Lek et al. [1] in Nature, describes a tour de force large scale reference data set of high-quality protein-coding variation generated via the Exome Aggregation Consortium (ExAC) [2]. This covers 7,404,909 variants of different types that can be interrogated from an open browser set up by the team http://exac.broadinstitute.org/ [2]. Many interesting and important aspects of protein variation in both medical and evolutionary contexts are subject to statistical analysis and the results discussed. This includes loss-of function (LoF) with both clinical manifestations and consequent possible opportunities for pharmacological intervention. As just one example they investigate genetic intolerance to 179,774 high-confidence protein truncation variants (PTVd) that mapped to 3,230 highly LoF-intolerant genes. It turns out that 72% have no human disease phenotype in the OMIM or ClinVar databases. The Exac resource provides opportunities for detailed analysis of functional variation as well as a filter for analysis of candidate pathogenic variants in Mendelian diseases. The paper also indicates that most of the proposed burden of Mendelian disease alleles per-person highlighted in previous reports, is due to misclassification in the literature and/or in databases [3]. In curating target records for GtoPdb the team have been finding it increasingly challenging to select between the many sources of protein variation and different levels of supporting evidence for the phenotypic consequences thereof. On the basis of these papers and our initial assessment of their database, we would now recommend Exac as a first-stop-shop for browsing the genomic variation landscape of GtoPdb targets, with GPCRdb, Swiss-Var, ClinVar and Orphanet as orthogonal backup.
[1] Lek et al. (2016). Analysis of protein-coding genetic variation in 60,706 humans. Nature 536, 285–291. [PMID: 27535533]
[2] Karczewski et al. (2016) The ExAC Browser: Displaying reference data information from over 60,000 exomes. bioRxiv (19 August 2016), 070581, doi:10.1101/070581
[3] Walsh et al. (2016). Reassessment of Mendelian gene pathogenicity using 7,855 cardiomyopathy cases and 60,706 reference samples.
Genetics in Medicine. Aug 17. doi: 10.1038/gim.2016.90. [Epub ahead of print]. [PMID: 27532257]
Comments by Chris Southan
guidetopharmacology blog 
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