A novel analysis pipeline and experimental design for measuring expanded repeat instability

The expansion of short tandem repeats is a feature of over 60 different human diseases. Ongoing somatic instability throughout a patient’s lifetime can influence disease progression and has emerged as a therapeutic target. Understanding its mechanism is essential for the identification of both drug targets and therapeutic interventions. A major obstacle towards this translational goal has been to measure changes in repeat size distribution given that these are complex datasets. To address this, here we provide a new analysis method, and accompanying software, that generates delta plots, extracts the instability frequency from targeted long-read sequencing data, the bias towards expansion or contraction, and the average size of the changes. It further provides statistical analysis for comparison between treatments. We show its applicability to non-dividing cells, and in vivo datasets. Moreover, we have developed a streamlined experimental design for dividing cells, Single Clone-based Instability Assay (SCIA), that saves weeks in assessing the effect of a gene knockout on repeat instability and is ideal for an initial screen. We have validated the approach using FAN1, PMS1, and MLH1 knockouts. Using SCIA, we find that although FAN1 knockout clones showed increased frequency of expansions, the size of the expansions were smaller. This highlights the wealth of information that can be extracted and the potential for novel insights into the mechanism of repeat instability.