A De Novo Algorithm for Allele Reconstruction from Oxford Nanopore Amplicon Reads, with Application to CYP2D6

The Oxford Nanopore Technologies’ sequencing platform offers a path towards bedside genomics, producing long reads that can completely cover a gene of interest, and thus detect any known or novel variant the gene contains. However, the analysis of these long reads to identify actionable genotypes remains challenging and typically requires customization depending on the target gene. Here, we describe a generic algorithm to accurately reconstruct allele sequences derived from long-reads of genomic-amplicon origin. Rather than calling variants directly from these long-reads, our method takes a "sequence-first" approach, performing an unbiased reconstruction of the underlying amplicon sequences to generate high-confidence reconstructed allele sequences. This is done without user input of the expected target gene, allowing for any source amplicon to be reconstructed. These high-confidence reconstructed allele sequences are then compared to the genomic reference sequence of the gene to infer the specific diplotype present in the sample. This approach is agnostic towards the number of genes and alleles present and readily detects novel variants. We demonstrate our approach using three independent data sets for CYP2D6, a diverse and complex gene with over 175 known alleles of clinical significance affecting drug dosing. We show how our approach can accurately recover validated CYP2D6 diplotypes from 20 Coriell samples sequenced using different primer sets, on different Oxford Nanopore Technologies flow cell versions, and to different depths. This includes inferring occurrences of copy number variation from relative abundances of each allele, a critical factor for ascribing functional effects to a diplotype.