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Dunwoodie, S. L.

Publications and source records attributed to Dunwoodie, S. L..

7 recordsLinked to original sources

HeartVar: An LLM-Assisted Tool for Clinical Classification of Variants in Cardiovascular Disease Cohorts

Manual clinical DNA variant classification is the bottleneck of every clinical and research rare disease workflow. The process typically requires a curator to assemble evidence from numerous databases, weigh 28 criteria, reconcile competing evidence, and produce a defensible case for the final classification. Additionally, the framework used to assess variants is not static and successive addenda have revised individual criteria. The most complete and current evidence aggregators available are commercial platforms, which can limit researcher access. We present HeartVar, an open-source web tool that automates the evidence-gathering and interpretation steps of variant classification associated with cardiovascular disease. Given a gene, a variant, and clinical context, HeartVar queries 20 public databases in parallel and assigns ACMG/AMP criteria through a hybrid rule-based/large language model (LLM) approach. Criteria that can be resolved from structured data are computed programmatically, and only those requiring interpretation of unstructured evidence are passed to the LLM. HeartVar returns a classification, point score, per-criterion breakdown, clinical-narrative summary, and database annotations. Benchmarking of 106 expert-curated ClinGen variants showed HeartVar outperformed other curation tools, assigning the correct ACMG tier in 72% of cases. HeartVar demonstrates that an LLM constrained by a domain-specific prompt and grounded in structured evidence can produce variant interpretations of first-pass quality for a cardiovascular disease cohort; however, it is not intended to replace manual assessment by a qualified variant curator. The tool is freely available to use and hosted at www.heartvar.victorchang.edu.au.

bioinformatics↗

NKX2-5 congenital heart disease mutations show diverse loss and gain of epigenomic, biochemical and chromatin search functions underpinning pathogenicity

Congenital heart defects (CHD) occur in [~]1% of live births, with inherited and acquired mutations and environmental factors contributing to causation. However, network perturbations in CHD remain poorly understood. We report an integrated functional-epigenomics approach to CHD, focusing on the cardiac homeodomain (HD) transcription factor NKX2-5, mutations which cause diverse heart structural and conduction defects. We selected twelve NKX2-5 CHD variants affecting different residue classes - homeodomain DNA base-contacting, backbone-contacting and helix-stabilizing, and those affecting other conserved protein:protein interaction (PPI) domains. In HL-1 cardiomyocytes, we profiled genome-wide DNA targets of NKX2-5 wild type (WT) and variants, their DNA binding affinity and specificity, PPI with known NKX2-5 cofactors and chromatin search dynamics. Variants showed diverse yet class-specific behaviours. All variants failed to bind many WT targets but retained binding to a subset of core cardiomyocyte-related targets, and bound hundreds of unique "off-targets" via changes to DNA binding site specificity, homodimerization, cofactor interactions and chromatin search functions. Our data suggest that complex residue-by-residue scale epigenomic, biochemical and chromatin search defects involving both loss-and gain-of-function contribute to CHD. These findings may inform precision molecular therapeutic approaches in patients with CHD.

genomics↗

Neural crest cell derived DKK1 modulates Wnt signalling in the second heart field to orchestrate cardiac outflow tract development

Heart morphogenesis is highly complex, and depends on the generation of diverse cell types which interact with each other in an orchestrated manner to remodel the primitive heart tube into a functional organ. Cardiac outflow tract formation critically depends on continued contribution of cardiac progenitor cells from the anterior second heart field to ensure proper growth of the outflow tract. Prior to entering the outflow tract, neural crest cells migrate in close apposition to the second heart field and may play important roles in regulating second heart field growth dynamics, however the molecular mechanisms by which neural crest cells interact with the second heart field have remained elusive. Here, we discover that neural crest cells are a primary source of Dickkopf1 (DKK1), a secreted Wnt signalling inhibitor, which modulates Wnt signalling activity in the second heart field to impose a balance between progenitor maintenance and differentiation. Further, we identify the ubiquitin ligase NEDD4 as a critical regulator of DKK1 levels, with disruption of Nedd4 activity leading to outflow tract defects. In the context of disease pathogenicity, we show a novel human congenital heart disease variant of NEDD4 has lost the ability to ubiquitinate DKK1, and is associated with heart defects in a mouse model of the genetic variant. Our findings point to an unexpected role for neural crest cells acting as a rheostat of Wnt signalling activity in cardiac progenitors, identifying a new molecular pathway underpinning correct outflow tract morphogenesis, and a new causative factor of congenital heart disease.

developmental biology↗

Benchmarking of variant pathogenicity prediction methods using a population genetics approach

MotivationVariant pathogenicity predictors are essential for identifying new associations between genetic variants and rare diseases. However, despite the availability of numerous predictors, there is no clear consensus on which methods provide the most reliable results. The common practice of training, testing, and benchmarking these predictors using known variant sets from disease or mutagenesis studies raises concerns about ascertainment bias and data circularity. ResultsWe benchmarked commonly used pathogenicity predictors using an orthogonal approach that does not rely on predefined "ground truth" datasets. By leveraging population-level genomic data from gnomAD and the Context-Adjusted Proportion of Singletons (CAPS) metric, we identified CADD and REVEL as the best-performing predictors for distinguishing extremely deleterious variants from moderately deleterious ones. REVEL demonstrated superior calibration. Additionally, we show that CAPS can serve as a meta-analysis tool for interpreting variant annotations and highlight biases in ClinVar-based predictor training. Availability and ImplementationCAPS analysis and benchmarking results are available at https://github.com/mgudVCCRI/PopGenVariantFiltering Contacte.giannoulatou@victorchang.edu.au

genomics↗

Impaired yolk sac NAD metabolism disrupts murine embryogenesis with relevance to human birth defects

Congenital malformations can originate from numerous genetic or non-genetic factors but in most cases the causes are unknown. Genetic disruption of nicotinamide adenine dinucleotide (NAD) de novo synthesis causes multiple malformations, collectively termed Congenital NAD Deficiency Disorder (CNDD), highlighting the necessity of this pathway during embryogenesis. Previous work in mice shows that NAD deficiency perturbs embryonic development specifically when organs are forming. While the pathway is predominantly active in the liver postnatally, the site of activity prior to and during organogenesis is unknown. Here, we used a mouse model of human CNDD and assessed pathway functionality in embryonic livers and extraembryonic tissues via gene expression, enzyme activity and metabolic analyses. We found that the extra-embryonic visceral yolk sac endoderm exclusively synthesises NAD de novo during early organogenesis before the embryonic liver takes over this function. Under CNDD-inducing conditions, visceral yolk sacs had reduced NAD levels and altered NAD-related metabolic profiles, affecting embryo metabolism. Expression of requisite pathway genes is conserved in the equivalent yolk sac cell type in humans. Our findings show that visceral yolk sac-mediated NAD de novo synthesis activity is essential for mouse embryogenesis and its perturbation causes CNDD. As mouse and human yolk sacs are functionally homologous, our data improve the understanding of human congenital malformation causation.

developmental biology↗

Quantitative trait and transcriptome analysis of genetic complexity underpinning cardiac interatrial septation in mice using an advanced intercross line

Unlike single-gene mutations leading to Mendelian conditions, common human diseases are likely emergent phenomena arising from multilayer, multiscale and highly interconnected interactions. Atrial and ventricular septal defects are the most common forms of cardiac congenital anomalies in humans. Atrial septal defects (ASD) show an open communication between left and right atria postnatally, potentially resulting in serious hemodynamic consequences if untreated. A milder form of atrial septal defect, patent foramen ovale (PFO), exists in about one quarter of the human population, strongly associated with ischaemic stroke and migraine. The anatomic liabilities and genetic and molecular basis of atrial septal defects remain unclear. Here, we advance our previous analysis of atrial septal variation through quantitative trait locus (QTL) mapping of an advanced intercross line (AIL) established between the inbred QSi5 and 129T2/SvEms mouse strains, that show extremes of septal phenotypes. Analysis resolved 37 unique septal QTL with high overlap between QTL for distinct septal traits. Whole genome sequencing of parental strains identified high confidence candidate deleterious variants, including in known human congenital heart disease genes, whereas transcriptome analysis of developing septa revealed networks involving ribosome, nucleosome, mitochondrial and extracellular matrix biosynthesis underlying septal variation. Analysis of variant architecture across different gene features, including enhancers and promoters, provided evidence for involvement of non-coding as well as protein coding variants. Our study provides the first high resolution picture of genetic complexity and network liability underlying common congenital heart disease, with relevance to human ASD and PFO.

genetics↗

Deleterious genetic variants in NOTCH1 are a major contributor to the incidence of non-syndromic Tetralogy of Fallot

AimsFamilial recurrence studies provide strong evidence for a genetic component to the predisposition to sporadic, non-syndromic Tetralogy of Fallot (TOF), the most common cyanotic congenital heart disease (CHD) phenotype. Rare genetic variants have been identified as important contributors to the risk of CHD, but relatively small numbers of TOF cases have been studied to date. Here, we use whole exome sequencing to assess the prevalence of rare, potentially deleterious variants in candidate genes previously associated with both syndromic and non-syndromic TOF, in the largest cohort of non-syndromic TOF patients reported to date.\n\nMethods & Results829 non-syndromic TOF patients underwent whole exome sequencing. A systematic review of the literature was conducted which revealed 77 genes in which mutations had been reported in patients with TOF. The presence of rare, deleterious variants in the 77 candidate genes was determined, defined by a minor allele frequency of [≤] 0.001 and scaled combined annotation-dependent depletion (CADD) score of [≥] 20. We found a clustering of heterozygous rare, deleterious variants in NOTCH1 (P=1.89E-15), DOCK6 (P=2.93E-07), MYOM2 (P= 7.35E-05), TTC37 (P=0.016), MESP1 (P=0.024) and TBX1 (P=0.039), after correcting for multiple testing. NOTCH1 was most frequently found to harbour deleterious variants. Changes were observed in 49 patients (6%; 95% confidence interval [CI]: 4.5% - 7.8%) and included six truncating/frameshift variants and forty missense variants. Sanger sequencing of the unaffected parents of thirteen cases identified five de novo variants. Variants were not confined to a single functional domain of the NOTCH1 protein but significant clustering of variants was evident in the EGF-like repeats (P=0.018). Three NOTCH1 missense variants (p.G200R, p.C607Y and de novo p.N1875S) were subjected to functional evaluation and showed a reduction in Jagged1 ligand-induced NOTCH signalling. p.C607Y, which exhibited the most significant reduction in signalling, also perturbed S1 cleavage of the NOTCH1 receptor in the Golgi.\n\nConclusionThe NOTCH1 locus is a frequent site of genetic variants predisposing to non-syndromic TOF with 6% of patients exhibiting rare, deleterious variants. Our data supports the polygenic origin of TOF and suggests larger studies may identify additional loci.

genetics↗