Abstract 1789A: Duplex DNA sequencing detects subclonal and ultra-rare mutations in human tumors.
Authors: Loeb Lawrence A. , Fox Edward J. , Kennedy Scott R. , Kuong Jessica , Schmitt Michael W. , Salk Jesse J. 
Published: August 2014

Abstract
Next-Generation DNA Sequencing now allows us to sequence billions of nucleotides in a single experiment and to detect germ-line mutations and driver mutations in human cancer. However, a major limitation is the error rate of approximately 1% to 0.1%. These scattered errors limit its utility in sequencing genetically heterogeneous mixtures such as human cancers or viruses. We have developed a method termed "Duplex Sequencing” that allows for the detection of rare mutations in DNA with unprecedented accuracy. This approach greatly lowers errors by independently sequencing each of the two strands of single DNA molecules. As the two strands are complementary, true mutations are scored only if they are present at the same position and are complementary. Moreover, small deletions and insertions can be easily identified. In contrast, sequencing errors, which occur from PCR - amplification of DNA containing damaged nucleotides, are present in only one strand and thus are not scored as mutations.
To demonstrate the power of duplex sequencing we measured the background error frequency in human mitochondrial DNA obtained from cortical regions of the brain of aged normal humans; an overall mutation frequency was 3 X 10-5. These mutations are not random, but rather, show an inordinately large frequency of mutations in the D-loop of the mitochondrial genome. The spectrum of mutations is strikingly different from that reported in the literature using next-generation sequencing. Prior reports have indicated a high frequency of G-&gt;T; however, we find that these are likely technical artifacts arising from oxidative DNA damage. In contrast, by Duplex Sequencing, we find a predominance of G-&gt;A and T-&gt;C single base substitutions. The G-&gt;A and T-&gt;C mutations could result from cytidine deamination or errors during replication by the mitochondrial DNA polymerase gamma.
In order to establish the background mutation frequency in nuclear DNA by Duplex Sequencing we first captured a small portion of the genome, the exons of the replicative DNA polymerases. Sequencing captured DNA from normal human tissues yielded a background mutation frequency of 10-6 to 1O-7 indicating that the error rate of duplex sequencing is less than one to ten mutations in ten million nucleotides. Current effort is to sequence nuclear DNA from different human cancers and the corresponding normal tissues. This result should indicate the distribution of subclonal mutations in human tumors. Subclonal mutations could delineate tumor cell lineage, account for the geographic heterogeneity of mutations in human tumors and serve as a biomarker for the presence of drug resistant cells prior to or during chemotherapy.
Citation Format: Lawrence A. Loeb, Edward J. Fox, Scott R. Kennedy, Jessica Kuong, Michael W. Schmitt, Jesse J. Salk. Duplex DNA sequencing detects subclonal and ultra-rare mutations in human tumors. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1789A. doi:10.1158/1538-7445.AM2013-1789A