DNA length polymorphisms are found
in many serious diseases, and
assessment of their length and abundance is often critical for accurate
diagnosis. However, measuring their length and frequency in a mostly
wild-type background, as occurs in many situations, remains challenging
due to their variable and repetitive nature. To overcome these hurdles,
we combined two powerful techniques, digital polymerase chain reaction
(dPCR) and high-speed atomic force microscopy (HSAFM), to create a
simple, rapid, and flexible method for quantifying both the size and
proportion of DNA length polymorphisms. In our approach, individual
amplicons from each dPCR partition are imaged and sized directly.
We focused on internal tandem duplications (ITDs) located within the FLT3 gene, which are associated with acute myeloid leukemia
and often indicative of a poor prognosis. In an analysis of over 1.5
million HSAFM-imaged amplicons from cell line and clinical samples
containing FLT3-ITDs, dPCR–HSAFM returned
the expected variant length and variant allele frequency, down to
5% variant samples. As a high-throughput method with single-molecule
resolution, dPCR–HSAFM thus represents an advance in HSAFM
analysis and a powerful tool for the diagnosis of length polymorphisms.