Paired plus-minus sequencing is an ultra-high throughput and accurate method for dual strand sequencing of DNA molecules.

TitlePaired plus-minus sequencing is an ultra-high throughput and accurate method for dual strand sequencing of DNA molecules.
Publication TypeJournal Article
Year of Publication2025
AuthorsCheng APellan, Rusinek I, Sossin A, Widman AJ, Meiri E, Krieger G, Hirschberg O, Tov DShem, Gilad S, Jaimovich A, Barad O, Avaylon S, Rajagopalan S, Potenski C, Prieto T, Yuan DJ, Furatero R, Runnels A, Costa BM, Shoag JE, Assaad MAl, Sigouros M, Manohar J, King A, Wilkes D, Otilano J, Malbari MS, Elemento O, Mosquera JMiguel, Altorki NK, Saxena A, Callahan MK, Robine N, Germer S, Evrony GD, Faltas BM, Landau D-A
JournalbioRxiv
Date Published2025 Aug 14
ISSN2692-8205
Abstract

Distinguishing real biological variation in the form of single-nucleotide variants (SNVs) from errors is a major challenge for genome sequencing technologies. This is particularly true in settings where SNVs are at low frequency such as cancer detection through liquid biopsy, or human somatic mosaicism. State-of-the-art molecular denoising approaches for DNA sequencing rely on duplex sequencing, where both strands of a single DNA molecule are sequenced to discern true variants from errors arising from single stranded DNA damage. However, such duplex approaches typically require massive over-sequencing to overcome low capture rates of duplex molecules. To address these challenges, we introduce paired plus-minus sequencing (ppmSeq) technology, in which both DNA strands are partitioned and clonally amplified on sequencing beads through emulsion PCR. In this reaction, both strands of a double-stranded DNA molecule contribute to a single sequencing read, allowing for a duplex yield that scales linearly with sequencing coverage across a wide range of inputs (1.8-98 ng). We benchmarked ppmSeq against current duplex sequencing technologies, demonstrating superior duplex recovery with ppmSeq, with a rate of 44%±5.5% (compared to ~5-11% for leading duplex technologies). Using both genomic as well as cell-free DNA, we established error rates for ppmSeq, which had residual SNV detection error rates as low as 7.98x10 for gDNA (using an end-repair protocol with dideoxy nucleotides) and 3.5x10±7.5x10 for cell-free DNA. To test the capabilities of ppmSeq for error-corrected whole-genome sequencing (WGS) for clinical application, we assessed circulating tumor DNA (ctDNA) detection for disease monitoring in cancer patients. We demonstrated that ppmSeq enables powerful tumor-informed ctDNA detection at concentrations of 10 across most cancers, and up to 10 in cancers with high mutation burden. We then leveraged genome-wide trinucleotide mutation patterns characteristic of urothelial (APOBEC3-related and platinum exposure-related signatures) and lung (tobacco-exposure-related signatures) cancers to perform tumor-naive ctDNA detection, showing that ppmSeq can identify a disease-specific signal in plasma cell-free DNA without a matched tumor, and that this signal correlates with imaging-based disease metrics. Altogether, ppmSeq provides an error-corrected, cost-efficient and scalable approach for high-fidelity WGS that can be harnessed for challenging clinical applications and emerging frontiers in human somatic genetics where high accuracy is required for mutation identification.

DOI10.1101/2025.08.11.669689
Alternate JournalbioRxiv
PubMed ID40832334
PubMed Central IDPMC12363824
Grant ListR01 CA266619 / CA / NCI NIH HHS / United States
UG3 NS132139 / NS / NINDS NIH HHS / United States
P30 CA008748 / CA / NCI NIH HHS / United States
UM1 DA058236 / DA / NIDA NIH HHS / United States
UG3 NS132024 / NS / NINDS NIH HHS / United States