Fig. 2

Framework for the Identification of Potentially Pathogenic Variants. Integrated laboratory processing and bioinformatic analysis procedures for comprehensive complete gene variant determination and analysis. Intermediate datasets resulting from filtering are represented in yellow and final datasets in green. Non-bioinformatic steps, such as sample preparation are represented in blue and prediction programs in purple. Sequencing analysis yields base calls for all samples. CASAVA [85] and CRAC [86] were used to align these sequencing results to hg19. GATK [88] was used to call variants from this data against GRCh37 release of the reference human genome. Variants with a quality score < 50 and/or call confidence score < 30 were eliminated along with variants falling outside of our target regions. SNPnexus [112–114] was used to identify the genomic location of the variants. Nonsense and indels were noted and prediction tools were used to assess the potential pathogenicity of missense variants. The Shannon Pipeline [91] evaluated the effect of a variant on natural and cryptic SSs, as well as SRFBSs. ASSEDA [38] was used to predict the potential isoforms as a result of these variants. PWMs for 83 TFs were built using an information weight matrix generator based on Bipad [106]. Mutation Analyzer evaluated the effect of variants found 10 kb upstream up to the first intron on protein binding. Bit thresholds (R _i values) for filtering variants on software program outputs are indicated. Variants falling within the UTR sequences were assessed using SNPfold [20], and the most probable variants that alter mRNA structure (p < 0.1) were then processed using mFold to predict the effect on stability [83]. All UTR variants were scanned with a modified version of the Shannon Pipeline, which uses PWMs computed from nucleotide frequencies for 28 RBPs in RBPDB [109] and 76 RBPs in CISBP-RNA [110]. All variants meeting these filtering criteria were verified with IGV [89, 90]. *Sanger sequencing was only performed for protein truncating, splicing, and selected missense variants