Our ability to sequence genomes has vastly surpassed our ability to interpret the genetic variation we discover. This presents a major challenge in the clinical setting, where the recent application of whole exome and whole genome sequencing has uncovered thousands of genetic variants of uncertain significance. Here, we present a strategy for targeted human gene replacement and phenomic characterization based on CRISPR-Cas9 genome engineering in the genetic model organism Caenorhabditis elegans that will facilitate assessment of the functional conservation of human genes and structure-function analysis of disease-associated variants with unprecedented precision.We validate our strategy by demonstrating that direct single-copy replacement of the C. elegans ortholog (daf-18) with the critical human disease-associated gene Phosphatase and Tensin Homolog (PTEN) is sufficient to rescue multiple phenotypic abnormalities caused by complete deletion of daf-18, including complex chemosensory and mechanosenory impairments. In addition, we used our strategy to generate animals harboring a single copy of the known pathogenic lipid phosphatase inactive PTEN variant (PTEN-G129E) and showed that our automated in vivo phenotypic assays could accurately and efficiently classify this missense variant as loss-of-function. The integrated nature of the human transgenes allows for analysis of both homozygous and heterozygous variants and greatly facilitates high-throughput precision medicine drug screens. By combining genome engineering with rapid and automated phenotypic characterization, our strategy streamlines identification of novel conserved gene functions in complex sensory and learning phenotypes that can be used as in vivo functional assays to decipher variants of uncertain significance. remarkably efficient and robust in C. elegans (Dickinson and Goldstein, 2016; Norris et 70 al., 2015). 71Here, we present a broadly applicable strategy that adapts CRISPR-Cas9 genome 72 engineering for targeted replacement of C. elegans genes with human genes. We illustrate 73 how the library of knockout and humanized transgenics generated with this approach can 74 be efficiently combined with automated machine vision phenotyping to rapidly discover 75 novel gene functions, assess the functional conservation of human genes, and how this 76 will allow for analysis of the effects of variants of uncertain significance with 77 unprecedented precision. It is our hope that the human gene replacement and phenomic 78 characterization strategy delineated in this article will serve both basic and health 79 researchers alike, by serving as an open and shareable resource that will aid any genome 80 engineer interested in understanding the functional conservation of human genes, and the 81 functional consequences of their variants. 82 83
Results
84A general genome editing strategy for direct replacement of a C. elegans gene with a 85 single copy of its human ortholog 86To replace the Open Reading Frame (ORF) of an orthologous gene with a human 87 gene ...