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Next-Generation Sequencing in Pathology - A Complete Review

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Next-generation sequencing (NGS) is a novel technique that is employed in variant or mutation identification as well as DNA and RNA sequencing.

Medically reviewed by

Dr. Kaushal Bhavsar

Published At February 5, 2024
Reviewed AtFebruary 5, 2024

Introduction

Next-generation sequencing (NGS), a revolutionary technology, has transformed the field of genetics and genomics. NGS is a technique for analyzing RNA (ribonucleic acid) and DNA (deoxyribonucleic acid) to identify genetic alterations. It combines sophisticated computer analysis, a variety of sequencing materials, and unique chemical techniques. This combination enables fast sequencing of individual DNA or RNA fragments, as well as whole genomes. It is a significant advancement over traditional methods like Sanger sequencing. NGS has several important phases. DNA fragmentation is the first step, which is followed by library preparation, extremely rapid sequencing, computer analysis, variant/mutation annotation, and interpretation.

How Did NGS Evolve From Sanger Sequencing?

Next-generation sequencing emerged as a successor to Sanger sequencing, the traditional method used for DNA sequencing. Unlike Sanger sequencing, NGS allows for the parallel sequencing of millions of DNA fragments, making the process faster, more efficient, and cost-effective.

What Are the Applications of NGS in Research?

In genetic research, NGS has emerged as the cornerstone. The whole DNA of an organism may be thoroughly analyzed using whole genome sequencing (WGS), which provides insight into genetic variants, mutations, and structural changes. WGS is essential for comprehending population genetics and the genetic causes of disease.

What Are the Clinical Applications of NGS?

NGS has advanced significantly in clinical contexts. It makes it possible to identify genetic markers linked to a range of illnesses, opening the door to customized treatment. For example, NGS might identify many mutations in a tumor at the same time in cancer care, expediting the diagnosis process and directing focused therapy. In customized precision medicine, NGS is essential for prognosis, therapy selection, and illness diagnosis.

What Are the Steps of NGS?

  • DNA Fragmentation - Scientists employ DNA fragmentation to break down specific DNA, which creates small bits that are between 100 and 300 base pairs long. Techniques such as enzymatic digestion, mechanical procedures, or sound-wave sonication can be used. Next, using a technique called a hybridization capture assay, the pertinent short segments are extracted using certain complementary probes. Another technique is PCR amplification, which multiplies the target DNA segments by employing several pairs of primers. These PCR results function as short, targeted DNA segments; this type of test is called an amplicon assay. Following their breakdown, a library is constructed using these DNA fragments.

  • Library Preparation - The process of customizing DNA fragments with distinctive identifiers, such as a sample ID that associates them with a particular patient, is known as library preparation. It also involves combining these DNA fragments using sequencing adaptors. This alteration makes sure that sequencing primers can bind to every DNA molecule, laying the groundwork for high-speed parallel sequencing thereafter.

  • Sequencing - An NGS sequencer is used for parallel sequencing. The prepared DNA library is placed onto a specific sequencing platform, which differs depending on the sequencer. The goal remains the same despite the variations: to allow for the simultaneous sequencing of every DNA molecule. Bioinformatics software is then used to evaluate the data produced from sequencing.

  • Bioinformatics Analysis and Data Interpretation - Bioinformatics analysis includes tasks like determining bases, aligning reads, spotting variations, and adding annotations. It compares the sequence to a human genome reference to find any changes in the targeted DNA. The information from each sequenced part is combined to give the overall sequencing results. These results are then sent back to the user for interpretation. The annotation and interpretation steps aim to recognize each genetic change and understand its potential significance in biology or clinical contexts.

What Are the Different Levels of NGS?

NGS can be used at different levels, each with a distinct function. In research, whole-genome sequencing is more prevalent and encompasses nearly every nucleotide in an organism's genome. Transcriptome-level sequencing, or RNA sequencing, examines the whole assembly of RNA transcripts in a particular cell type, whereas whole-exome sequencing concentrates on the coding regions.

What Is Targeted Panel Sequencing?

Most NGS assays utilized in clinical settings, particularly for cancer diagnosis, are targeted panel sequencing. Compared to whole-genome sequencing, it allows for deeper sequencing coverage by focusing on certain genes associated with a disease. This depth is crucial for detecting mutations with varying allelic frequencies in diverse tumor specimens.

What Are the Advantages of Next-Generation Sequencing?

NGS is unique in that it can analyze hundreds to millions of targets at once. In therapeutic applications, this capacity is quite helpful. For example, tumors treated for cancer may include many mutations. Conventional testing would need more tissue as each mutation would need to be tested in numerous assays. On the other hand, NGS requires less tissue and can evaluate hundreds or even thousands of DNA targets at once, all in a single test.

What Is the Scope of NGS Technology?

NGS is capable of functioning at many levels. Almost every nucleotide in an organism's genome is examined by whole-genome sequencing, which is more often used in research than clinical use. It provides additional information when certain mutations are not detected by other tests, which helps in the diagnosis of uncommon genetic illnesses. RNA sequencing, also known as transcriptome-level sequencing, examines every transcript of RNA within a cell. The most popular type of sequencing for cancer is called targeted panel sequencing, which provides better coverage than whole-genome sequencing by focusing on certain genes associated with a disease.

What Are the Challenges in Clinical Applications of NGS?

NGS has transformational potential; however, there are drawbacks when using it in clinical settings. To guarantee reliable and precise findings, problems, including variant interpretation, protocol standardization, and the requirement for strong bioinformatics pipelines, must be addressed.

Conclusion

Next-generation sequencing is rapidly changing the landscape in the fields of genomics and genetics. NGS has developed into a vital tool for both research and clinical applications, from helping unravel the complexities of an organism's whole genome to directing customized treatments. The accuracy, effectiveness, and accessibility of NGS technologies are expected to be significantly improved despite obstacles, creating new opportunities for research in the fields of biology, medicine, and other fields.

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Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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