title: Exploring the landscape of pathogenic genetic variation in the ExAC population database: insights of relevance to variant classification.
abstract: We evaluated the Exome Aggregation Consortium (ExAC) database as a control cohort to classify variants across a diverse set of genes spanning dominant and recessively inherited disorders.
  
  
  
  The frequency of pathogenic variants in ExAC was compared with the estimated maximal pathogenic allele frequency (MPAF), based on the disease prevalence, penetrance, inheritance, allelic and locus heterogeneity of each gene. Additionally, the observed carrier frequency and the ethnicity-specific variant distribution were compared between ExAC and the published literature.
  
  
  
  The carrier frequency and ethnic distribution of pathogenic variants in ExAC were concordant with reported estimates. Of 871 pathogenic/likely pathogenic variants across 19 genes, only 3 exceeded the estimated MPAF. Eighty-four percent of variants with ExAC frequencies above the estimated MPAF were classified as "benign." Additionally, 20% of the cardiac and 19% of the Lynch syndrome gene variants originally classified as "VUS" occurred with ExAC frequencies above the estimated MPAF, making these suitable for reassessment.
  
  
  
  The ExAC database is a useful source for variant classification and is not overrepresented for pathogenic variants in the genes evaluated. However, the mutational spectrum, pseudogenes, genetic heterogeneity, and paucity of literature should be considered in deriving meaningful classifications using ExAC.Genet Med 18 8, 850-854.
authors.affiliation: Integrated Genetics, Laboratory Corporation of America Holdings, Westborough, Massachusetts, USA.|Integrated Genetics, Laboratory Corporation of America Holdings, Research Triangle Park, North Carolina, USA.
authors.forename: Wei
authors.identifier: 0000-0003-3943-6082
authors.initials: W
authors.lastname: Song
authors.affiliation: Integrated Genetics, Laboratory Corporation of America Holdings, Westborough, Massachusetts, USA.|Integrated Genetics, Laboratory Corporation of America Holdings, Research Triangle Park, North Carolina, USA.
authors.forename: Sabrina A
authors.identifier: 0000-0003-2566-3743
authors.initials: SA
authors.lastname: Gardner
authors.affiliation: Integrated Genetics, Laboratory Corporation of America Holdings, Westborough, Massachusetts, USA.|Integrated Genetics, Laboratory Corporation of America Holdings, Research Triangle Park, North Carolina, USA.
authors.forename: Hayk
authors.identifier: 0000-0003-3956-8835
authors.initials: H
authors.lastname: Hovhannisyan
authors.affiliation: Integrated Genetics, Laboratory Corporation of America Holdings, Westborough, Massachusetts, USA.|Integrated Genetics, Laboratory Corporation of America Holdings, Research Triangle Park, North Carolina, USA.
authors.forename: Amanda
authors.identifier: 0000-0002-2299-0506
authors.initials: A
authors.lastname: Natalizio
authors.affiliation: Integrated Genetics, Laboratory Corporation of America Holdings, Westborough, Massachusetts, USA.|Integrated Genetics, Laboratory Corporation of America Holdings, Research Triangle Park, North Carolina, USA.
authors.forename: Katelyn S
authors.initials: KS
authors.lastname: Weymouth
authors.affiliation: Integrated Genetics, Laboratory Corporation of America Holdings, Westborough, Massachusetts, USA.|Integrated Genetics, Laboratory Corporation of America Holdings, Research Triangle Park, North Carolina, USA.
authors.forename: Wenjie
authors.initials: W
authors.lastname: Chen
authors.affiliation: Integrated Genetics, Laboratory Corporation of America Holdings, Westborough, Massachusetts, USA.|Integrated Genetics, Laboratory Corporation of America Holdings, Research Triangle Park, North Carolina, USA.
authors.forename: Ildiko
authors.identifier: 0000-0001-6875-574X
authors.initials: I
authors.lastname: Thibodeau
authors.affiliation: Integrated Genetics, Laboratory Corporation of America Holdings, Westborough, Massachusetts, USA.|Integrated Genetics, Laboratory Corporation of America Holdings, Research Triangle Park, North Carolina, USA.
authors.forename: Ekaterina
authors.identifier: 0000-0002-8902-1291
authors.initials: E
authors.lastname: Bogdanova
authors.affiliation: Integrated Genetics, Laboratory Corporation of America Holdings, Westborough, Massachusetts, USA.|Integrated Genetics, Laboratory Corporation of America Holdings, Research Triangle Park, North Carolina, USA.
authors.forename: Stanley
authors.initials: S
authors.lastname: Letovsky
authors.affiliation: Integrated Genetics, Laboratory Corporation of America Holdings, Westborough, Massachusetts, USA.|Integrated Genetics, Laboratory Corporation of America Holdings, Research Triangle Park, North Carolina, USA.
authors.forename: Alecia
authors.identifier: 0000-0003-0691-0665
authors.initials: A
authors.lastname: Willis
authors.affiliation: Integrated Genetics, Laboratory Corporation of America Holdings, Westborough, Massachusetts, USA.|Integrated Genetics, Laboratory Corporation of America Holdings, Research Triangle Park, North Carolina, USA.
authors.forename: Narasimhan
authors.identifier: 0000-0002-3860-5799
authors.initials: N
authors.lastname: Nagan
mesh_terms: D030541:Databases, Genetic; D005006:Ethnicity / Q000235:genetics*; D059472:Exome; D005787:Gene Frequency; D020022:Genetic Predisposition to Disease; D014644:Genetic Variation; D006801:Humans