Improved Characterization of Complex β-Globin Gene Cluster Structural Variants Using Long-Read Sequencing

Aruna Rangan, Molly S. Hein, William G. Jenkinson, Tejaswi Koganti, Ross A. Aleff, Christopher A. Hilker, Joseph H. Blommel, Tavanna R. Porter, Kenneth C. Swanson, Patrick Lundquist, Phuong L. Nguyen, Min Shi, Rong He, David S. Viswanatha, Jin Jen, Eric W. Klee, Benjamin R. Kipp, James D. Hoyer, Eric D. Wieben, Jennifer L. Oliveira

Research output: Contribution to journalArticlepeer-review


Complex insertion-deletion (indel) events in the globin genes manifest in widely variable clinical phenotypes. Many are incompletely characterized because of a historic lack of efficient methods. A more complete assessment enables improved prediction of clinical impact, which guides emerging therapeutic choices. Current methods have limited capacity for breakpoint assignment and accurate assessment of mutation extent, especially in cases containing duplications or multiple deletions and insertions. Technology, such as long-read sequencing, holds promise for significant impact in the characterization of indel events because of read lengths that span large regions, resulting in improved resolution. Four known complex β-globin gene cluster indel types were assessed using single-molecule, real-time sequencing technology and showed high correlation with previous reports, including the Caribbean locus control deletion (g.5,305,478_5,310,336del), a large β-gene duplication containing the Hb S mutation (g.4,640,335_5,290,171dup with g.5,248,232T>A, c.20A>T; variant allele fraction, 64%), and two nested variants (double deletions with intervening inversion): the Indian Gγ(Aγδβ)0-thalassemia (g.5,246,804-5,254,275del, g.5,254,276_5,269,600inv, and g.5,269,601_5,270,442del) and the Turkish/Macedonian (δβ)0 thalassemia (g.5,235,064_5,236,652del, g.5,236,653_5,244,280inv, and g.5,244,281_5,255,766del). Our data confirm long-read sequencing as an efficient and accurate method to identify these clinically significant complex events. Limitations include high-complexity sample preparation requirements, which hinder routine use in clinical laboratories. Continued improvements in sample and data workflow processes are needed to accommodate volumes in a tertiary clinical laboratory.

Original languageEnglish (US)
Pages (from-to)1732-1740
Number of pages9
JournalJournal of Molecular Diagnostics
Issue number12
StatePublished - Dec 2021

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Molecular Medicine


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