We often discuss how more comprehensive and sensitive techniques improve the diagnostic yield for patients affected by rare genetic diseases. Indeed, yields have improved as we've gone from microarrays to whole genome #sequencing.

However, there's another critical component.
Case-Level Reanalysis (CLR)

By reanalyzing genomic data, as our global knowledge-base grows, we improve diagnostic yields.

We believe the broadest tests should be done first to avoid the need to re-contact and re-accession patient samples.

ncbi.nlm.nih.gov/pmc/articles/P…
The economics for both the lab (and patient) change dramatically as well in a 'generate-once-reassess-often' framework. As more is known, variant interpretation may shift from being more manual to more automated.

Still, this is a really hard technological problem.
Variant interpretation, we think, is the most difficult and least commoditized aspect of sequence data analysis. It also follows the garbage-in-garbage-out rule. This is another reason why we believe rare disease patients should receive comprehensive sequencing.
As the technology improves on the bases of cost and feasibility, we think phased genome assembly is the most powerful tool for comprehensive variant detection, especially for patients afflicted with rare disease.

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More from @sbarnettARK

14 Apr
The widespread adoption of liquid biopsy seems to be 'un-commoditizing' DNA synthesis in the molecular diagnostics industry.

Recall that synthetic DNA probes, molecules that bind and pull a DNA out of solution, are a critical input for liquid biopsy.
Diagnostics companies buy probes to use in their clinical tests, oftentimes in bulk, from a synthetic DNA provider. There's been a prevailing notion recently that DNA providers only can differentiate on the basis of cost or turnaround time.

I think liquid biopsy changes this.
Firstly, a huge technical constraint in liquid biopsy is the availability of cancerous DNA in a tube of blood, which decreases exponentially with tumor size.

Remember that smaller tumors don't leak as much DNA into the bloodstream.

Sequencing can be a lossy process.
Read 10 tweets
11 Mar
@NatHarooni @snicobio I’m watching Jeopardy—will come back later tonight. Short answer—no, not competitive to PacBio. Likely friends down the road.
@NatHarooni @snicobio Alright, so in theory the QSI platform can enable DNA (or RNA) sequencing on chip. However, I think of it more like a call option and less of a near-term goal. Proteomics is the killer app enabled by the QSI platform. But, as OP alluded to, multi-omics (inc. proteins) on one ...
@NatHarooni @snicobio ... instrument could be an attractive value prop. from a capital outlay point of view, especially for $50K which is achievable for many labs w/o needing to seek a major grant (so speedy sales cycles). Now, back to the main point about sequencing. If you read the patents ...
Read 10 tweets
22 Feb
@NatHarooni @AlbertVilella In my opinion — HiFi reads are the most accurate/complete, but currently are more expensive and lower throughput. Nanopore reads are cheap, fast, and high-throughput, but have a weaker error profile. Both of these descriptors are changing and may not be the case in a few years.
@NatHarooni @AlbertVilella As far as QSI is concerned, it’s a little too early for me to calculate operating costs per run. I’ll update when I know more.
@NatHarooni @AlbertVilella Regardless of how you consider the remaining engineering obstacles, necessary R&D spend, or computational issues—I feel that long-read sequencing (as a class of tech), will outperform short reads on virtually every relevant metric by 2024-2025
Read 4 tweets
21 Feb
@nhawk45 @AlbertVilella Hey, @nhawk45 -- Sure, I think I can take some of these. Let's start from the beginning to help explain why certain features of QSI's approach/IP are needed and interesting.

First: Why are proteins the hardest molecules to sequence of the 'big three'? (DNA/RNA/Proteins) ...
@nhawk45 @AlbertVilella Here are some of my notes on reasons I could think of, but I'll take a moment to elaborate on some of them.

The proteome is estimated to have the largest 'unit diversity' for lack of a better term. DNA = 20K genes, RNA = 10^5 isoforms, proteins = 10^6 proteofroms ...
@nhawk45 @AlbertVilella Proteomic diversity is driven by post-translational modifications (PTM), which is a set of chemical alterations to peptides not dissimilar to how DNA can have #epigenetic modifications like methylation. Combine this w/ the fact that peptides have a 20-letter alphabet ...
Read 7 tweets
18 Feb
Anyone have any opinions on how self-insured employers consider innovative healthcare offerings to pass on to their employees?

As I understand it, by shouldering the financial risk, self-insured employers can curate a list of more relevant benefits ... (1/10)
... thereby avoiding paying out lofty insurance premiums for services that its employees don't use or want. There seems to be a long list of intangible benefits having to do with talent acquisition and retention, but I'd like to understand the cost equations more fully. (2/10)
In the context of multi-cancer screening, I'm skeptical that it could be cost-saving for small or medium-sized employers (<500 employees). Assuming a representative sample of the population, there are simply too few cancers and too many false positives w/ expensive ... (3/10)
Read 11 tweets
17 Feb
@TerraPharma1 @hiddensmallcaps Apologies for the incoming Tweet storm . . .
@TerraPharma1 @hiddensmallcaps Here are some of my thoughts on the Personalis <> Natera tie-up. This is mostly a tech-focused breakdown, so not a recommendation to buy, sell, or hold any security: (bit.do/eyRo8)

First, a bit of background on the details and opinions scattered throughout . . .
@TerraPharma1 @hiddensmallcaps Historically, Personalis has focused entirely on serving the biopharma market. These customers aren't as price-sensitive and they have an insatiable appetite for novel discoveries. In our view, Personalis' NeXT platform is a great biopharma product-market fit. Why? . . .
Read 17 tweets

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