Diagnostic utility and reporting recommendations for clinical DNA methylation episignature testing in genetically undiagnosed rare diseases

Jennifer Kerkhof, Cassandra Rastin, Michael A Levy, Raissa Relator, Haley McConkey, Leigh Demain, Elena Dominguez-Garrido, Laura Donker Kaat, Sofia Douzgou Houge, Barbara R DuPont, Timothy Fee, Robin S Fletcher, David Gokhale, Bjørn Ivar Haukanes, Peter Henneman, Sarah Hilton, Benjamin A Hilton, Sarah Jenkinson, Raymond J Louie, M Mahdi MotazackerJessica Rzasa, Roger E Stevenson, Astrid Plomp, Liselot van der Laan, Jasper van der Smagt, Kellie K Walden, Siddharth Banka, Marcel Mannens, Steven A Skinner, Michael J Friez, Christopher Campbell, Matthew L Tedder, Marielle Alders, Bekim Sadikovic

Research output: Contribution to journalArticlepeer-review


Purpose: This study aims to assess the diagnostic utility and provide reporting recommendations for clinical DNA methylation episignature testing based on the cohort of patients tested through the EpiSign Clinical Testing Network. Methods: The EpiSign assay utilized unsupervised clustering techniques and a support vector machine–based classification algorithm to compare each patient's genome-wide DNA methylation profile with the EpiSign Knowledge Database, yielding the result that was reported. An international working group, representing distinct EpiSign Clinical Testing Network health jurisdictions, collaborated to establish recommendations for interpretation and reporting of episignature testing. Results: Among 2399 cases analyzed, 1667 cases underwent a comprehensive screen of validated episignatures, imprinting, and promoter regions, resulting in 18.7% (312/1667) positive reports. The remaining 732 referrals underwent targeted episignature analysis for assessment of sequence or copy-number variants (CNVs) of uncertain significance or for assessment of clinical diagnoses without confirmed molecular findings, and 32.4% (237/732) were positive. Cases with detailed clinical information were highlighted to describe various utility scenarios for episignature testing. Conclusion: Clinical DNA methylation testing including episignatures, imprinting, and promoter analysis provided by an integrated network of clinical laboratories enables test standardization and demonstrates significant diagnostic yield and clinical utility beyond DNA sequence analysis in rare diseases.

Original languageEnglish
Article number101075
Pages (from-to)101075
Number of pages17
JournalGenetics in medicine : official journal of the American College of Medical Genetics
Issue number5
Early online date18 Jan 2024
Publication statusPublished - 1 May 2024


  • DNA methylation
  • EpiSign
  • Episignature
  • Molecular diagnostics
  • VUS classification


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