Exome sequencing has proven to be a powerful and cost-effective approach for the identification of causal mutations in many patients suffering from rare, severe Mendelian diseases. However, exome analysis unambiguously identifies a causal mutation in only 30–50% of sequenced families, indicating much work remains to be done to increase the yield of causal variants from sequencing-based approaches. Causal mutations can be missed by current exome sequencing approaches for a variety of reasons. Conversely, there may be multiple gene candidates that require further information to prioritize for functional studies. We describe the development of an integrated pipeline for the identification of causal variants from exome data and its application to a cohort of severe, undiagnosed muscle disease patients. Our online application called xBrowse enables the intuitive analysis of family-based exome data, permitting researchers and clinicians to rapidly explore the effects of altering inheritance modes and function/quality filters on the identification of potential causal mutations. Through xBrowse, our collaborators have early access to gene-based RNA expression data across various human tissues, a disease gene-centric protein–protein interaction networks and a large reference panel of over 50,000 exomes. We have applied this integrated approach to exome data over 250 individuals consisting of families and probands affected by a range of neuromuscular diseases. We describe the detection of novel sequence variants with strong evidence for causality in these patients, and provide case studies indicating the value of tissue expression data, protein–protein interaction networks, large reference panels for the prioritization of disease-associated mutations.
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