Development and Validation of a Mass Spectrometry–Based Assay for the Molecular Diagnosis of Mucin-1 Kidney Disease  Brendan Blumenstiel, Matthew DeFelice,

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Development and Validation of a Mass Spectrometry–Based Assay for the Molecular Diagnosis of Mucin-1 Kidney Disease  Brendan Blumenstiel, Matthew DeFelice, Ozge Birsoy, Anthony J. Bleyer, Stanislav Kmoch, Todd A. Carter, Andreas Gnirke, Kendrah Kidd, Heidi L. Rehm, Lucienne Ronco, Eric S. Lander, Stacey Gabriel, Niall J. Lennon  The Journal of Molecular Diagnostics  Volume 18, Issue 4, Pages 566-571 (July 2016) DOI: 10.1016/j.jmoldx.2016.03.003 Copyright © 2016 American Society for Investigative Pathology and the Association for Molecular Pathology Terms and Conditions

Figure 1 Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry spectra readout of a wild-type negative sample (A) and +C positive sample (B). Unextended probe products are indicated by asterisks. Successful restriction digestion is indicated by a strong peak at 4889.21 Da and low-intensity peak at 5162.4 Da (MwoI control). Reaction performance is indicated by the GAPDH control extension product at 5557.63 Da. +C insertion event indicated by a peak at 5904.83 Da (shaded area). The Journal of Molecular Diagnostics 2016 18, 566-571DOI: (10.1016/j.jmoldx.2016.03.003) Copyright © 2016 American Society for Investigative Pathology and the Association for Molecular Pathology Terms and Conditions

Figure 2 Flowchart of mucin-1 kidney disease (MKD) calling. Signal to noise ratios (SNRs) for four potential peaks are used to determine the test result. Conclusive calls of wild-type (negative) or +C (positive) are only reported when both the GAPDH and MwoI (−) controls pass the set thresholds. Samples with low but detectable signal for the MKD extension product (SNR, 1.5 to 15) are called inconclusive. The Journal of Molecular Diagnostics 2016 18, 566-571DOI: (10.1016/j.jmoldx.2016.03.003) Copyright © 2016 American Society for Investigative Pathology and the Association for Molecular Pathology Terms and Conditions

Figure 3 A: The distribution of peak signal to noise ratios (SNRs) for the mucin-1 kidney disease +C analyte at 5904.83 Da was observed for all 384 validation reactions. Results binned by known sample reference. Eleven of 384 reactions generated a SNR between 1.5 and 15 (shaded area) and were called inconclusive. B: Distribution of GAPDH control extension analyte SNR at 5557.63 Da for 384 assays performed during validation. Three of 384 wells failed because the signal was below the set SNR threshold of 15 (dotted line). C: Successful MwoI restriction digestion is determined by assessing the two potential extension products of a probe interrogating the restriction site of a synthetic amplicon spike in. One of 384 assays failed the MwoI control with a signal below the SNR threshold of 10 (dotted line) at mass 4889.21 Da. Both peak values are plotted for 384 assay wells run in the validation. Data presented as distributions with outlier box plots. The Journal of Molecular Diagnostics 2016 18, 566-571DOI: (10.1016/j.jmoldx.2016.03.003) Copyright © 2016 American Society for Investigative Pathology and the Association for Molecular Pathology Terms and Conditions