Name: oncogenic gene fusion detection using anchored multiplex polymerase chain reaction followed by next generation sequencing
Uploaded: 2019-07-05T14:00:00
Description: Watch this Scientific Journal Video about Oncogenic Gene Fusion Detection Using Anchored Multiplex Polymerase Chain Reaction Followed by Next Generation Sequencing at JoVE.com

This work was supported by the Molecular Pathology Shared Resource of the University of Colorado (National Cancer Institute Cancer Center Support Grant No. P30-CA046934) and by the Colorado Center for Personalized Medicine.

1. Library preparation and sequencing
<ol>
	<li>General assay considerations and pre-assay steps
	<ol>
		<li>Assay runs typically consist of seven clinical samples and one positive control (although the number of samples per library preparation run can be adjusted as necessary). Use a positive control that contains at least several gene fusions (that the assay targets) that have been confirmed by a manufacturer and/or have been confirmed by an orthogonal methodology. A non-template control (NTC) must b...

<ol>
	<li>Mitelman, F., Johansson, B., Mertens, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+impact+of+translocations+and+gene+fusions+on+cancer+causation.">The impact of translocations and gene fusions on cancer causation.</a> Nature Reviews Cancer. 7 (4), 233-245 (2007).</li><li>Daley, G. Q., Van Etten, R. A., Baltimore, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Induction+of+chronic+myelogenous+leukemia+in+mice+by+the+P210bcr/abl+gene+of+the+Philadelphia+chromosome.">Induction of chronic myelogenous leukemia in mice by the P210bcr/abl gene of the Philadelphia chromosome.</a> Science. 247 (4944), 824-830 (1990).</li><li>Druker, B. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Activity+of+a+specific+inhibitor+of+the+BCR-ABL+tyrosine+kinase+in+the+blast+crisis+of+chronic+myeloid+leukemia+and+acute+lymphoblastic+leukemia+with+the+Philadelphia+chromosome.">Activity of a specific inhibitor of the BCR-ABL tyrosine kinase in the blast crisis of chronic myeloid leukemia and acute lymphoblastic leukemia with the Philadelphia chromosome.</a> New England Journal of Medicine. 344 (14), 1038-1042 (2001).</li><li>Solomon, B. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=First-line+crizotinib+versus+chemotherapy+in+ALK-positive+lung+cancer.">First-line crizotinib versus chemotherapy in ALK-positive lung cancer.</a> New England Journal of Medicine. 371 (23), 2167-2177 (2014).</li><li>Shaw, A. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Crizotinib+in+ROS1-rearranged+non-small-cell+lung+cancer.">Crizotinib in ROS1-rearranged non-small-cell lung cancer.</a> New England Journal of Medicine. 371 (21), 1963-1971 (2014).</li><li>Drilon, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+of+Larotrectinib+in+TRK+Fusion-Positive+Cancers+in+Adults+and+Children.">Efficacy of Larotrectinib in TRK Fusion-Positive Cancers in Adults and Children.</a> New England Journal of Medicine. 378 (8), 731-739 (2018).</li><li>Kawai, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=SYT-SSX+gene+fusion+as+a+determinant+of+morphology+and+prognosis+in+synovial+sarcoma.">SYT-SSX gene fusion as a determinant of morphology and prognosis in synovial sarcoma.</a> New England Journal of Medicine. 338 (3), 153-160 (1998).</li><li>de Alava, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=EWS-FLI1+fusion+transcript+structure+is+an+independent+determinant+of+prognosis+in+Ewing's+sarcoma.">EWS-FLI1 fusion transcript structure is an independent determinant of prognosis in Ewing's sarcoma.</a> Journal of Clinical Oncology. 16 (4), 1248-1255 (1998).</li><li>Pierron, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+new+subtype+of+bone+sarcoma+defined+by+BCOR-CCNB3+gene+fusion.">A new subtype of bone sarcoma defined by BCOR-CCNB3 gene fusion.</a> Nature Genetics. 44 (4), 461-466 (2012).</li><li>Papaemmanuil, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Genomic+Classification+and+Prognosis+in+Acute+Myeloid+Leukemia.">Genomic Classification and Prognosis in Acute Myeloid Leukemia.</a> New England Journal of Medicine. 374 (23), 2209-2221 (2016).</li><li>Arber, D. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+2016+revision+to+the+World+Health+Organization+classification+of+myeloid+neoplasms+and+acute.">The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute.</a> Blood. 127 (20), 2391-2405 (2016).</li><li>Sanders, H. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Exon+scanning+by+reverse+transcriptase-polymerase+chain+reaction+for+detection+of+known+and+novel+EML4-ALK+fusion+variants+in+non-small+cell+lung+cancer.">Exon scanning by reverse transcriptase-polymerase chain reaction for detection of known and novel EML4-ALK fusion variants in non-small cell lung cancer.</a> Cancer Genetics. 204 (1), 45-52 (2011).</li><li>Camidge, D. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Optimizing+the+Detection+of+Lung+Cancer+Patients+Harboring+Anaplastic+Lymphoma+Kinase+(ALK)+Gene+Rearrangements+Potentially+Suitable+for+ALK+Inhibitor+Treatment.">Optimizing the Detection of Lung Cancer Patients Harboring Anaplastic Lymphoma Kinase (ALK) Gene Rearrangements Potentially Suitable for ALK Inhibitor Treatment.</a> Clinical Cancer Research. 16 (22), 5581-5590 (2010).</li><li>Mino-Kenudson, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+novel,+highly+sensitive+antibody+allows+for+the+routine+detection+of+ALK-rearranged+lung+adenocarcinomas+by+standard+immunohistochemistry.">A novel, highly sensitive antibody allows for the routine detection of ALK-rearranged lung adenocarcinomas by standard immunohistochemistry.</a> Clinical Cancer Research. 16 (5), 1561-1571 (2010).</li><li>Suehara, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Identification+of+KIF5B-RET+and+GOPC-ROS1+fusions+in+lung+adenocarcinomas+through+a+comprehensive+mRNA-based+screen+for+tyrosine+kinase+fusions.">Identification of KIF5B-RET and GOPC-ROS1 fusions in lung adenocarcinomas through a comprehensive mRNA-based screen for tyrosine kinase fusions.</a> Clinical Cancer Research. 18 (24), 6599-6608 (2012).</li><li>Davies, K. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+Molecular+Testing+Modalities+for+Detection+of+ROS1+Rearrangements+in+a+Cohort+of+Positive+Patient+Samples.">Comparison of Molecular Testing Modalities for Detection of ROS1 Rearrangements in a Cohort of Positive Patient Samples.</a> Journal of Thoracic Oncology. 13 (10), 1474-1482 (2018).</li><li>Reeser, J. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validation+of+a+Targeted+RNA+Sequencing+Assay+for+Kinase+Fusion+Detection+in+Solid+Tumors.">Validation of a Targeted RNA Sequencing Assay for Kinase Fusion Detection in Solid Tumors.</a> Journal of Molecular Diagnostics. 19 (5), 682-696 (2017).</li><li>Beadling, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Multiplexed+Amplicon+Approach+for+Detecting+Gene+Fusions+by+Next-Generation+Sequencing.">A Multiplexed Amplicon Approach for Detecting Gene Fusions by Next-Generation Sequencing.</a> Journal of Molecular Diagnostics. 18 (2), 165-175 (2016).</li><li>Mamanova, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Target-enrichment+strategies+for+next-generation+sequencing.">Target-enrichment strategies for next-generation sequencing.</a> Nature Methods. 7 (2), 111-118 (2010).</li><li>Zheng, Z., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anchored+multiplex+PCR+for+targeted+next-generation+sequencing.">Anchored multiplex PCR for targeted next-generation sequencing.</a> Nature Medicine. 20 (12), 1479-1484 (2014).</li><li>Davies, K. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dramatic+Response+to+Crizotinib+in+a+Patient+with+Lung+Cancer+Positive+for+an+HLA-DRB1-MET+Gene+Fusion.">Dramatic Response to Crizotinib in a Patient with Lung Cancer Positive for an HLA-DRB1-MET Gene Fusion.</a> JCO Precision Oncology. 2017 (1), (2017).</li><li>Vendrell, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Detection+of+known+and+novel+ALK+fusion+transcripts+in+lung+cancer+patients+using+next-generation+sequencing+approaches.">Detection of known and novel ALK fusion transcripts in lung cancer patients using next-generation sequencing approaches.</a> Scientific Reports. 7 (1), 12510 (2017).</li><li>Agaram, N. P., Zhang, L., Cotzia, P., Antonescu, C. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Expanding+the+Spectrum+of+Genetic+Alterations+in+Pseudomyogenic+Hemangioendothelioma+With+Recurrent+Novel+ACTB-FOSB+Gene+Fusions.">Expanding the Spectrum of Genetic Alterations in Pseudomyogenic Hemangioendothelioma With Recurrent Novel ACTB-FOSB Gene Fusions.</a> American Journal of Surgical Pathology. 42 (12), 1653-1661 (2018).</li><li>Skalova, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Molecular+Profiling+of+Mammary+Analog+Secretory+Carcinoma+Revealed+a+Subset+of+Tumors+Harboring+a+Novel+ETV6-RET+Translocation:+Report+of+10+Cases.">Molecular Profiling of Mammary Analog Secretory Carcinoma Revealed a Subset of Tumors Harboring a Novel ETV6-RET Translocation: Report of 10 Cases.</a> American Journal of Surgical Pathology. 42 (2), 234-246 (2018).</li><li>Guseva, N. V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anchored+multiplex+PCR+for+targeted+next-generation+sequencing+reveals+recurrent+and+novel+USP6+fusions+and+upregulation+of+USP6+expression+in+aneurysmal+bone+cyst.">Anchored multiplex PCR for targeted next-generation sequencing reveals recurrent and novel USP6 fusions and upregulation of USP6 expression in aneurysmal bone cyst.</a> Genes Chromosomes and Cancer. 56 (4), 266-277 (2017).</li></ol>

Anchored multiplex PCR-based target enrichment and library preparation followed by next-generation sequencing is well suited for multiplexed gene fusion assessment in clinical tumor samples. By focusing on RNA input rather than genomic DNA, the need to sequence large and repetitive introns is avoided. Additionally, since this approach amplifies gene fusions regardless of the identity of the fusion partner, novel fusions are detected. This is a critical advantage in the clinical realm, and there have been many examples of...

The fusion of two or more genes into a single transcriptional entity can occur as the result of large scale chromosomal variations including deletions, duplications, insertions, inversions, and translocations. Through altered transcriptional control and/or altered functional properties of the expressed gene product, these fusion genes can confer oncogenic properties to cancer cells1. In many cases, fusion genes are known to act as primary oncogenic drivers by directly activating cellular proliferation and survival pathways.
The clinical relevance of gene fusions for cancer patients first became apparent with the discovery of the Philadelphia chromosome and the corresponding BCR-ABL1 fusion gene in chronic myelogenous leukemia (CML)2. The small molecule inhibitor imatinib mesylate was developed to specifically target this fusion gene and demonstrated remarkable efficacy in BCR-ABL1-positive CML patients3. Therapeutic targeting of oncogenic gene fusions has also been successful in solid tumors, with inhibition of ALK and ROS1 fusion genes in non-small cell lung cancer serving as primary examples4,5. Recently, the NTRK inhibitor larotrectinib was FDA approved for NTRK1/2/3 fusion-positive solid tumors, regardless of disease site6. Beyond therapy selection, gene fusion detection also has roles in disease diagnosis and prognosis. This is particularly prevalent in various sarcoma and hematologic malignancy subtypes that are diagnostically defined by the presence of specific fusions and/or for which presence of a fusion directly informs prognosis7,8,9,10,11. These are but a few of the examples of the clinical application of gene fusion detection for cancer patients.
Due to the critical role in clinical decision making, accurate gene fusion detection from clinical samples is of vital importance. Numerous techniques have been applied in clinical laboratories for fusion or chromosomal rearrangement analysis including: cytogenetic techniques, reverse transcription polymerase chain reaction (RT-PCR), fluorescence in situ hybridization (FISH), immunohistochemistry (IHC), and 5&#8217;/3&#8217; expression imbalance analysis (among others)12,13,14,15. Presently, the rapidly expanding list of actionable gene fusions in cancer has resulted in the need to assess fusion status of multiple genes simultaneously. Consequently, some traditional techniques that can only query one or a few genes at a time are becoming inefficient approaches, especially when considering that clinical tumor samples are often very finite and not amenable to being divided among several assays. Next generation sequencing (NGS), however, is an analysis platform that is well suited for multi-gene testing, and NGS-based assays have become common in clinical molecular diagnostic laboratories.
Currently used NGS assays for fusion/rearrangement detection vary in regard to the input material used, the chemistries employed for library preparation and target enrichment, and the number of genes queried within an assay. NGS assays can be based on RNA or DNA (or both) extracted from the sample. Although RNA-based analysis is hampered by the tendency of clinical samples to contain highly degraded RNA, it circumvents the need to sequence large and often repetitive introns that are the targets of DNA-based fusion testing but have proven to be difficult for NGS data analysis16. Target enrichment strategies for RNA-based NGS assays can be largely divided into hybrid capture or amplicon-mediated approaches. While both strategies have been successfully utilized for fusion detection, each contains advantages over the other17,18. Hybrid capture assays generally result in more complex libraries and reduced allelic dropout, whereas amplicon-based assays generally require lower input and result in less off-target sequencing19. However, perhaps the primary limitation of traditional amplicon-based enrichment is the need for primers to all known fusion partners. This is problematic since many clinically important genes are known to fuse with dozens of different partners, and even if primer design allowed for detection of all known partners, novel fusion events would remain undetected. A recently described technique termed anchored multiplex PCR (or AMP for short) addresses this limitation20. In AMP, a &#8216;half-functional&#8217; NGS adapter is ligated to cDNA fragments that are derived from input RNA. Target enrichment is achieved by amplification between gene specific primers and a primer to the adapter. As a result, all fusions to genes of interest, even if a novel fusion partner is involved, should be detected (see Figure 1). This article describes the use of the ArcherDx FusionPlex Solid Tumor kit, an NGS-based assay that employs AMP for target enrichment and library preparation, for the detection of oncogenic gene fusions in solid tumor samples (see Supplementary Table 1 for complete gene list). The wet-bench protocol and data analysis steps have been rigorously validated in a Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory.

<table>
	<tbody>
		<tr>
			<td>10 mM Tris HCl pH 8.0</td>
			<td>IDT</td>
			<td>11-05-01-13</td>
			<td>Used for TNA dilution</td>
		</tr>
		<tr>
			<td>1M Tris pH 7.0</td>
			<td>Thermo Fisher</td>
			<td>AM9850G</td>
			<td>Used in library pooling</td>
		</tr>
		<tr>
			<td>25 mL Reagent Reservoir with divider</td>
			<td>USA Scientific</td>
			<td>9173-2000</td>
			<td>For use with multi-channel pipetters and large reagent volumes</td>
		</tr>
		<tr>
			<td>96-well TemPlate Semi-Skirt 0.1mL PCR plate-natural</td>
			<td>USA Scientific</td>
			<td>1402-9700</td>
			<td>Plate used for thermocycler steps</td>
		</tr>
		<tr>
			<td>Agencourt AMPure XP Beads</td>
			<td>Beckman Coulter</td>
			<td>A63881</td>
			<td>Used in purification after several assay steps</td>
		</tr>
		<tr>
			<td>Agencourt Formapure Kit</td>
			<td>Beckman Coulter</td>
			<td>A33343</td>
			<td>Used in TNA extraction</td>
		</tr>
		<tr>
			<td>Archer FusionPlex Solid Tumor kit</td>
			<td>ArcherDX</td>
			<td>AB0005</td>
			<td>This kit contains most of the reagents necessary to perform library preperation for Illumina sequencing (kits for Ion Torrent sequencing are also available)</td>
		</tr>
		<tr>
			<td>Cold block, 96-well</td>
			<td>Light Labs</td>
			<td>A7079</td>
			<td>Used for keeping samples chilled at various steps</td>
		</tr>
		<tr>
			<td>Ethanol</td>
			<td>Decon Labs</td>
			<td>DSP-MD.43</td>
			<td>Used for bead washes</td>
		</tr>
		<tr>
			<td>Library Quantification for Illumina Internal Control Standard</td>
			<td>Kapa Biosystems</td>
			<td>KK4906</td>
			<td>Used for library quantitation</td>
		</tr>
		<tr>
			<td>Library Quantification Primers and ROX Low qPCR mix</td>
			<td>Kapa Biosystems</td>
			<td>KK4973</td>
			<td>Used for library quantitation</td>
		</tr>
		<tr>
			<td>Library Quantification Standards</td>
			<td>Kapa Biosystems</td>
			<td>KK4903</td>
			<td>Used for library quantitation</td>
		</tr>
		<tr>
			<td>Magnet Plate, 96-well (N38 grade)</td>
			<td>Alpaqua</td>
			<td>A32782</td>
			<td>Used in bead purificiation steps</td>
		</tr>
		<tr>
			<td>MBC Adapters Set B</td>
			<td>ArcherDX</td>
			<td>AK0016-48</td>
			<td>Adapters that contain sample-specific indexes to enable multiplex sequencing</td>
		</tr>
		<tr>
			<td>Micro Centrifuge</td>
			<td>USA Scientific</td>
			<td>2641-0016</td>
			<td>Used for spinning down PCR tubes</td>
		</tr>
		<tr>
			<td>MicroAmp EnduraPlate Optical 96 well Plate</td>
			<td>Thermo-Fisher</td>
			<td>4483485</td>
			<td>Used for Pre-Seq QClibrary quantitation</td>
		</tr>
		<tr>
			<td>Microamp Optical Film Compression Pad</td>
			<td>Applied Biosystems</td>
			<td>4312639</td>
			<td>Used for library quantitation</td>
		</tr>
		<tr>
			<td>Mini Plate Spinner</td>
			<td>Labnet</td>
			<td>MPS-1000</td>
			<td>Used for collecing liquid at bottom of plate wells</td>
		</tr>
		<tr>
			<td>MiSeq Reagent Kit v3 (600 cycle)</td>
			<td>Illumina</td>
			<td>MS-102-3003</td>
			<td>Contains components necessary for a MiSeq sequencing run</td>
		</tr>
		<tr>
			<td>MiSeqDx System</td>
			<td>Illumina</td>
			<td></td>
			<td>NGS Sequencing Instrument</td>
		</tr>
		<tr>
			<td>Model 9700 Thermocycler</td>
			<td>Applied Biosystems</td>
			<td></td>
			<td>Used for several steps during assay</td>
		</tr>
		<tr>
			<td>nuclease free water</td>
			<td>Ambion</td>
			<td>9938</td>
			<td>Used as general diluent</td>
		</tr>
		<tr>
			<td>Optical ABI 96-well PCR plate covers</td>
			<td>Thermo-Fisher</td>
			<td>4311971</td>
			<td>Used for Pre-Seq QClibrary quantitation</td>
		</tr>
		<tr>
			<td>PCR Workstation Model 600</td>
			<td>Air Clean Systems</td>
			<td>BZ10119636</td>
			<td>Wet-bench assay steps performed in this &#39;dead air box&#39;</td>
		</tr>
		<tr>
			<td>Proteinase K</td>
			<td>Qiagen</td>
			<td>1019499</td>
			<td>Used in TNA extraction</td>
		</tr>
		<tr>
			<td>QuantStudio 5</td>
			<td>Applied Biosystems</td>
			<td>LSA28139</td>
			<td>qPCR instrument used for PreSeq and library quantitation</td>
		</tr>
		<tr>
			<td>Qubit RNA HS Assay Kit</td>
			<td>Life Technologies</td>
			<td>Q32855</td>
			<td>Use for determing RNA concentration in TNA samples</td>
		</tr>
		<tr>
			<td>RNase Away</td>
			<td>Fisher</td>
			<td>12-402-178</td>
			<td>Used for general RNase decontamination of work areas</td>
		</tr>
		<tr>
			<td>Seraseq FFPE Tumor Fusion RNA Reference Material v2</td>
			<td>SeraCare</td>
			<td>0710-0129</td>
			<td>Used as the assay positive control</td>
		</tr>
		<tr>
			<td>Sodium Hydroxide</td>
			<td>Fisher</td>
			<td>BP359-212</td>
			<td>Used in clean-up steps and for sequencing setup</td>
		</tr>
		<tr>
			<td>SYBR Green Supermix</td>
			<td>Bio Rad</td>
			<td>172-5120</td>
			<td>Component of PreSeq QC Assay</td>
		</tr>
		<tr>
			<td>TempAssure PCR 8-tube Strips</td>
			<td>USA Scientific</td>
			<td>1402-2700</td>
			<td>Used for reagent and sample mixing etc.</td>
		</tr>
		<tr>
			<td>Template RT PCR film</td>
			<td>USA Scientific</td>
			<td>2921-7800</td>
			<td>Used for covering 96-well plates</td>
		</tr>
		<tr>
			<td>U-Bottom 96-well Microplate</td>
			<td>LSP</td>
			<td>MP8117-R</td>
			<td>Used during bead purification</td>
		</tr>
	</tbody>
</table>

oncogenic gene fusion detection using anchored multiplex polymerase chain reaction followed by next generation sequencing

Gene fusions frequently contribute to the oncogenic phenotype of many different types of cancer. Additionally, the presence of certain fusions in samples from cancer patients often directly influences diagnosis, prognosis, and/or therapy selection. As a result, the accurate detection of gene fusions has become a critical component of clinical management for many disease types. Until recently, clinical gene fusion detection was predominantly accomplished through the use of single-gene assays. However, the ever-growing list of gene fusions with clinical significance has created a need for assessing fusion status of multiple genes simultaneously. Next generation sequencing (NGS)-based testing has met this demand through the ability to sequence nucleic acid in massively parallel fashion. Multiple NGS-based approaches that employ different strategies for gene target enrichment are now available for use in clinical molecular diagnostics, each with its own strengths and weaknesses. This article describes the use of anchored multiplex PCR (AMP)-based target enrichment and library preparation followed by NGS to assess for gene fusions in clinical solid tumor specimens. AMP is unique among amplicon-based enrichment approaches in that it identifies gene fusions regardless of the identity of the fusion partner. Detailed here are both the wet-bench and data analysis steps that ensure accurate gene fusion detection from clinical samples.

Shown in Figure 3, Figure 4 and Figure 5 are screenshots from the analysis user interface demonstrating results from a lung adenocarcinoma sample. In Figure 3, the sample summary is shown (top) that lists the called strong evidence fusions, as well as the QC status (circled in red). The ADCK4-NUMBL fusion (of which 3 isoforms are listed) is immediately ignored because it is a persistent transcr...

Watch this Scientific Journal Video about Oncogenic Gene Fusion Detection Using Anchored Multiplex Polymerase Chain Reaction Followed by Next Generation Sequencing at JoVE.com

Oncogenic Gene Fusion Detection Using Anchored Multiplex Polymerase Chain Reaction Followed by Next Generation Sequencing

This article details the use of an anchored multiplex polymerase chain reaction-based library preparation kit followed by next-generation sequencing to assess for oncogenic gene fusions in clinical solid tumor samples. Both wet-bench and data analysis steps are described.

Gene fusions frequently contribute to the oncogenic phenotype of many different types of cancer. Additionally, the presence of certain fusions in samples ...

This protocol is used for the detection of critically informative gene fusions for patient tumor samples. The fusion status of dozens of genes is assessed simultaneously in a single assay. The advantage of this technique is that I can identify gene fusions regardless of the identity of the fusion partner from tumor samples that have been processed by formulative fixation.The detection of certain gene fusion in clinical tumor sample directly informs diagnosis, prognosis and treatment selection in many cancer types. It is critical to understand that many fusions called by the analysis algorithm are artifacts. The most difficult task when analyzing data is distinguishing between artifact and real fusion calls.Begin by diluting total nucleic acid to achieve the desired concentration of RNA. For each sample, transfer 20 microliters of the dilution into the random priming reagent strip tubes in a pre-chilled aluminum block and mix by pipetting up and down six to eight times. Briefly spin down the samples, transfer the entire volume to a 96-well PCR plate, and seal with plate sealer film.Insert the plate into a thermocycler, cover with the compression pad, and close the lid. Incubate at 65 degree Celsius for five minutes. After the incubation, transfer the entire volume of the random priming product in the first strand reagent strip tubes.Mix by pipetting up and down and briefly spin down. Transfer the entire volume to a 96-well PCR plate and seal with RT film. Insert the plate into the thermocycler and run the reaction according to the manuscript directions.Perform second strand cDNA synthesis, and repair, and ligation step one according to the manuscript directions and proceed to the second ligation step. To number the molecular barcode or MBC adapter strip tubes, position the tubes horizontally with hinges to the back and use a permanent marker. Take the bead purification plate from the first ligation step and transfer 40 microliters of each sample into the MBC adapter strip tubes, taking care not to disturb the bead pellet.Mix the reagents by pipetting, spin down the tubes, and transfer the entire volume to the ligation step two reagent strip tubes. Mix the samples, spin them down, and place in a thermocycler block. Leave the heated lid off and run the thermocycler at 22 degrees Celsius for five minutes, followed by 4 degrees Celsius hold.Next, prepare the ligation cleanup beads by vortexing them and adding 50 microliters to a new set of PCR strip tubes. Incubate on the magnet for one minute and discard the supernatant. Remove the strip tubes from the magnet and resuspend the beads in 50 microliters of ligation cleanup buffer by pipetting up and down.Transfer the entire sample volume from the second ligation step into the ligation cleanup bead strip. Vortex the samples to mix and leave them at room temperature for 10 minutes. Vortex the sample once halfway through the incubation.Afterwards, vortex the samples, spin them down, and incubate on the magnet for one minute. Discard the supernatant and add 200 microliters of fresh ligation cleanup buffer. Vortex to resuspend, spin down, and place on the magnet for one minute.After the two washes, perform a third wash using ultrapure water instead of buffer. Resuspend the beads in 20 microliters of 5 millimeters sodium hydroxide and transfer the samples to a 96-well PCR plate. Place the plate into a thermocycler with a compression pad and run it at 75 degrees Celsius for 10 minutes, followed by a 4 degrees Celsius hold.Once the samples have cooled to 4 degrees Celsius, place the plate on a magnet for at least three minutes and proceed with the first PCR. Prepare the PCR reactions by adding two microliters of GSP1 primers to each well of the first PCR reagent strip. Transfer 18 microliters of the second ligation cleanup product to the first PCR reagent strip tubes and mix by pipetting up and down.Spin down the samples and transfer them to a 96-well PCR plate. Place them into the thermocycler and run PCR according to the manuscript directions. Proceed with bead purification by adding 20 microliters of the PCR product to a U-bottom plate filled with 24 microliters of purification beads per well.Pipette up and down to mix and leave the plate at room temperature for five minutes, then incubate the plate on the magnet for two minutes. Discard the supernantant from the beads and wash them twice with 200 microliters of 70%ethanol. After the final wash, remove all of the ethanol and let the sample air dry for two minutes.Remove the plate from the magnet and resuspend the beads in 24 microliters of 10 millimeter Tris-HCl and pH 8.0. Incubate off the magnet for three minutes and then place the plate back on the magnet for two minutes. Begin library quantitation by preparing one to five dilutions of the second PCR product in 10 millimeter Tris-HCl.Follow this by a serial dilution of 1:199, 1:199, and 20:80 in 10 millimeter Tris-HCl with 05%polysorbate. Set up key PCR by adding six microliters of master mix to each well of a optical 96-well plate, followed by four microliters of the appropriate dilution or standard. Spin down the plate and load it into the qPCR instrument.Perform qPCR according to the manuscript directions. After library quantification is complete, dilute all libraries to two nanomolar with 10 millimeter Tris-HCl. Make a library pool by combining 10 microliters of each normalized library into one 1.5 milliliter microcentrifuge tube.Next, prepare the denatured amplicon library, or DAL pool, by combining 10 microliters of the library pool with 10 microliters of 0.2 normal sodium hydroxide and incubating the mixture for five minutes at room temperature. After the incubation, add 10 microliters of 200 millimeter Tris-HCl at pH 7.0, followed by 970 microliters of HT1 Hybridization Buffer. Make the final load tube by combining 300 microliters of HT1, 25 microliters of 20 picomolar PhiX, and 675 microliters of the DAL pool.Add the entire volume of the load tube to the sample well of the sequencer reagent cartridge and load the cartridge in to the sequencer. Start by selecting the positive control sample and ensure that all expected fusions and oncogenic isoforms have been detected and are listed in the strong evidence tab. For each sample, inspect the average unique start sites per GSP2 control value, then visualize the supporting reads for each potential fusion by clicking the Visualize link which takes the user to a web-based JBrowse view of pileups of individual fusion supporting reads.Confirm that the reads are mostly free of mismatch, but more than 30 bases of the reads align with the fusion partner, and that sequences adjacent to the breakpoint between the genes and primer binding sites are free of insertions or deletions. It is critical to ensure that every call fusion is generally free of misalignment and that a significant portion of the reads align to the fusion partner. This protocol has been used to investigate gene fusion status in a lung adenocarcinoma sample.The summary shows strong evidence fusions and the Read Statistics page shows metrics of the sample. This sample exhibits good RNA quality so negative results would be reported if no fusions were found. A legitimate fusion call has a high number of supporting reads, a high percent of reads from the primer supporting the fusion, and a high number of start sites.Visualization of the reads demonstrates good alignment to large regions of the fusion partner. Conversely, an artifactual fusion call has lower supporting metrics and a high error rate when mapping to the partner. Artifactual fusion calls made by the analysis algorithm are common.It is critical to manually inspect every call to ensure that it represents a real gene fusion in the patient sample.

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