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M-CAP eliminates a majority of variants of uncertain significance in clinical exomes at high sensitivity


Variant pathogenicity classifiers such as SIFT, PolyPhen-2, CADD, and MetaLR assist in interpretation of the hundreds of rare, missense variants in the typical patient genome by deprioritizing some variants as likely benign. These widely used methods misclassify 26 to 38% of known pathogenic mutations, which could lead to missed diagnoses if the classifiers are trusted as definitive in a clinical setting. We developed M-CAP, a clinical pathogenicity classifier that outperforms existing methods at all thresholds and correctly dismisses 60% of rare, missense variants of uncertain significance in a typical genome at 95% sensitivity.

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Figure 1: M-CAP outperforms existing pathogenicity likelihood metrics, particularly at the high sensitivity levels required for clinical applications.
Figure 2: M-CAP correctly eliminates the most variants of uncertain consequences as benign at 95% sensitivity.


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We thank the members of the Bejerano laboartory, particularly J. Notwell, S. Chinchali, and J. Birgmeier, for technical advice and helpful discussions. P.D.S. and D.N.C. receive financial support from Qiagen through a license agreement with Cardiff University. We thank the PolyPhen-2, CADD, Eigen, FATHMM, MutationTaster, and MetaLR teams for making their training and testing data readily available. This work was funded in part by the Stanford Pediatrics Department, DARPA, a Packard Foundation Fellowship, and a Microsoft Faculty Fellowship to G.B.

Author information




K.A.J., A.M.W., M.J.B., and G.B. designed the study and analyzed results. K.A.J. and M.J.B. implemented the model and performed the experiments. K.A.J., A.M.W., and H.G. wrote software tools that were used for analysis. P.D.S. and D.N.C. curated the HGMD data and provided feedback. J.A.B. provided patient exome cases and feedback. K.A.J., A.M.W., and G.B. wrote the manuscript. All authors reviewed and commented on the manuscript.

Corresponding author

Correspondence to Gill Bejerano.

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The authors declare no competing financial interests.

Supplementary information

Supplementary Text and Figures

Supplementary Tables 1–4, 6, 9 and 10. (PDF 486 kb)

Supplementary Table 5

M-CAP scores for disease-causing mutations found in BRCA1, BRCA2, CFTR and MLL2. (XLSX 43 kb)

Supplementary Table 7

Clinical phenotypes for case study patients. (XLSX 73 kb)

Supplementary Table 8

Rare missense variants in case study patients. (XLSX 150 kb)

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Jagadeesh, K., Wenger, A., Berger, M. et al. M-CAP eliminates a majority of variants of uncertain significance in clinical exomes at high sensitivity. Nat Genet 48, 1581–1586 (2016).

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