants of the standard protocol may be used, for example increasing or decreasing the times of certain steps in the protocol, increasing or decreasing the temperature of certain steps, increasing or decreasing the amounts of various reagents, etc.
  • the DNA amplification transforms the initial sample of DNA into a sample of DNA that is similar in the set of sequences, but of much greater quantity. In some cases, amplification may not be required.
  • the genetic data of the target individual and/or of the related individual can be transformed from a molecular state to an electronic state by measuring the appropriate genetic material using tools and or techniques taken from a group including, but not limited to: genotyping microarrays, and high throughput sequencing.
  • Some high throughput sequencing methods include Sanger DNA sequencing, pyrosequencing, the ILLUMINA SOLEXA platform, ILLUMINA's GENOME ANALYZER, or APPLIED BIOSYSTEM's 454 sequencing platform, HELICOS's TRUE SINGLE MOLECULE SEQUENCING platform, HALCYON MOLECULAR' s electron microscope sequencing method, or any other sequencing method. All of these methods physically transform the genetic data stored in a sample of DNA into a set of genetic data that is typically stored in a memory device en route to being processed.
  • Any relevant individual's genetic data can be measured by analyzing substances taken from a group including, but not limited to: the individual's bulk diploid tissue, one or more diploid cells from the individual, one or more haploid cells from the individual, one or more blastomeres from the target individual, extra-cellular genetic material found on the individual, extra-cellular genetic material from the individual found in maternal blood, cells from the individual found in maternal blood, one or more embryos created from (a) gamete(s) from the related individual, one or more blastomeres taken from such an embryo, extra-cellular genetic material found on the related individual, genetic material known to have originated from the related individual, and combinations thereof.
  • a set of at least one ploidy state hypothesis may be created for each of the chromosomes of interest of the target individual.
  • Each of the ploidy state hypotheses may refer to one possible ploidy state of the chromosome or chromosome segment of the target individual.
  • the set of hypotheses may include some or all of the possible ploidy states that the chromosome of the target individual may be expected to have.
  • Some of the possible ploidy states may include nullsomy, monosomy, disomy, uniparental disomy, euploidy, trisomy, matching trisomy, unmatching trisomy, maternal trisomy, paternal trisomy, tetrasomy, balanced (2:2) tetrasomy, unbalanced (3: 1) tetrasomy, other aneuploidy, and they may additionally involve unbalanced translocations, balanced translocations, Robertsonian translocations, recombinations, deletions, insertions, crossovers, and combinations thereof.
  • the knowledge of the determined ploidy state may be used to make a clinical decision.
  • This knowledge typically stored as a physical arrangement of matter in a memory device, may then be transformed into a report. The report may then be acted upon.
  • the clinical decision may be to terminate the pregnancy; alternately, the clinical decision may be to continue the pregnancy.
  • the clinical decision may involve an intervention designed to decrease the severity of the phenotypic presentation of a genetic disorder, or a decision to take relevant steps to prepare for a special needs child.
  • any of the methods described herein may be modified to allow for multiple targets to come from the same target individual, for example, multiple blood draws from the same pregnant mother. This may improve the accuracy of the model, as multiple genetic measurements may provide more data with which the target genotype may be determined.
  • one set of target genetic data serves as the primary data which was reported, and the other serves as data to double-check the primary target genetic data.
  • a plurality of sets of genetic data, each measured from genetic material taken from the target individual are considered in parallel, and thus both sets of target genetic data serve to help determine which sections of parental genetic data, measured with high accuracy, composes the fetal genome.
  • the disclosed method is employed to determine the genetic state of one or more embryos for the purpose of embryo selection in the context of IVF.
  • This may include the harvesting of eggs from the prospective mother and fertilizing those eggs with sperm from the prospective father to create one or more embryos. It may involve performing embryo biopsy to isolate a blastomere from each of the embryos. It may involve amplifying and genotyping the genetic data from each of the blastomeres. It may include obtaining, amplifying and genotyping a sample of diploid genetic material from each of the parents, as well as one or more individual sperm from the father. It may involve incorporating the measured diploid and haploid data of both the mother and the father, along with the measured genetic data of the embryo of interest into a dataset.
  • the couple arranges to have her eggs harvested and fertilized with sperm from the man, producing nine viable embryos.
  • a blastomere is harvested from each embryo, and the genetic material from the blastomeres are amplified using a targeted amplification protocol and sequenced on the ILLUMINA HISEQ.
  • diploid data may be measured from tissue taken from both parents also using the same or a similar protocol.
  • haploid data from the father's sperm is measured using the same or a similar method.
  • the method disclosed herein is applied to the measured genetic data of the nine blastomeres, and possibly also the diploid maternal and paternal genetic data, and possibly also three sperm from the father.
  • the methods described herein are used to make ploidy calls for all of the chromosomes on all of the embryos, with high confidences.
  • Six of the nine embryos are found to be aneuploid, and three embryos are found to be euploid.
  • a report is generated that discloses these diagnoses, and is sent to the doctor.
  • the doctor along with the prospective parents, decides to transfer two of the three embryos found to be euploid, one of which implants in the mother's uterus.
  • Some of the math in the presently disclosed embodiments makes hypotheses concerning a limited number of states of aneuploidy. In some cases, for example, only zero, one or two chromosomes are expected to originate from each parent. In some embodiments of the present disclosure, the mathematical derivations can be expanded to take into account other forms of aneuploidy, such as quadrosomy, where three chromosomes originate from one parent, pentasomy, hexasomy etc., without changing the fundamental concepts of the present disclosure. At the same time, it is possible to focus on a smaller number of ploidy states, for example, only trisomy and disomy. Note that ploidy determinations that indicate a non-whole number of chromosomes may indicate mosaicism in a sample of genetic material.
  • the genetic abnormality is a type of aneuploidy, such as Down syndrome (or trisomy 21), Edwards syndrome (trisomy 18), Patau syndrome (trisomy 13), Turner Syndrome (45X0) Klinefelter' s syndrome (a male with 2 X chromosomes), Prader-Willi syndrome, and DiGeorge syndrome.
  • Congenital disorders such as those listed in the prior sentence, are commonly undesirable, and the knowledge that a fetus is afflicted with one or more phenotypic abnormalities may provide the basis for a decision to terminate the pregnancy, to take necessary precautions to prepare for the birth of a special needs child, or to take some therapeutic approach meant to lessen the severity of a chromosomal abnormality.
  • a very small amount of DNA is available, typically one or a small number of cell's worth of DNA.
  • blastomere biopsy typically one cell is available; in the context of day 5 trophectoderm biopsy, typically two to ten cells are available.
  • the genetic information relevant to the embryo i.e. genetic abnormalities in the form of aneuploidy, single gene diseases, and/or multigenic diseases, can be determined using targeted amplification followed by sequencing. A number of methods for targeted amplification and sequencing are decribed elsewhere in this document.
  • ⁇ is known, consider the following model for depth of read on SNP i, which is located on chromosome c. If all SNPs were equally effective, they would all have ⁇ equal to the inverse of the total number of SNPs.
  • a set of jS j can be estimated very simply from training data with known copy number as follows.
  • the first step is to measure to what extent the set of jS f correspond to the data. This can be done by comparing the depth of read on different SNPs within the same chromosome, which eliminates the effect of unknown copy number.
  • D be the set of SNPs on a single chromosome, on a single target. Define the following.
  • the likelihood at each SNP, given a hypothesis is Gaussian with mean m £ (3 ⁇ 4) and standard deviation £ ⁇ 4(ft.)determined by the hypothesis.
  • the standard deviation will be scaled by the factor K in order to reflect how well the data fits the binomial model and s.
  • the ploidy state of each chromosome was estimated using the Parental Support algorithm, described elsewhere in this document.
  • the observed allele ratio at each targeted SNP was compared against a theoretical model of ploidy hypotheses (monosomy, disomy, trisomy) for each chromosome.
  • the model combines a Monte Carlo simulation of the PCR process with a binomial model to incorporate variations in depth of read.
  • FIG. 1 shows allele ratio data from a genomic sample from an individual with a 47,XY +13 karyotype.
  • FIG. 2. shows allele ratio data from a genomic sample from an individual with a 47,XX +18 karyotype.
  • FIG. 3. shows allele ratio data from a genomic sample from an individual with a 47,XX +21 karyotype.
  • Plots are shown for cases with trisomy 13 (47,XY +13; FIG. 1), trisomy 18 (47,XX +18; FIG. 2), and trisomy 21 (47,XX +21 ; FIG. 3).
  • the data is displayed for SNPs chromosomes 1, 2, 13, 18, 21 and X, and the regions on the graph are arranged in that order.
  • FIG. 4, FIG. 5, and FIG. 6 show the same plot for allele ratio data from a 3 cell sample with trisomy 21 where the extra chromosome is of maternal origin.
  • FIG. 4, FIG. 5, and FIG. 6 show data an individual with a 47,XX +21 karyotype, graphed for a plurality of SNPs on chromosomes 1, 21 and X.
  • the spots in FIG. 4, FIG. 5, and FIG. 6 are coded according to the maternal genotype at that SNP: triangles and diamonds for homozygous for allele 1 and allele 2, respectively, and squares for homozygous.
  • all spots are included; in FIG. 5 only SNPs where the mother is heterozygous are plotted (squares), and in FIG.
  • FIG. 5 shows those SNPs that are heterozygous in the mother, and none of these on chromosome 21 are homozygous in the child. This shows that the child inherited both an A and a B allele from the mother; this is indicative of a meiotic non-disjunction error where the fetus inherited two homologous but non-identical chromosomes from the mother.
  • FIG. 6 shows only SNPs homozygous in the mother (triangles and diamonds). The fact that the 67% band contains only triangles and the band at 33% contains only diamonds indicates that the trisomy is of maternal origin. The fact that in FIG. 5 the band at 100% and 0% do not contain squares indicate that the two chromosomes from the mother are non-identical.
  • FIG. 7 shows depth of read data for three cells from the same individual, run separately. Only heterozygous SNPs are shown.
  • the relative amount of the two alleles is plotted here for heterozygous SNPs for three different cells.
  • the SNPs are ordered along the horizontal axis according to the relative amount of the two alleles for cell #1 (big diamonds).
  • FIG. 7 shows depth of read data for three cells from the same individual, run separately. Only heterozygous SNPs are shown.
  • the relative amount of the two alleles is plotted here for heterozygous SNPs for three different cells.
  • the SNPs are ordered along the horizontal axis according to the relative amount of the two alleles for cell #1 (big diamonds).
  • a regression analysis shows that the relative
  • FIG. 8 shows genetic data for a single cell sample from an individual with a 47,XX +21 karyotype, graphed for a plurality of SNPs on chromosomes 1 , 2, 13, 18, 21 and X from an experiment where 3,600 individual PCR assays were used. Only SNPs where the mother is homozygous are shown. The graphs are presented in the same way as before except that the size of the circle indicates the depth of read; i.e. the number of measured sequences that mapped to that SNP. The sample in question was trisomy 21, specifically 47,XX +21.
  • FIG. 9, FIG. 10, FIG. 11, FIG. 12, FIG. 13, and FIG. 14 show typical plots for a plurality of SNPs on chromosomes 1, 21 and X from single cells with 47,XX+21 (black, four replicates, FIG. 9, FIG. 10, FIG. 11, and FIG. 12), 46,XY (FIG. 13) and 46,XX (FIG. 14).
  • 47,XX +21 black, four replicates, FIG. 9, FIG. 10, FIG. 11, and FIG. 12
  • 46,XY FIG. 13
  • 46,XX FIG. 14
  • the following protocol was used for 800-plex amplification of DNA isolated from a triploidy 21 cell line using standard PCR (meaning no nesting was used).
  • Library preparation and amplification involved single tube blunt ending followed by A-tailing.
  • Adaptor ligation was run using the ligation kit found in the AGILENT SURESELECT kit, and PCR was run for 7 cycles. Then, 15 cycles of STA (95°C for 30s; 72 ° C for 1 min; 60 ° C for 4 min; 65 ° C for 1 min; 72 ° C for 30s) using 800 different primer pairs targeting SNPs on chromosomes 2, 21 and X.
  • the reaction was run with 12.5 nM primer concentration.
  • the DNA was then sequenced with an ILLUMINA IIGAX sequencer. The sequencer output 1.9 million reads, of which 92% mapped to the genome; of those reads that mapped to the genome, more than 99% mapped to one of the regions targeted by the targeted primers.
  • the DNA of the single/three cells was amplified with 25 cycles of STA (95 ° C for 10 min for initial polymerase activation, then 25 cycles of 95°C for 30s; 72 ° C for 10 s; 65 ° C for 1 min; 60 ° C for 8 min; 65 ° C for 3 min and 72 ° C for 30s; and a final extension at 72°C for for 2 min) using 50 nM primer concentration of 1200 target-specific forward and tagged reverse primers.
  • the semi-nested PCR protocol involved three parallel second amplification of a dilution of the first STAs product for 20 cycles of STA (95°C for 10 min for initial polymerase activation, then 15 cycles of 95°C for 30s; 65 ° C for 1 min; 60°C for 5 min; 65°C for 5 min and 72°C for 30s; and a final extension at 72 ° C for for 2 min) using reverse tag specific primer concentration of 1000 nM, and a concentration of 60 nM for each of 400 target-specific nested forward primers.
  • the total of 1200 targets amplified in the first STA were thus amplified.
  • the sequencing data was analyzed using informatics methods disclosed herein and the ploidy state was called at the three chromosomes for the samples.
  • a method for determining a ploidy state of an embryo at a chromosome of interest includes: obtaining a genetic sample from the embryo; preparing the genetic sample for sequencing; sequencing the genetic sample to give sequencing data; counting the number of sequence reads in the sequence data associated with each of a plurality of loci on the
  • the genetic sample is one, two, three to five, six to ten, eleven to twenty, twenty one to fifty, or fifty one to one hundred cells biopsied from an embryo.
  • the genetic sample is prepared for sequencing by performing amplification or universal amplification of the DNA in the genetic sample.
  • the method includes preferentially enriching the DNA in the genetic sample at a plurality of polymorphic loci.
  • the step of preferentially enriching the DNA includes performing targeted PCR amplification of the DNA in the genetic sample at a plurality of polymorphic loci.
  • the step of preferentially enriching the DNA comprises: obtaining a forward probe such that the 3 ' end of the forward probe is designed to hybridize to the region of DNA immediately upstream from the polymorphic region, and separated from the polymorphic region by a small number of bases, where the small number is selected from the group consisting of 1, 2, 3, 4, 5, 6 to 10, and 11 to 20; obtaining a reverse probe such that the 3' end of the reverse probe is designed to hybridize to the region of DNA immediately downstream from the polymorphic region, and separated from the polymorphic region by a small number of bases, where the small number is selected from the group consisting of 1, 2, 3, 4, 5, 6 to 10, and 11 to 20; hybridizing the two probes to DNA in the first sample of DNA; and amplifying the DNA using the polymerase chain reaction.
  • preferentially enriching the DNA results in average degree of allelic bias between the second sample and the first sample of a factor selected from the group consisting of no more than a factor of 2, no more than a factor of 1.5, no more than a factor of 1.2, no more than a factor of 1.1 , no more than a factor of 1.05, no more than a factor of 1.02, no more than a factor of 1.01 , no more than a factor of 1.005, no more than a factor of 1.002, no more than a factor of 1.001 and no more than a factor of 1.0001.
  • the sequencing is performed using a high throughput sequencer.
  • the method includes using maximum likelihood estimates to select the ploidy state corresponding to a hypothesis with the greatest probability.
  • determining the most likely ploidy state of the chromosome includes: counting the number of sequence reads in the sequence data associated with each of a plurality of loci on one or more reference chromosomes; and comparing the number of sequence reads associated with each of the plurality of loci on the chromosome of interest to the number of sequence reads associated with each of a plurality of targeted loci at one or a plurality of reference chromosomes where the reference chromosome(s) is assumed to be disomic.
  • the method further includes counting the number of sequence reads in the sequence data associated with each of a plurality of loci on one or more reference chromosomes, wherein: the ploidy state of the chromosome of interest is determined to be trisomy where the number of sequence reads associated with each of the plurality of loci at the chromosome of interest is about 50% greater than the number of sequence reads associated with each of a plurality of loci at one or a plurality of reference chromosomes; the ploidy state of the chromosome of interest is determined to be disomy where the number of sequence reads associated with each of the plurality of loci at the chromosome of interest is about the same as the number of sequence reads associated with each of a plurality of loci at one or a plurality of reference chromosomes; and the ploidy state of the chromosome of interest is determined to be monosomy where the number of sequence reads associated with each of the plurality of loci at the chromosome
  • the loci are single nucleotide polymorphisms.
  • the method includes comparing the number of sequence reads associated with each of the alleles at the plurality of loci on the chromosome of interest, where certain allele ratios are associated with certain ploidy states.
  • the ploidy state of the chromosome of interest is determined to be trisomy when the ratios of the number of sequence reads associated with each of the alleles at a plurality of polymorphic loci on the chromosome of interest are about 100%, 67%, 33% or 0%; the ploidy state of the chromosome of interest is determined to be disomy when the ratios of the number of sequence reads associated with each of the alleles at a plurality of polymorphic loci on the chromosome of interest are about 100%, 50% or 0%; and the ploidy state of the chromosome of interest is determined to be monosomy when the ratios of the number of sequence reads associated with each of the alleles at a plurality of polymorphic loci on the chromosome of interest are about 100% or 0%.
  • the method includes calculating a confidence estimate for a called ploidy state. In an embodiment, the method includes producing a report stating the called ploidy state of the embryo at that chromosome. In an embodiment, the method includes taking a clinical action based on the determined ploidy state of the embryo, wherein the clinical action is to transfer or not transfer the embryo into the uterus of the mother.
  • a method for determining a ploidy state of an embryo at a chromosome includes: obtaining a genetic sample from the embryo; amplifying the DNA present in the genetic sample by targeted PCR; sequencing the amplified DNA using a high throughput sequencer to give sequencing data; counting the number of sequence reads in the sequence data associated with each allele at a plurality of single nucleotide polymorphisms on the chromosome; calculating the allele ratios between the alleles at the plurality of single nucleotide
  • polymorphisms on the chromosome determining, on a computer, the most likely ploidy state of the chromosome given the calculated allele ratios at each of the polymorphisms on the chromosome.
  • a method for determining a ploidy state of an embryo at a chromosome of interest includes: obtaining a genetic sample from the embryo; amplifying the DNA present in the genetic sample by targeted PCR where the targeted PCR targets a plurality of loci on the chromosome of interest and on one or more reference chromosomes; sequencing the amplified DNA using a high throughput sequencer to give sequencing data; counting the number of sequence reads in the sequence data associated with each targeted locus on the chromosome of interest and on one or more reference chromosomes; determining, on a computer, the most likely ploidy state of the chromosome of interest given the ratio between the sequence read count associated with each targeted locus on the target chromosome and the sequence read count associated with each targeted allele on the reference chromosome(s), where certain ratios are associated with certain ploidy states.

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Abstract

La présente invention concerne des procédés qui permettent de déterminer le statut de ploïdie d'un embryon au niveau d'un chromosome provenant d'un échantillon d'ADN provenant d'un embryon. L'état de ploïdie est déterminé par le séquençage de l'ADN provenant d'une ou de plusieurs cellules issues d'une biopsie provenant de l'embryon, et l'analyse des quantités relatives de chaque allèle à une pluralité de loci polymorphiques sur le chromosome. Dans un mode de réalisation, l'état de ploïdie est déterminé par la comparaison des rapports alléliques observés aux rapports alléliques attendus pour différents états de ploïdie. Dans un mode de réalisation, l'ADN est amplifié sélectivement au niveau d'une pluralité de loci polymorphiques par le séquençage ciblé. Dans un mode de réalisation, l'échantillon mixte d'ADN peut être enrichi de préférence au niveau d'une pluralité de loci polymorphiques d'une façon qui réduit à un minimum le biais allélique.
PCT/US2012/058578 2010-05-18 2012-10-03 Procédés pour diagnostic génétique préimplantatoire par séquençage WO2013052557A2 (fr)

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PCT/US2013/028378 WO2013130848A1 (fr) 2012-02-29 2013-02-28 Analyse améliorée par informatique d'échantillons de fœtus soumis à une contamination maternelle
US14/225,356 US20140206552A1 (en) 2010-05-18 2014-03-25 Methods for preimplantation genetic diagnosis by sequencing
US14/877,925 US20170051355A1 (en) 2010-05-18 2015-10-07 Highly multiplex pcr methods and compositions
US14/918,544 US10316362B2 (en) 2010-05-18 2015-10-20 Methods for simultaneous amplification of target loci
US16/140,298 US20190010543A1 (en) 2010-05-18 2018-09-24 Methods for simultaneous amplification of target loci
US16/288,022 US10597723B2 (en) 2010-05-18 2019-02-27 Methods for simultaneous amplification of target loci
US16/353,636 US10655180B2 (en) 2010-05-18 2019-03-14 Methods for simultaneous amplification of target loci
US16/399,103 US10557172B2 (en) 2010-05-18 2019-04-30 Methods for simultaneous amplification of target loci
US16/399,947 US10793912B2 (en) 2010-05-18 2019-04-30 Methods for simultaneous amplification of target loci
US16/399,268 US10538814B2 (en) 2010-05-18 2019-04-30 Methods for simultaneous amplification of target loci
US16/412,353 US20190309365A1 (en) 2010-05-18 2019-05-14 Methods for simultaneous amplification of target loci
US16/412,331 US10526658B2 (en) 2010-05-18 2019-05-14 Methods for simultaneous amplification of target loci
US16/734,814 US20200123612A1 (en) 2010-05-18 2020-01-06 Methods for simultaneous amplification of target loci
US16/743,724 US10731220B2 (en) 2010-05-18 2020-01-15 Methods for simultaneous amplification of target loci
US16/747,833 US11312996B2 (en) 2010-05-18 2020-01-21 Methods for simultaneous amplification of target loci
US16/777,700 US11332793B2 (en) 2010-05-18 2020-01-30 Methods for simultaneous amplification of target loci
US16/817,117 US20200208221A1 (en) 2010-05-18 2020-03-12 Methods for simultaneous amplification of target loci
US16/829,133 US11525162B2 (en) 2010-05-18 2020-03-25 Methods for simultaneous amplification of target loci
US16/856,924 US20200318191A1 (en) 2010-05-18 2020-04-23 Methods for simultaneous amplification of target loci
US16/934,407 US11519035B2 (en) 2010-05-18 2020-07-21 Methods for simultaneous amplification of target loci
US17/018,966 US11939634B2 (en) 2010-05-18 2020-09-11 Methods for simultaneous amplification of target loci
US17/061,877 US11111545B2 (en) 2010-05-18 2020-10-02 Methods for simultaneous amplification of target loci
US17/196,822 US11286530B2 (en) 2010-05-18 2021-03-09 Methods for simultaneous amplification of target loci
US17/196,722 US20210198743A1 (en) 2010-05-18 2021-03-09 Methods for simultaneous amplification of target loci
US17/196,659 US20210198742A1 (en) 2010-05-18 2021-03-09 Methods for simultaneous amplification of target loci
US17/505,588 US20220033909A1 (en) 2010-05-18 2021-10-19 Methods for simultaneous amplification of target loci
US17/545,881 US20220098667A1 (en) 2010-05-18 2021-12-08 Methods for simultaneous amplification of target loci
US17/842,118 US20220356526A1 (en) 2010-05-18 2022-06-16 Methods for simultaneous amplification of target loci
US17/868,141 US20220411875A1 (en) 2012-10-03 2022-07-19 Methods for simultaneous amplification of target loci
US17/868,238 US20230053752A1 (en) 2010-05-18 2022-07-19 Methods for simultaneous amplification of target loci
US18/111,804 US20240158855A1 (en) 2010-05-18 2023-02-20 Methods for simultaneous amplification of target loci
US18/126,344 US20230383348A1 (en) 2010-05-18 2023-03-24 Methods for simultaneous amplification of target loci
US18/243,593 US20240068031A1 (en) 2010-05-18 2023-09-07 Methods for simultaneous amplification of target loci

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US201161542508P 2011-10-03 2011-10-03
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US13/335,043 Continuation-In-Part US10113196B2 (en) 2009-07-17 2011-12-22 Prenatal paternity testing using maternal blood, free floating fetal DNA and SNP genotyping
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US13/683,604 Continuation-In-Part US20130123120A1 (en) 2010-05-18 2012-11-21 Highly Multiplex PCR Methods and Compositions
US13/780,022 Continuation-In-Part US20130196862A1 (en) 2009-07-17 2013-02-28 Informatics Enhanced Analysis of Fetal Samples Subject to Maternal Contamination
US14/225,356 Continuation US20140206552A1 (en) 2010-05-18 2014-03-25 Methods for preimplantation genetic diagnosis by sequencing
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