METHODS AND PROCESSES FOR THE NON-INVASIVE ASSESSMENT OF GENETIC VARIATIONS

Description

Field

[0001] The present invention is defined by the claims. Technology provided herein relates in part to methods, processes and apparatuses for non-invasive assessment of genetic variations.Background

[0002] Genetic information of living organisms (e.g., animals, plants and microorganisms) and other forms of replicating genetic information (e.g., viruses) is encoded in deoxyribonucleic acid (DNA) or ribonucleic acid (RNA). Genetic information is a succession of nucleotides or modified nucleotides representing the primary structure of chemical or hypothetical nucleic acids. In humans, the complete genome contains about 30,000 genes located on twenty-four (24) chromosomes (see The Human Genome, T. Strachan, BIOS Scientific Publishers, 1992). Each gene encodes a specific protein, which after expression via transcription and translation fulfills a specific biochemical function within a living cell.

[0003] Many medical conditions are caused by one or more genetic variations. Certain genetic variations cause medical conditions that include, for example, hemophilia, thalassemia, Duchenne Muscular Dystrophy (DMD), Huntington's Disease (HD), Alzheimer's Disease and Cystic Fibrosis (CF) (Human Genome Mutations, D. N. Cooper and M. Krawczak, BIOS Publishers, 1993). Such genetic diseases can result from an addition, substitution, or deletion of a single nucleotide in DNA of a particular gene. Certain birth defects are caused by a chromosomal abnormality, also referred to as an aneuploidy, such as Trisomy 21 (Down's Syndrome), Trisomy 13 (Patau Syndrome), Trisomy 18 (Edward's Syndrome), Monosomy X (Turner's Syndrome) and certain sex chromosome aneuploidies such as Klinefelter's Syndrome (XXY), for example. Another genetic variation is fetal gender, which can often be determined based on sex chromosomes X and Y. Some genetic variations may predispose an individual to, or cause, any of a number of diseases such as, for example, diabetes, arteriosclerosis, obesity, various autoimmune diseases and cancer (e.g., colorectal, breast, ovarian, lung).

[0004] Identifying one or more genetic variations or variances can lead to diagnosis of, or determining predisposition to, a particular medical condition. Identifying a genetic variance can result in facilitating a medical decision and / or employing a helpful medical procedure. For instance, WO 2013 / 177086 describes methods and machines for the non-invasive assessment of genetic variations. US 2013 / 237431 describes the determination of a fractional concentration of clinically-relevant DNA in a mixture of DNA from a biological sample based on amounts of DNA fragments at multiple sizes. US 2014 / 180594 provides methods, processes and apparatuses for non-invasive assessment of genetic variation. Yu at al. (2014), PNAS, 111 (23):8583-8588 relates to size-based molecular diagnostics using plasma DNA for non-invasive prenatal testing. In certain aspects, identification of one or more genetic variations or variances involves the analysis of cell-free DNA. Cell-free DNA (CF-DNA) is composed of DNA fragments that originate from cell death and circulate in peripheral blood. High concentrations of CF-DNA can be indicative of certain clinical conditions such as cancer, trauma, burns, myocardial infarction, stroke, sepsis, infection, and other illnesses. Additionally, cell-free fetal DNA (CFF-DNA) can be detected in the maternal bloodstream and used for various noninvasive prenatal diagnostics.Summary

[0005] The present invention is defined by the claims. Accordingly, the present invention relates in a first aspect to a computer-implemented method for determining the presence or absence of a chromosome aneuploidy, microduplication or microdeletion in a fetus, comprising: (a) normalizing counts of nucleotide sequence reads mapped to portions of a reference genome, which sequence reads are 1) reads of circulating cell-free nucleic acid from a test sample from a pregnant female bearing a fetus and 2) reads from nucleic acid fragments having lengths less than or equal to a selected fragment length, thereby providing normalized counts; (b) segmenting by a first segmenting process comprising a wavelet segmenting process and a second segmenting process comprising a circular binary segmentation process the normalized counts of the portions or the normalized counts in a subset of the portions, thereby providing one or more discrete segments; (c) identifying a candidate segment among the one or more discrete segments; and (d) determining the presence or absence of a chromosome aneuploidy, microduplication or microdeletion according to the candidate segment.

[0006] The present invention relates in a second aspect to a computer-implemented method for determining the presence or absence of a chromosome aneuploidy, microduplication or microdeletion in a subject, comprising: (a) normalizing counts of nucleotide sequence reads mapped to portions of a reference genome, which sequence reads are 1) reads of circulating cell-free nucleic acid from a test sample from a subject and 2) reads from nucleic acid fragments having lengths less than or equal to a selected fragment length, thereby providing normalized counts; (b) segmenting by a first segmenting process comprising a wavelet segmenting process and a second segmenting process comprising a circular binary segmentation process the normalized counts of the portions or the normalized counts in a subset of the portions, thereby providing one or more discrete segments; (c) identifying a candidate segment among the one or more discrete segments; and (d) determining the presence or absence of a chromosome aneuploidy, microduplication or microdeletion according to the candidate segment.

[0007] In accordance with a preferred embodiment of the second aspect the chromosome aneuploidy, microduplication or microdeletion is from cancer cell nucleic acid in the subject.

[0008] In accordance with a preferred embodiment of the first and second aspect the method further comprises sequencing nucleic acid by a nucleotide sequencing process to generate nucleotide sequence reads.

[0009] In accordance with a more preferred embodiment of the first and second aspect the nucleotide sequencing process comprises a paired end nucleotide sequencing process.

[0010] In accordance with an even more preferred embodiment of the first and second aspect the nucleotide sequence reads comprise paired end nucleotide sequence reads.

[0011] In accordance with another preferred embodiment of the first and second aspect the test sample is blood, blood serum, blood plasma or urine.

[0012] In accordance with a preferred embodiment of the second aspect the chromosome aneuploidy, microduplication or microdeletion is from cancer cell nucleic acid in the subject.Brief Description of the Drawings

[0013] The drawings illustrate certain aspects of the technology and are not limiting. For clarity and ease of illustration, the drawings are not made to scale and, in some instances, various aspects may be shown exaggerated or enlarged to facilitate an understanding of particular aspects. FIG. 1 shows a schematic of a wavelet method. Normalized portion count data (upper right panel) is wavelet transformed producing a wavelet smoothed profile (bottom right). A non-uniform event is clearly visible after wavelet denoising. FIG. 2 shows the effect of leveling without thresholding. The optimal level can be determined by the desired size of event. FIG. 3 shows a profile comprising a non-uniform profile (Top) and a wavelet transformed profile (Middle) for a sample for Chromosome 13. The bottom panel shows a null edge height distribution obtained from multiple euploid reference samples for Chromosome 13. In the middle panel, two large differences (circled) correspond to the boundary of the non-uniform event. FIG. 4 shows an example of merging segments after wavelet or CBS. Three originally partitioned segments (left panels, right half of chromosome) were merged into a single long stretch (right panel, right half of chromosome), making the microduplications clearly visible. FIG. 5A to FIG. 5E show chromosome profiles that were wavelet smoothed (FIG. 5B), CBS smoothed (FIG. 5C) and segment merged (FIG. 5D and FIG. 5E). The two best segments from the two methods were compared and "cross-confirm" each other. FIG. 6A and FIG. 6B show non-limiting examples of a decision analysis. Some elements (e.g., boxes) of the flow chart shown are optional. Additional elements may be added (e.g., a validation). FIG. 7 shows a non-limiting example of a comparison expanded from 650. FIG. 8 shows a non-limiting example of a comparison of two wavelet events represented by 631 and 632. FIG. 9 shows a chromosome profile (A) that is wavelet smoothed and merged (B) and CBS smoothed and merged (C). After comparison, the two best segments from the two methods "cross-reject" each other. FIG. 10 shows profiles of a segment of Chromosome 22 associated with genetic variations associated with DiGeorge syndrome. Genetic microdeletions and microduplication associated with the DiGeorge syndrome have been mapped to this region. The profiles one the left (panels A-G) were segmented by Haar wavelet and CBS, smoothed, merged and compared. Composite profiles are shown in the right panels (A'-G'). Differences in sample load per flow cell is shown in panels A-A', 0.5-plex; B-B', 1-plex; C-C', 2-plex, D-D', 3-plex; E-E', 4-plex; F-F', 5-plex and G-G', 6-plex. A DiGeorge microdeletion was detected even at a 10-fold decrease in sample read coverage (e.g., see Panel F'). FIG. 11A shows a composite wavelet event representing the detection of a microdeletion in a profile of Chromosome 1. FIG. 11B shows a composite wavelet event representing the detection of a microduplication in a profile of Chromosome 2. FIG. 12 shows a representative example illustrating the detection of the location of microduplications in Chromosome 12 utilizing the method of maximum entropy. FIG. 13 shows an enlarged view of the DiGeorge region for 16 samples labeled with pairs of numbers indicating the locations of the samples on a plate. The sample pairs 3_4 (second from bottom) and 9_10 (fifth from bottom) belong to fetal DiGeorge pregnancies. All other samples have been karyotyped as euploids. The highlighted box (grey region) outlines the overlap between DiGeorge region and the PERUN portion selection (portions of a reference genome chr22_368- chr22_451). FIG. 14 shows Z-scores for the DiGeorge region. Each data point is derived from a sum of two profiles, obtained from two separate plasma aliquots from each patient. Z-standardization was done based on all 16 patients, including the two affected cases. FIGS. 15-16 show representative histograms for samples 3_4 (DiGeorge) and 1_2 (Euploid), respectively. Each histogram shows a distribution of Z-scores obtained on a 15x15 grid of regions contained within the DiGeorge region. The regions were selected by sliding both the left and the right edge of the DiGeorge region by one portion, starting from the outer edges and moving inward. The histograms for samples 3_4 and 9_10 (not shown) consistently showed depletion, with only a few Z-scores for 3_4 exceeding Z = -3. The histogram for sample 13_14 (not shown) consistently suggested overrepresentation, with only a few regions yielding Z-scores below 3. All other samples (e.g., 1_2) remained confined within the [-3, 3] segment of Z-scores. FIG. 17 shows median Z-scores and their ±3 MAD confidence intervals for each of 16 samples. Each median Z-score was determined from a 15x15 grid of regions (225 regions) obtained from sliding edges. The Z-scores for the known DiGeorge samples (3_4 and 9_10) remained below -3 for an overwhelming majority of DiGeorge subregions. The apparent duplication in the sample 13_14 was confirmed by the fact that its Z-scores for the most part exceed 3. The Z-scores of all other samples were always confined within the [-3, 3] segment. FIGS. 18-19 show representative histograms for samples 3_4 (DiGeorge) and 1_2 (Euploid), respectively. Each histogram shows a distribution of Z-scores obtained for the DiGeorge region. Each Z-score was calculated using 16 different sets of reference samples using the "leave one out" method. The histogram for the sample 9_10 (not shown) confirmed depletion. Depending on the reference set, sample 3_4 was either clearly depleted, or had borderline Z-scores. The histogram for sample 13_14 (not shown) suggested overrepresentation, with a few borderline Z-scores. All other samples, including 1_2, remained confined within the [-3, 3] segment of Z-scores. FIG. 20 shows median Z-scores for each sample, representatives of which are shown in FIGS. 18-19. The median Z-scores and their ±3 MAD confidence intervals were calculated from the 16 different sets of reference samples determined using the "leave one out" method. The Z-scores for the known DiGeorge samples (3_4 and 9_10) remained below -3 for an overwhelming majority of subsets of reference samples. The apparent duplication in the sample 13_14 was confirmed by the fact that its Z-scores for the most part exceed 3. The Z-scores of all other samples were always confined within the [-3, 3] segment. FIG. 21 shows median Z-scores obtained using the 15x15 grid of DiGeorge subregions (x-axis) compared to the median Z-scores generated by the "leave one out" technique (y-axis) for each of the 16 samples. The diagonal represents ideal agreement (slope=1, intercept=0). FIGS. 22-23 show representative histograms for samples 3_4 (DiGeorge) and 1_2 (Euploid), respectively. Each histogram shows a distribution of Z-scores obtained for a subregion of the DiGeorge region, using 16 different sets of reference samples. The subregion was randomly chosen from the 15x15 grid of 225 subregions. The "leave one out" analysis confirmed depletion for samples 3_4 (FIG. 37) and 9_10 (not shown). The histogram for the sample 13_14 confirmed overrepresentation (not shown). All other samples, including 1_2, remained confined within the [-3, 3] segment of Z-scores. FIG. 24 shows median Z-scores and their ±3 MAD confidence intervals for a randomly chosen subregion of the DiGeorge region for each of 16 samples using the "leave one out" method. The Z-scores for the known DiGeorge samples (3_4 and 9_10) remained below -3 for most reference samples. The apparent duplication in the sample 13_14 was indicated by the fact that its Z-scores for the most part exceed 3. The Z-scores of all other samples were always confined within the [-3, 3] segment, except for the sample 17_18. FIGS. 25-26 show representative histograms for samples 3_4 (DiGeorge) and 1_2 (Euploid), respectively, representing distributions of Z-scores obtained for all 225 subregions of the DiGeorge region, using 16 different sets of reference samples. The 225 subregions were generated using a sliding edge method on a 15x15 grid for each sample. The sliding edges were combined with the "leave one out" analysis. The results confirm depletion for both affected samples 3_4 and 9_10 (not shown). The histogram for the sample 13_14 confirmed overrepresentation (not shown). All other samples, including 1_2, remain confined within the [-3, 3] segment of Z-scores, with a sporadic exception in 17_18 (not shown). FIG. 27 shows median Z-scores obtained using the 15x15 grid of DiGeorge subregions in combination with the "leave one out" technique compared against the median Z-scores derived from the 15x15 grid alone. The diagonal represents ideal agreement (slope=1, intercept=0). FIG. 28 shows MADs of Z-scores obtained using the 15x15 grid of DiGeorge subregions in combination with the "leave one out" technique were compared against the MADs of Z-scores derived from the 15x15 grid alone. The diagonal represents ideal agreement (slope=1, intercept=0). FIG. 29 shows median Z-scores and their ±3 MAD confidence intervals as evaluated on the complete 15x15 grid of subregions of the canonic DiGeorge region in combination with the "leave one out" method. The Z-scores for the known DiGeorge samples (3_4 and 9_10) remained below -3 for most reference samples. The apparent duplication in the sample 13_14 was indicated by the fact that its Z-scores for the most part exceed 3. The Z-scores of all other samples were always confined within the [-3, 3] segment, except for the sample 17_18. FIG. 30 shows an illustrative example of a system in which certain aspects of the technology may be implemented. FIG. 31 shows classification results for LDTv2 male samples using the log odds ratio (LOR) method. FIG. 32 graphically depicts certain aspects of equation 23 described in Example 6. FIG. 33 shows an example of a GC density provided by an Epanechnikov kernel (bandwidth=200bp). FIG. 34 shows a plot of GC densities (y-axis) for the HTRA1 gene where GC densities are normalized across an entire genome. Genomic positions are shown on the x-axis. FIG. 35 shows a distribution of local genome bias estimates (e.g., GC Density, x-axis) for a reference genome (solid line) and for sequence reads obtained from a sample (dashed line). Bias frequencies (e.g., Density Frequency) are shown on the y-axis. GC density estimates are normalized across an entire genome. In this example, the sample has more reads with high GC content than would be expected from the reference. FIG. 36 shows a comparison of a distribution of GC density estimates for a reference genome and GC density estimates of sequence reads for a sample using a weighted 3 rd< order polynomial fitted relationship. GC density estimates (x-axis) were normalized across an entire genome. GC density frequencies are represented on the y-axis as a log2 ratio of density frequencies of the reference divided by those of the sample FIG. 37A shows a distribution of median GC densities (x-axis) for all portions of a genome. FIG. 37B shows median absolute deviation (MAD) values (x-axis) determined according to the GC density distributions for multiple samples. GC density frequencies are shown on the y-axis. Portions were filtered according to median GC density distributions for multiple reference samples (e.g., a training set) and MAD values determined according to GC density distributions of multiple samples. Portions comprising GC densities outside of an established threshold (e.g., four times the inter-quartile range of MAD) were removed from consideration according to the filtering process. FIG. 38A shows a read density profile of a sample for a genome comprising median read densities (y-axis, e.g., read density / portion) and relative positions of each genomic portion (x-axis, portion index) within a genome. FIG. 38B shows a first principal component (PC1) and FIG. 38C shows a second principal component (PC2) obtained from a principal component analysis of read density profiles obtained from a training set of 500 euploids. FIG. 39A-C shows an example of a read density profile of a sample for a genome comprising a trisomy of Chromosome 21 (e.g., bracketed with two vertical lines). Relative positions of each genomic portion are shown on the x-axis. Read densities are provided on the y-axis. FIG. 39A shows a raw (e.g., not adjusted) read density profile. FIG. 39B shows the profile of 39A comprising a first adjustment comprising a subtraction of the median profile. FIG. 39C shows the profile of 39B comprising a second adjustment. The second adjustment comprises subtraction of 8x principal component profiles, weighted based on their representation found in this sample. (e.g., a model is built). For example a SampleProfile = A*PC1 + B*PC2 + C*PC3 ...and a corrected profile, for example as shown in 39C = SampleProfile - A*PC1 + B*PC2 + C*PC3 ... FIG. 40 shows a QQ-plot of test p-values from bootstrapped training samples for a T21 test. A QQ plot generally compares two distributions. FIG. 40 shows a comparison of ChAI scores (y-axis) from test samples to a uniform distribution (i.e., expected distribution of p-values, x-axis). Each point represents log-p value scores of a single test sample. The samples are sorted and assigned an 'expected' value (x-axis) based on the uniform distribution. The lower dashed line represents the diagonal and the upper line represents a Bonferroni threshold. Samples that follow a uniform distribution would be expected to land on the lower diagonal (lower dashed line). The data values lie well off of the diagonals due to correlations in the portions (e.g., bias) indicating more high-scoring (low p-value) samples than expected. Methods described herein (e.g., ChAl, e.g., see Example 7) can correct for this observed bias. FIG. 41A shows a read density plot showing a difference in PC2 coefficients for men and women in a training set. FIG. 41B shows a receiver operating characteristic (ROC) plot for gender calls with a PC2 coefficient. Gender calls performed by sequencing was used for the truth reference. FIG. 42A-42B shows an example of a system. FIG. 43 shows a distribution of fragment lengths for three different library preparation methods. They include enzymatic with automated bead cleanup, enzymatic without automated bead cleanup, and TRUSEQ with automated bead cleanup. The vertical lines represent 143 base and 166 base fragment lengths. FIG. 44 shows chromosome 13 representation without a fragment length filter. FIG. 45 shows chromosome 13 representation with a fragment length filter at 150 bases. FIG. 46 shows chromosome 18 representation without a fragment length filter. FIG. 47 shows chromosome 18 representation with a fragment length filter at 150 bases. FIG. 48 shows chromosome 21 representation without a fragment length filter. FIG. 49 shows chromosome 21 representation with a fragment length filter at 150 bases. FIG. 50 shows chromosome 13 representation (PERUN PAD with LOESS) with variable fragment length filters. FIG. 51 shows chromosome 18 representation (PERUN PAD with LOESS) with variable fragment length filters. FIG. 52 shows chromosome 21 representation (PERUN PAD with LOESS) with variable fragment length filters. FIG. 53 shows a table presenting a description of data used for certain analyses. FIG. 54 shows 50 kb normalized traces for a male sample with a fetal microdeletion event on chromosome 1. The event is more pronounced using fragments <= 135 bp than using fragments > 199 bp or using all the fragments. FIG. 55 shows fetal fraction difference using fragments > 199 bp and fragments <= c, where c ranges from 100 bp to 199 bp. The left panel is for the event region (chromosome 1 microdeletion). The right panel is for chromosome X. FIG. 56 shows fetal fraction difference using longer fragments VS shorter fragments for two low level mosaic maternal Turners samples. FIG. 57 presents a flowchart to illustrate a method for using fragment length information to differentiate fetal events from maternal events. FIG. 58 shows fetal fraction estimates from a MD region using fragments <= 135 bp vs. all fragments. On average, the increase of fetal fraction was about 2.5 fold. FIG. 59 shows a trisomy 7 example. The chromosome is uniformly elevated. FIG. 60 shows fragment length analysis for chromosome 7. Chromosome level (or its corresponding fetal fraction) increases with respect to shorter fragments. The plot point at the far right represents fetal fraction using all fragments. FIG. 61 shows fragment length analysis for a non-trisomy sample. Chromosome level is constant with respect to fragment length. Detailed Description

[0014] Provided herein are methods for determining the presence or absence of a genetic variation (e.g., a chromosome aneuploidy, microduplication or microdeletion) where a determination is made, in part and / or in full, according to nucleic acid sequences. Also provided herein are methods for determining whether a genetic variation is fetal or maternal. Nucleic acid sequences may be obtained from a sample obtained from a pregnant female (e.g., from the blood of a pregnant female). Also provided herein are methods for determining whether a genetic variation is from cancer cell nucleic acid or non-cancer cell nucleic acid. Nucleic acid sequences may be obtained from a sample obtained from a subject (e.g., from the blood of a cancer patient or a subject suspected of having cancer). Also provided herein are improved data manipulation methods as well as systems, apparatuses and modules that may carry out the methods described herein. Identifying a genetic variation by a method described herein can lead to a diagnosis of, or determine a predisposition to, a particular medical condition. Identifying a genetic variance can result in facilitating a medical decision and / or employing a helpful medical procedure.Samples

[0015] Provided herein are methods and compositions for analyzing nucleic acid. Nucleic acid fragments in a mixture of nucleic acid fragments may be analyzed. A mixture of nucleic acids can comprise two or more nucleic acid fragment species having different nucleotide sequences, different fragment lengths, different origins (e.g., genomic origins, fetal vs. maternal origins, cancer vs. non-cancer origins, cell or tissue origins, sample origins, subject origins, and the like), or combinations thereof.

[0016] Nucleic acid or a nucleic acid mixture utilized in methods and apparatuses described herein often is isolated from a sample obtained from a subject. A subject can be any living or non-living organism, including but not limited to a human, a non-human animal, a plant, a bacterium, a fungus or a protist. Any human or non-human animal can be selected, including but not limited to mammal, reptile, avian, amphibian, fish, ungulate, ruminant, bovine (e.g., cattle), equine (e.g., horse), caprine and ovine (e.g., sheep, goat), swine (e.g., pig), camelid (e.g., camel, llama, alpaca), monkey, ape (e.g., gorilla, chimpanzee), ursid (e.g., bear), poultry, dog, cat, mouse, rat, fish, dolphin, whale and shark. A subject may be a male or female (e.g., woman, a pregnant woman). A subject may be any age (e.g., an embryo, a fetus, infant, child, adult).

[0017] Nucleic acid may be isolated from any type of suitable biological specimen or sample (e.g., a test sample). A sample or test sample can be any specimen that is isolated or obtained from a subject or part thereof (e.g., a human subject, a pregnant female, a fetus). Non-limiting examples of specimens include fluid or tissue from a subject, including, without limitation, blood or a blood product (e.g., serum, plasma, or the like), umbilical cord blood, chorionic villi, amniotic fluid, cerebrospinal fluid, spinal fluid, lavage fluid (e.g., bronchoalveolar, gastric, peritoneal, ductal, ear, arthroscopic), biopsy sample (e.g., from pre-implantation embryo), celocentesis sample, cells (blood cells, placental cells, embryo or fetal cells, fetal nucleated cells or fetal cellular remnants) or parts thereof (e.g., mitochondrial, nucleus, extracts, or the like), washings of female reproductive tract, urine, feces, sputum, saliva, nasal mucous, prostate fluid, lavage, semen, lymphatic fluid, bile, tears, sweat, breast milk, breast fluid, the like or combinations thereof. A biological sample may be a cervical swab from a subject. A biological sample may be blood and sometimes plasma or serum. The term "blood" as used herein refers to a blood sample or preparation from a pregnant woman or a woman being tested for possible pregnancy. The term encompasses whole blood, blood product or any fraction of blood, such as serum, plasma, buffy coat, or the like as conventionally defined. Blood or fractions thereof often comprise nucleosomes (e.g., maternal and / or fetal nucleosomes). Nucleosomes comprise nucleic acids and are sometimes cell-free or intracellular. Blood also comprises buffy coats. Buffy coats are sometimes isolated by utilizing a ficoll gradient. Buffy coats can comprise white blood cells (e.g., leukocytes, T-cells, B-cells, platelets, and the like). Buffy coats may comprise maternal and / or fetal nucleic acid. Blood plasma refers to the fraction of whole blood resulting from centrifugation of blood treated with anticoagulants. Blood serum refers to the watery portion of fluid remaining after a blood sample has coagulated. Fluid or tissue samples often are collected in accordance with standard protocols hospitals or clinics generally follow. For blood, an appropriate amount of peripheral blood (e.g., between 3-40 milliliters) often is collected and can be stored according to standard procedures prior to or after preparation. A fluid or tissue sample from which nucleic acid is extracted may be acellular (e.g., cell-free). A fluid or tissue sample may contain cellular elements or cellular remnants. Fetal cells or cancer cells may be included in the sample.

[0018] A sample often is heterogeneous, by which is meant that more than one type of nucleic acid species is present in the sample. For example, heterogeneous nucleic acid can include, but is not limited to, (i) fetal derived and maternal derived nucleic acid, (ii) cancer and non-cancer nucleic acid, (iii) pathogen and host nucleic acid, and more generally, (iv) mutated and wild-type nucleic acid. A sample may be heterogeneous because more than one cell type is present, such as a fetal cell and a maternal cell, a cancer and non-cancer cell, or a pathogenic and host cell. A minority nucleic acid species and a majority nucleic acid species may be present.

[0019] For prenatal applications of technology described herein, fluid or tissue sample may be collected from a female at a gestational age suitable for testing, or from a female who is being tested for possible pregnancy. Suitable gestational age may vary depending on the prenatal test being performed. A pregnant female subject sometimes may be in the first trimester of pregnancy, at times in the second trimester of pregnancy, or sometimes in the third trimester of pregnancy. A fluid or tissue may be collected from a pregnant female between about 1 to about 45 weeks of fetal gestation (e.g., at 1-4, 4-8, 8-12, 12-16, 16-20, 20-24, 24-28, 28-32, 32-36, 36-40 or 40-44 weeks of fetal gestation), and sometimes between about 5 to about 28 weeks of fetal gestation (e.g., at 6, 7, 8, 9,10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26 or 27 weeks of fetal gestation). A fluid or tissue sample may be collected from a pregnant female during or just after (e.g., 0 to 72 hours after) giving birth (e.g., vaginal or non-vaginal birth (e.g., surgical delivery)).Acquisition of Blood Samples and Extraction of DNA

[0020] Methods herein often include separating, enriching and analyzing fetal DNA found in maternal blood as a non-invasive means to detect the presence or absence of a maternal and / or fetal genetic variation and / or to monitor the health of a fetus and / or a pregnant female during and sometimes after pregnancy. Thus, the first steps of practicing certain methods herein often include obtaining a blood sample from a pregnant woman and extracting DNA from a sample.Acquisition of Blood Samples

[0021] A blood sample can be obtained from a pregnant woman at a gestational age suitable for testing using a method of the present technology. A suitable gestational age may vary depending on the disorder tested, as discussed below. Collection of blood from a woman often is performed in accordance with the standard protocol hospitals or clinics generally follow. An appropriate amount of peripheral blood, e.g., typically between 5-50 ml, often is collected and may be stored according to standard procedure prior to further preparation. Blood samples may be collected, stored or transported in a manner that minimizes degradation or the quality of nucleic acid present in the sample.Preparation of Blood Samples

[0022] An analysis of fetal DNA found in maternal blood may be performed using, e.g., whole blood, serum, or plasma. Methods for preparing serum or plasma from maternal blood are known. For example, a pregnant woman's blood can be placed in a tube containing EDTA or a specialized commercial product such as Vacutainer SST (Becton Dickinson, Franklin Lakes, N.J.) to prevent blood clotting, and plasma can then be obtained from whole blood through centrifugation. Serum may be obtained with or without centrifugation-following blood clotting. If centrifugation is used then it is typically, though not exclusively, conducted at an appropriate speed, e.g., 1,500-3,000 times g. Plasma or serum may be subjected to additional centrifugation steps before being transferred to a fresh tube for DNA extraction.

[0023] In addition to the acellular portion of the whole blood, DNA may also be recovered from the cellular fraction, enriched in the buffy coat portion, which can be obtained following centrifugation of a whole blood sample from the woman and removal of the plasma.Extraction of DNA

[0024] There are numerous known methods for extracting DNA from a biological sample including blood and urine. The general methods of DNA preparation (e.g., described by Sambrook and Russell, Molecular Cloning: A Laboratory Manual 3d ed., 2001) can be followed; various commercially available reagents or kits, such as Qiagen's QIAamp Circulating Nucleic Acid Kit, QiaAmp DNA Mini Kit or QiaAmp DNA Blood Mini Kit (Qiagen, Hilden, Germany), GenomicPrep ™< Blood DNA Isolation Kit (Promega, Madison, Wis.), and GFX ™< Genomic Blood DNA Purification Kit (Amersham, Piscataway, N.J.), may also be used to obtain DNA from a blood sample from a pregnant woman. Combinations of more than one of these methods may also be used.

[0025] The sample may first be enriched or relatively enriched for fetal nucleic acid by one or more methods. For example, the discrimination of fetal and maternal DNA can be performed using the compositions and processes of the present technology alone or in combination with other discriminating factors. Examples of these factors include, but are not limited to, single nucleotide differences between chromosome X and Y, chromosome Y-specific sequences, polymorphisms located elsewhere in the genome, size differences between fetal and maternal DNA and differences in methylation pattern between maternal and fetal tissues.

[0026] Other methods for enriching a sample for a particular species of nucleic acid are described in PCT Patent Application Number PCT / US07 / 69991, filed May 30, 2007, PCT Patent Application Number PCT / US2007 / 071232, filed June 15, 2007, PCT Patent Application Number PCT / EP05 / 012707, filed November 28, 2005. Maternal nucleic acid may be selectively removed (either partially, substantially, almost completely or completely) from the sample.

[0027] The terms "nucleic acid" and "nucleic acid molecule" may be used interchangeably throughout the disclosure. The terms refer to nucleic acids of any composition from, such as DNA (e.g., complementary DNA (cDNA), genomic DNA (gDNA) and the like), RNA (e.g., message RNA (mRNA), short inhibitory RNA (siRNA), ribosomal RNA (rRNA), tRNA, microRNA, RNA highly expressed by the fetus or placenta, and the like), and / or DNA or RNA analogs (e.g., containing base analogs, sugar analogs and / or a non-native backbone and the like), RNA / DNA hybrids and polyamide nucleic acids (PNAs), all of which can be in single- or double-stranded form, and unless otherwise limited, can encompass known analogs of natural nucleotides that can function in a similar manner as naturally occurring nucleotides. A nucleic acid may be, or may be from, a plasmid, phage, autonomously replicating sequence (ARS), centromere, artificial chromosome, chromosome, or other nucleic acid able to replicate or be replicated in vitro or in a host cell, a cell, a cell nucleus or cytoplasm of a cell. A template nucleic acid can be from a single chromosome (e.g., a nucleic acid sample may be from one chromosome of a sample obtained from a diploid organism). Unless specifically limited, the term encompasses nucleic acids containing known analogs of natural nucleotides that have similar binding properties as the reference nucleic acid and are metabolized in a manner similar to naturally occurring nucleotides. Unless otherwise indicated, a particular nucleic acid sequence also implicitly encompasses conservatively modified variants thereof (e.g., degenerate codon substitutions), alleles, orthologs, single nucleotide polymorphisms (SNPs), and complementary sequences as well as the sequence explicitly indicated. Specifically, degenerate codon substitutions may be achieved by generating sequences in which the third position of one or more selected (or all) codons is substituted with mixed-base and / or deoxyinosine residues. The term nucleic acid is used interchangeably with locus, gene, cDNA, and mRNA encoded by a gene. The term also may include, as equivalents, derivatives, variants and analogs of RNA or DNA synthesized from nucleotide analogs, single-stranded ("sense" or "antisense", "plus" strand or "minus" strand, "forward" reading frame or "reverse" reading frame) and double-stranded polynucleotides. The term "gene" means the segment of DNA involved in producing a polypeptide chain; it includes regions preceding and following the coding region (leader and trailer) involved in the transcription / translation of the gene product and the regulation of the transcription / translation, as well as intervening sequences (introns) between individual coding segments (exons).

[0028] Deoxyribonucleotides include deoxyadenosine, deoxycytidine, deoxyguanosine and deoxythymidine. For RNA, the base cytosine is replaced with uracil. A template nucleic acid may be prepared using a nucleic acid obtained from a subject as a template.Nucleic Acid Isolation and Processing

[0029] Nucleic acid may be derived from one or more sources (e.g., cells, serum, plasma, buffy coat, lymphatic fluid, skin, soil, and the like) by methods known in the art. Any suitable method can be used for isolating, extracting and / or purifying DNA from a biological sample (e.g., from blood or a blood product; urine), non-limiting examples of which include methods of DNA preparation (e.g., described by Sambrook and Russell, Molecular Cloning: A Laboratory Manual 3d ed., 2001), various commercially available reagents or kits, such as Qiagen's QIAamp Circulating Nucleic Acid Kit, QiaAmp DNA Mini Kit or QiaAmp DNA Blood Mini Kit (Qiagen, Hilden, Germany), GenomicPrep ™< Blood DNA Isolation Kit (Promega, Madison, Wis.), and GFX ™< Genomic Blood DNA Purification Kit (Amersham, Piscataway, N.J.), the like or combinations thereof.

[0030] Cell lysis procedures and reagents are known in the art and may generally be performed by chemical (e.g., detergent, hypotonic solutions, enzymatic procedures, and the like, or combination thereof), physical (e.g., French press, sonication, and the like), or electrolytic lysis methods. Any suitable lysis procedure can be utilized. For example, chemical methods generally employ lysing agents to disrupt cells and extract the nucleic acids from the cells, followed by treatment with chaotropic salts. Physical methods such as freeze / thaw followed by grinding, the use of cell presses and the like also are useful. High salt lysis procedures also are commonly used. For example, an alkaline lysis procedure may be utilized. The latter procedure traditionally incorporates the use of phenol-chloroform solutions, and an alternative phenol-chloroform-free procedure involving three solutions can be utilized. In the latter procedures, one solution can contain 15mM Tris, pH 8.0; 10mM EDTA and 100 ug / ml Rnase A; a second solution can contain 0.2N NaOH and 1% SDS; and a third solution can contain 3M KOAc, pH 5.5. These procedures can be found in Current Protocols in Molecular Biology, John Wiley & Sons, N.Y., 6.3.1-6.3.6 (1989).

[0031] Nucleic acid may be isolated at a different time point as compared to another nucleic acid, where each of the samples is from the same or a different source. A nucleic acid may be from a nucleic acid library, such as a cDNA or RNA library, for example. A nucleic acid may be a result of nucleic acid purification or isolation and / or amplification of nucleic acid molecules from the sample. Nucleic acid provided for processes described herein may contain nucleic acid from one sample or from two or more samples (e.g., from 1 or more, 2 or more, 3 or more, 4 or more, 5 or more, 6 or more, 7 or more, 8 or more, 9 or more, 10 or more, 11 or more, 12 or more, 13 or more, 14 or more, 15 or more, 16 or more, 17 or more, 18 or more, 19 or more, or 20 or more samples).

[0032] Nucleic acids can include extracellular nucleic acid. The term "extracellular nucleic acid" as used herein can refer to nucleic acid isolated from a source having substantially no cells and also is referred to as "cell-free" nucleic acid and / or "cell-free circulating" nucleic acid. Extracellular nucleic acid can be present in and obtained from blood and / or urine (e.g., from the blood of a pregnant female). Extracellular nucleic acid often includes no detectable cells and may contain cellular elements or cellular remnants. Non-limiting examples of acellular sources for extracellular nucleic acid are blood, blood plasma, blood serum and urine. As used herein, the term "obtain cell-free circulating sample nucleic acid" includes obtaining a sample directly (e.g., collecting a sample, e.g., a test sample) or obtaining a sample from another who has collected a sample. Without being limited by theory, extracellular nucleic acid may be a product of cell apoptosis and cell breakdown, which provides basis for extracellular nucleic acid often having a series of lengths across a spectrum (e.g., a "ladder").

[0033] Extracellular nucleic acid can include different nucleic acid species, and therefore may be referred to herein as "heterogeneous". For example, blood serum or plasma from a person having cancer can include nucleic acid from cancer cells (cancer cell nucleic acid; also referred to as circulating tumor DNA (ctDNA) in certain instances) and nucleic acid from non-cancer cells. In another example, blood serum or plasma from a pregnant female can include maternal nucleic acid and fetal nucleic acid. In some instances, fetal nucleic acid sometimes is about 5% to about 50% of the overall nucleic acid (e.g., about 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, or 49% of the total nucleic acid is fetal nucleic acid). The majority of fetal nucleic acid in nucleic acid may be of a length of about 500 base pairs or less, about 250 base pairs or less, about 200 base pairs or less, about 150 base pairs or less, about 100 base pairs or less, about 50 base pairs or less or about 25 base pairs or less. The majority of fetal nucleic acid in nucleic acid may be of a length of about 500 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of fetal nucleic acid is of a length of about 500 base pairs or less). The majority of fetal nucleic acid in nucleic acid may be of a length of about 250 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of fetal nucleic acid is of a length of about 250 base pairs or less). The majority of fetal nucleic acid in nucleic acid may be of a length of about 200 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of fetal nucleic acid is of a length of about 200 base pairs or less). The majority of fetal nucleic acid in nucleic acid may be of a length of about 150 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of fetal nucleic acid is of a length of about 150 base pairs or less). The majority of fetal nucleic acid in nucleic acid may be of a length of about 100 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of fetal nucleic acid is of a length of about 100 base pairs or less). The majority of fetal nucleic acid in nucleic acid may be of a length of about 90 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of fetal nucleic acid is of a length of about 90 base pairs or less). The majority of fetal nucleic acid in nucleic acid may be of a length of about 50 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of fetal nucleic acid is of a length of about 50 base pairs or less). The majority of fetal nucleic acid in nucleic acid may be of a length of about 25 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of fetal nucleic acid is of a length of about 25 base pairs or less).

[0034] In one example, blood serum or plasma or urine from a person having cancer can include nucleic acid from cancer cells (cancer cell nucleic acid; also referred to as circulating tumor DNA (ctDNA) in certain instances) and nucleic acid from non-cancer cells (non-cancer cell nucleic acid). Cancer cell nucleic acid sometimes is about 5% to about 50% of the overall nucleic acid (e.g., about 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, or 49% of the total nucleic acid is cancer cell nucleic acid). The majority of cancer cell nucleic acid in nucleic acid may be of a length of about 500 base pairs or less, about 250 base pairs or less, about 200 base pairs or less, about 175 base pairs or less, about 150 base pairs or less, about 100 base pairs or less, about 50 base pairs or less or about 25 base pairs or less. The majority of cancer cell nucleic acid in nucleic acid may be of a length of about 500 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of cancer cell nucleic acid is of a length of about 500 base pairs or less). The majority of cancer cell nucleic acid in nucleic acid may be of a length of about 250 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of cancer cell nucleic acid is of a length of about 250 base pairs or less). The majority of cancer cell nucleic acid in nucleic acid may be of a length of about 200 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of cancer cell nucleic acid is of a length of about 200 base pairs or less). The majority of cancer cell nucleic acid in nucleic acid may be of a length of about 175 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of cancer cell nucleic acid is of a length of about 175 base pairs or less). The majority of cancer cell nucleic acid in nucleic acid may be of a length of about 150 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of cancer cell nucleic acid is of a length of about 150 base pairs or less). The majority of cancer cell nucleic acid in nucleic acid may be of a length of about 100 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of cancer cell nucleic acid is of a length of about 100 base pairs or less). The majority of cancer cell nucleic acid in nucleic acid may be of a length of about 90 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of cancer cell nucleic acid is of a length of about 90 base pairs or less). The majority of cancer cell nucleic acid in nucleic acid may be of a length of about 50 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of cancer cell nucleic acid is of a length of about 50 base pairs or less). The majority of cancer cell nucleic acid in nucleic acid may be of a length of about 25 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of cancer cell nucleic acid is of a length of about 25 base pairs or less). The majority of nucleic acid fragments in a sample that may be of lengths of about 500 base pairs or less, about 250 base pairs or less, about 200 base pairs or less, about 175 base pairs or less, about 150 base pairs or less, about 100 base pairs or less, about 50 base pairs or less or about 25 base pairs or less are from cancer cell nucleic acid. The majority of cancer cell nucleic acid in nucleic acid may be of a length of between about 20 base pairs and about 100 base pairs. For example, the majority of cancer cell nucleic acid in nucleic acid can be of a length of about 20 base pairs, about 30 base pairs, about 40 base pairs, about 50 base pairs, about 60 base pairs, about 70 base pairs, about 80 base pairs, about 90 base pairs or about 100 base pairs. The majority of cancer cell nucleic acid in nucleic acid may be of a length of between about 50 base pairs and about 100 base pairs. The majority of cancer cell nucleic acid in nucleic acid may be of a length of about 90 base pairs. The majority of cancer cell nucleic acid in nucleic acid may be of a length of between about 20 base pairs and about 50 base pairs. The majority of cancer cell nucleic acid in nucleic acid may be of a length of about 30 base pairs. The majority of nucleic acid fragments in a sample that may be of lengths of between about 50 base pairs and about 100 base pairs are from cancer cell nucleic acid. The majority of nucleic acid fragments in a sample that may be of lengths of between about 20 base pairs and about 50 base pairs are from cancer cell nucleic acid. The majority of nucleic acid fragments in a sample that are of lengths of 30 base pairs may be from cancer cell nucleic acid.

[0035] The majority of cancer cell nucleic acid in nucleic acid may be of a length of about 500 base pairs or more, about 600 base pairs or more, about 700 base pairs or more, about 800 base pairs or more, about 900 base pairs or more, about 1000 base pairs or more, or about 1500 base pairs or more. The majority of cancer cell nucleic acid in nucleic acid may be of a length of about 500 base pairs or more (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of cancer cell nucleic acid is of a length of about 500 base pairs or more). The majority of cancer cell nucleic acid in nucleic acid may be of a length of about 600 base pairs or more (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of cancer cell nucleic acid is of a length of about 600 base pairs or more). The majority of cancer cell nucleic acid in nucleic acid may be of a length of about 700 base pairs or more (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of cancer cell nucleic acid is of a length of about 700 base pairs or more). The majority of cancer cell nucleic acid in nucleic acid may be of a length of about 800 base pairs or more (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of cancer cell nucleic acid is of a length of about 800 base pairs or more). The majority of cancer cell nucleic acid in nucleic acid may be of a length of about 900 base pairs or more (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of cancer cell nucleic acid is of a length of about 900 base pairs or more). The majority of cancer cell nucleic acid in nucleic acid may be of a length of about 1000 base pairs or more (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of cancer cell nucleic acid is of a length of about 1000 base pairs or more). The majority of cancer cell nucleic acid in nucleic acid may be of a length of about 1500 base pairs or more (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of cancer cell nucleic acid is of a length of about 1500 base pairs or more). The majority of nucleic acid fragments in a sample that may be of lengths of about 500 base pairs or more, about 600 base pairs or more, about 700 base pairs or more, about 800 base pairs or more, about 900 base pairs or more, about 1000 base pairs or more, or about 1500 base pairs or more are from cancer cell nucleic acid.

[0036] Nucleic acid fragment of a certain length, range of lengths, or lengths under or over a particular threshold or cutoff may be analyzed. Fragments having a length under a particular threshold or cutoff (e.g., 500 bp, 400 bp, 300 bp, 200 bp, 175 bp, 150 bp, 135 bp, 100 bp, 50 bp) may be referred to as "short" fragments and fragments having a length over a particular threshold or cutoff (e.g., 500 bp, 400 bp, 300 bp, 200 bp, 175 bp, 150 bp, 135 bp, 100 bp, 50 bp) may be referred to as "long" fragments. For example, fragments having a length under 200 bp are referred to as "short" fragments and fragments having a length equal to or over 200 bp are referred to as "long" fragments. Fragments of a certain length, range of lengths, or lengths under or over a particular threshold or cutoff may be analyzed while fragments of a different length or range of lengths, or lengths over or under the threshold or cutoff are not analyzed. Fragments of a certain length, range of lengths, or lengths under a particular threshold or cutoff may be analyzed separately from fragments of a different length or range of lengths, or lengths over the threshold or cutoff.

[0037] Fragments that are less than about 500 bp may be analyzed. Fragments that are less than about 400 bp may be analyzed. Fragments that are less than about 300 bp may be analyzed. Fragments that are less than about 200 bp may be analyzed. Fragments that are less than about 150 bp may be analyzed. For example, Fragments that are less than about 200 bp, 190 bp, 180 bp, 170 bp, 160 bp, 150 bp, 140 bp, 130 bp, 120 bp, 110 bp or 100 bp may be analyzed. Fragments that are about 100 bp to about 200 bp may be analyzed. For example, fragments that are about 190 bp, 180 bp, 170 bp, 160 bp, 150 bp, 140 bp, 130 bp, 120 bp or 110 bp are analyzed. Fragments that are in the range of about 100 bp to about 200 bp may be analyzed. For example, fragments that are in the range of about 110 bp to about 190 bp, 130 bp to about 180 bp, 170 bp to about 180 bp, 140 bp to about 170 bp, 140 bp to about 150 bp, 150 bp to about 160 bp, 145 bp to about 155 bp, or 130 bp to 140 bp are analyzed. Fragments that are about 135 bp may be analyzed. Fragments that are about 175 bp are analyzed. Fragments that are about 200 bp or greater may be analyzed. Fragments that are about 200 bp may be analyzed. Fragments that are less than about 100 bp may be analyzed. Fragments that are less than about 90 bp are analyzed. Fragments that are about 10 bp to about 100 bp may be analyzed. For example, fragments that are about 90 bp, 80 bp, 70 bp, 60 bp, 50 bp, 40 bp, 30 bp, 20 bp or 10 bp are analyzed. Fragments that are about 20 bp to about 50 bp may be analyzed. Fragments that are about 30 bp may be analyzed. Fragments that are about 50 bp to about 100 bp may be analyzed. Fragments that are about 90 bp may be analyzed. Fragments that are about 500 bp to about 1000 bp may be analyzed. Fragments that are about 10 bp to about 30 bp shorter than other fragments of a certain length or range of lengths may be analyzed. Fragments that are about 10 bp to about 20 bp shorter than other fragments of a certain length or range of lengths may be analyzed. Fragments that are about 10 bp to about 15 bp shorter than other fragments of a certain length or range of lengths may be analyzed.

[0038] Nucleic acid may be provided for conducting methods described herein without processing of the sample(s) containing the nucleic acid. Nnucleic acid may be provided for conducting methods described herein after processing of the sample(s) containing the nucleic acid. For example, a nucleic acid can be extracted, isolated, purified, partially purified or amplified from the sample(s). The term "isolated" as used herein refers to nucleic acid removed from its original environment (e.g., the natural environment if it is naturally occurring, or a host cell if expressed exogenously), and thus is altered by human intervention (e.g., "by the hand of man") from its original environment. The term "isolated nucleic acid" as used herein can refer to a nucleic acid removed from a subject (e.g., a human subject). An isolated nucleic acid can be provided with fewer non-nucleic acid components (e.g., protein, lipid) than the amount of components present in a source sample. A composition comprising isolated nucleic acid can be about 50% to greater than 99% free of non-nucleic acid components. A composition comprising isolated nucleic acid can be about 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or greater than 99% free of non-nucleic acid components. The term "purified" as used herein can refer to a nucleic acid provided that contains fewer non-nucleic acid components (e.g., protein, lipid, carbohydrate) than the amount of non-nucleic acid components present prior to subjecting the nucleic acid to a purification procedure. A composition comprising purified nucleic acid may be about 80%, 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or greater than 99% free of other non-nucleic acid components. The term "purified" as used herein can refer to a nucleic acid provided that contains fewer nucleic acid species than in the sample source from which the nucleic acid is derived. A composition comprising purified nucleic acid may be about 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or greater than 99% free of other nucleic acid species. For example, fetal nucleic acid can be purified from a mixture comprising maternal and fetal nucleic acid. In certain examples, nucleosomes comprising small fragments of fetal nucleic acid can be purified from a mixture of larger nucleosome complexes comprising larger fragments of maternal nucleic acid.

[0039] Nucleic acids may be fragmented or cleaved prior to, during or after a method described herein. Fragmented or cleaved nucleic acid may have a nominal, average or mean length of about 5 to about 10,000 base pairs, about 100 to about 1,000 base pairs, about 100 to about 500 base pairs, or about 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 200, 300, 400, 500, 600, 700, 800, 900, 1000, 2000, 3000, 4000, 5000, 6000, 7000, 8000 or 9000 base pairs. Fragments can be generated by a suitable method known in the art, and the average, mean or nominal length of nucleic acid fragments can be controlled by selecting an appropriate fragment-generating procedure.

[0040] Nucleic acid fragments may contain overlapping nucleotide sequences, and such overlapping sequences can facilitate construction of a nucleotide sequence of the non-fragmented counterpart nucleic acid, or a segment thereof. For example, one fragment may have subsequences x and y and another fragment may have subsequences y and z, where x, y and z are nucleotide sequences that can be 5 nucleotides in length or greater. Overlap sequence y can be utilized to facilitate construction of the x-y-z nucleotide sequence in nucleic acid from a sample. Nucleic acid may be partially fragmented (e.g., from an incomplete or terminated specific cleavage reaction) or fully fragmented.

[0041] Nucleic acid may be fragmented or cleaved by a suitable method, non-limiting examples of which include physical methods (e.g., shearing, e.g., sonication, French press, heat, UV irradiation, the like), enzymatic processes (e.g., enzymatic cleavage agents (e.g., a suitable nuclease, a suitable restriction enzyme, a suitable methylation sensitive restriction enzyme)), chemical methods (e.g., alkylation, DMS, piperidine, acid hydrolysis, base hydrolysis, heat, the like, or combinations thereof), processes described in U.S. Patent Application Publication No. 20050112590, the like or combinations thereof.

[0042] As used herein, "fragmentation" or "cleavage" refers to a procedure or conditions in which a nucleic acid molecule, such as a nucleic acid template gene molecule or amplified product thereof, may be severed into two or more smaller nucleic acid molecules. Such fragmentation or cleavage can be sequence specific, base specific, or nonspecific, and can be accomplished by any of a variety of methods, reagents or conditions, including, for example, chemical, enzymatic, physical fragmentation.

[0043] As used herein, "fragments", "cleavage products", "cleaved products" or grammatical variants thereof, refers to nucleic acid molecules resultant from a fragmentation or cleavage of a nucleic acid template gene molecule or amplified product thereof. While such fragments or cleaved products can refer to all nucleic acid molecules resultant from a cleavage reaction, typically such fragments or cleaved products refer only to nucleic acid molecules resultant from a fragmentation or cleavage of a nucleic acid template gene molecule or the segment of an amplified product thereof containing the corresponding nucleotide sequence of a nucleic acid template gene molecule. The term "amplified" as used herein refers to subjecting a target nucleic acid in a sample to a process that linearly or exponentially generates amplicon nucleic acids having the same or substantially the same nucleotide sequence as the target nucleic acid, or segment thereof. The term "amplified" refers to a method that comprises a polymerase chain reaction (PCR). For example, an amplified product can contain one or more nucleotides more than the amplified nucleotide region of a nucleic acid template sequence (e.g., a primer can contain "extra" nucleotides such as a transcriptional initiation sequence, in addition to nucleotides complementary to a nucleic acid template gene molecule, resulting in an amplified product containing "extra" nucleotides or nucleotides not corresponding to the amplified nucleotide region of the nucleic acid template gene molecule). Accordingly, fragments can include fragments arising from segments or parts of amplified nucleic acid molecules containing, at least in part, nucleotide sequence information from or based on the representative nucleic acid template molecule.

[0044] As used herein, the term "complementary cleavage reactions" refers to cleavage reactions that are carried out on the same nucleic acid using different cleavage reagents or by altering the cleavage specificity of the same cleavage reagent such that alternate cleavage patterns of the same target or reference nucleic acid or protein are generated. Nucleic acid may be treated with one or more specific cleavage agents (e.g., 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 or more specific cleavage agents) in one or more reaction vessels (e.g., nucleic acid is treated with each specific cleavage agent in a separate vessel). The term "specific cleavage agent" as used herein refers to an agent, sometimes a chemical or an enzyme that can cleave a nucleic acid at one or more specific sites.

[0045] Nucleic acid also may be exposed to a process that modifies certain nucleotides in the nucleic acid before providing nucleic acid for a method described herein. A process that selectively modifies nucleic acid based upon the methylation state of nucleotides therein can be applied to nucleic acid, for example. In addition, conditions such as high temperature, ultraviolet radiation, x-radiation, can induce changes in the sequence of a nucleic acid molecule. Nucleic acid may be provided in any suitable form useful for conducting a suitable sequence analysis.

[0046] Nucleic acid may be single or double stranded. Single stranded DNA, for example, can be generated by denaturing double stranded DNA by heating or by treatment with alkali, for example. Nucleic acid may be in a D-loop structure, formed by strand invasion of a duplex DNA molecule by an oligonucleotide or a DNA-like molecule such as peptide nucleic acid (PNA). D loop formation can be facilitated by addition of E. Coli RecA protein and / or by alteration of salt concentration, for example, using methods known in the art.Minority vs. Majority Speci

[0047] At least two different nucleic acid species can exist in different amounts in extracellular (e.g., circulating cell-free) nucleic acid and sometimes are referred to as minority species and majority species. In certain instances, a minority species of nucleic acid is from an affected cell type (e.g., cancer cell, wasting cell, cell attacked by immune system). A chromosome alteration may be determined for a minority nucleic acid species. A chromosome alteration may be determined for a majority nucleic acid species. As used herein, it is not intended that the terms "minority" or "majority" be rigidly defined in any respect. In one aspect, a nucleic acid that is considered "minority", for example, can have an abundance of at least about 0.1% of the total nucleic acid in a sample to less than 50% of the total nucleic acid in a sample. A minority nucleic acid can have an abundance of at least about 1% of the total nucleic acid in a sample to about 40% of the total nucleic acid in a sample. A minority nucleic acid can have an abundance of at least about 2% of the total nucleic acid in a sample to about 30% of the total nucleic acid in a sample. A minority nucleic acid can have an abundance of at least about 3% of the total nucleic acid in a sample to about 25% of the total nucleic acid in a sample. For example, a minority nucleic acid can have an abundance of about 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 11%, 12%, 13%, 14%, 15%, 16%, 17%, 18%, 19%, 20%, 21%, 22%, 23%, 24%, 25%, 26%, 27%, 28%, 29% or 30% of the total nucleic acid in a sample. In some instances, a minority species of extracellular nucleic acid sometimes is about 1% to about 40% of the overall nucleic acid (e.g., about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39 or 40% of the nucleic acid is minority species nucleic acid). The minority nucleic acid may be extracellular DNA. The minority nucleic acid may be extracellular DNA from apoptotic tissue. The minority nucleic acid may be extracellular DNA from tissue affected by a cell proliferative disorder. The minority nucleic acid may be extracellular DNA from a tumor cell. The minority nucleic acid may be extracellular fetal DNA.

[0048] In another aspect, a nucleic acid that is considered "majority", for example, can have an abundance greater than 50% of the total nucleic acid in a sample to about 99.9% of the total nucleic acid in a sample. A majority nucleic acid can have an abundance of at least about 60% of the total nucleic acid in a sample to about 99% of the total nucleic acid in a sample. A majority nucleic acid can have an abundance of at least about 70% of the total nucleic acid in a sample to about 98% of the total nucleic acid in a sample. A majority nucleic acid can have an abundance of at least about 75% of the total nucleic acid in a sample to about 97% of the total nucleic acid in a sample. For example, a majority nucleic acid can have an abundance of at least about 70%, 71%, 72%, 73%, 74%, 75%, 76%, 77%, 78%, 79%, 80%, 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98% or 99% of the total nucleic acid in a sample. The majority nucleic acid may be extracellular DNA. The majority nucleic acid may be extracellular maternal DNA. The majority nucleic acid may be DNA from healthy tissue. The majority nucleic acid may be DNA from non-tumor cells.

[0049] A minority species of extracellular nucleic acid may be of a length of about 500 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of minority species nucleic acid is of a length of about 500 base pairs or less). A minority species of extracellular nucleic acid may be of a length of about 300 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of minority species nucleic acid is of a length of about 300 base pairs or less). A minority species of extracellular nucleic acid may be of a length of about 200 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of minority species nucleic acid is of a length of about 200 base pairs or less). A minority species of extracellular nucleic acid may be of a length of about 175 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of minority species nucleic acid is of a length of about 175 base pairs or less). A minority species of extracellular nucleic acid may of a length of about 150 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of minority species nucleic acid is of a length of about 150 base pairs or less). A minority species of extracellular nucleic acid may be of a length of about 135 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of minority species nucleic acid is of a length of about 135 base pairs or less). A minority species of extracellular nucleic acid may be of a length of about 100 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of minority species nucleic acid is of a length of about 100 base pairs or less). A minority species of extracellular nucleic acid may be of a length of about 90 base pairs or less (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of minority species nucleic acid is of a length of about 90 base pairs or less). A minority species of extracellular nucleic acid may be of a length of between about 50 base pairs to about 100 base pairs (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of minority species nucleic acid is of a length of about between about 50 base pairs to about 100 base pairs). A minority species of extracellular nucleic acid may be of a length of between about 20 base pairs to about 50 base pairs (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of minority species nucleic acid is of a length of about between about 20 base pairs to about 50 base pairs). A minority species of extracellular nucleic acid is of a length of about 30 base pairs (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of minority species nucleic acid is of a length of about 30 base pairs). A minority species of extracellular nucleic acid may be of a length of about 500 base pairs or more (e.g., about 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 or 100% of minority species nucleic acid is of a length of about 500 base pairs or more).Cell types

[0050] As used herein, a "cell type" refers to a type of cell that can be distinguished from another type of cell. Extracellular nucleic acid can include nucleic acid from several different cell types. Non-limiting examples of cell types that can contribute nucleic acid to circulating cell-free nucleic acid include liver cells (e.g., hepatocytes), lung cells, spleen cells, pancreas cells, colon cells, skin cells, bladder cells, eye cells, brain cells, esophagus cells, cells of the head, cells of the neck, cells of the ovary, cells of the testes, prostate cells, placenta cells, epithelial cells, endothelial cells, adipocyte cells, kidney / renal cells, heart cells, muscle cells, blood cells (e.g., white blood cells), central nervous system (CNS) cells, the like and combinations of the foregoing. Cell types that may contribute nucleic acid to circulating cell-free nucleic acid analyzed include white blood cells, endothelial cells and hepatocyte liver cells. Different cell types can be screened as part of identifying and selecting nucleic acid loci for which a marker state is the same or substantially the same for a cell type in subjects having a medical condition and for the cell type in subjects not having the medical condition, as described in further detail herein.

[0051] A particular cell type sometimes remains the same or substantially the same in subjects having a medical condition and in subjects not having a medical condition. In a non-limiting example, the number of living or viable cells of a particular cell type may be reduced in a cell degenerative condition, and the living, viable cells are not modified, or are not modified significantly, in subjects having the medical condition.

[0052] A particular cell type sometimes is modified as part of a medical condition and has one or more different properties than in its original state. In a non-limiting example, a particular cell type may proliferate at a higher than normal rate, may transform into a cell having a different morphology, may transform into a cell that expresses one or more different cell surface markers and / or may become part of a tumor, as part of a cancer condition. In aspects for which a particular cell type (i.e., a progenitor cell) is modified as part of a medical condition, the marker state for each of the one or more markers assayed often is the same or substantially the same for the particular cell type in subjects having the medical condition and for the particular cell type in subjects not having the medical condition. Thus, the term "cell type" sometimes pertains to a type of cell in subjects not having a medical condition, and to a modified version of the cell in subjects having the medical condition. A "cell type" may be a progenitor cell only and not a modified version arising from the progenitor cell. A "cell type" sometimes pertains to a progenitor cell and a modified cell arising from the progenitor cell. A marker state for a marker analyzed often may be the same or substantially the same for a cell type in subjects having a medical condition and for the cell type in subjects not having the medical condition.

[0053] A cell type may be a cancer cell. Certain cancer cell types include, for example, leukemia cells (e.g., acute myeloid leukemia, acute lymphoblastic leukemia, chronic myeloid leukemia, chronic lymphoblastic leukemia); cancerous kidney / renal cells (e.g., renal cell cancer (clear cell, papillary type 1, papillary type 2, chromophobe, oncocytic, collecting duct), renal adenocarcinoma, hypernephroma, Wilm's tumor, transitional cell carcinoma); brain tumor cells (e.g., acoustic neuroma, astrocytoma (grade I: pilocytic astrocytoma, grade II: low-grade astrocytoma, grade III: anaplastic astrocytoma, grade IV: glioblastoma (GBM)), chordoma, cns lymphoma, craniopharyngioma, glioma (brain stem glioma, ependymoma, mixed glioma, optic nerve glioma, subependymoma), medulloblastoma, meningioma, metastatic brain tumors, oligodendroglioma, pituitary tumors, primitive neuroectodermal (PNET), schwannoma, juvenile pilocytic astrocytoma (JPA), pineal tumor, rhabdoid tumor).

[0054] Different cell types can be distinguished by any suitable characteristic, including without limitation, one or more different cell surface markers, one or more different morphological features, one or more different functions, one or more different protein (e.g., histone) modifications and one or more different nucleic acid markers. Non-limiting examples of nucleic acid markers include single-nucleotide polymorphisms (SNPs), methylation state of a nucleic acid locus, short tandem repeats, insertions (e.g., micro-insertions), deletions (micro-deletions) the like and combinations thereof. Non-limiting examples of protein (e.g., histone) modifications include acetylation, methylation, ubiquitylation, phosphorylation, sumoylation, the like and combinations thereof.

[0055] As used herein, the term a "related cell type" refers to a cell type having multiple characteristics in common with another cell type. In related cell types, 75% or more cell surface markers sometimes are common to the cell types (e.g., about 80%, 85%, 90% or 95% or more of cell surface markers are common to the related cell types).Determining Nucleic Acid Content

[0056] The amount of nucleic acid (e.g., concentration, relative amount, absolute amount, copy number, and the like) in a sample may be determined. The amount of a minority nucleic acid (e.g., concentration, relative amount, absolute amount, copy number, and the like) in nucleic acid may be determined. The amount of a minority nucleic acid species in a sample may be referred to as "minority species fraction." "Minority species fraction" may refer to the fraction of a minority nucleic acid species in circulating cell-free nucleic acid in a sample (e.g., a blood sample, a serum sample, a plasma sample, a urine sample) obtained from a pregnant female or other subject.

[0057] The amount of cancer cell nucleic acid (e.g., concentration, relative amount, absolute amount, copy number, and the like) in nucleic acid may be determined. The amount of cancer cell nucleic acid in a sample may be referred to as "fraction of cancer cell nucleic acid." "Fraction of cancer cell nucleic acid" may refer to the fraction of cancer cell nucleic acid in circulating cell-free nucleic acid in a sample (e.g., a blood sample, a serum sample, a plasma sample, a urine sample) obtained from a subject. Certain methods described herein or known in the art for determining fetal fraction can be used for determining a fraction of cancer cell nucleic acid and / or a minority species fraction.

[0058] The amount of fetal nucleic acid (e.g., concentration, relative amount, absolute amount, copy number, and the like) in nucleic acid may be determined. The amount of fetal nucleic acid in a sample may be referred to as "fetal fraction." "Fetal fraction" may refer to the fraction of fetal nucleic acid in circulating cell-free nucleic acid in a sample (e.g., a blood sample, a serum sample, a plasma sample, a urine sample) obtained from a pregnant female.

[0059] The amount of fetal nucleic acid may be determined according to markers specific to a male fetus (e.g., Y-chromosome STR markers (e.g., DYS 19, DYS 385, DYS 392 markers); RhD marker in RhD-negative females), allelic ratios of polymorphic sequences, or according to one or more markers specific to fetal nucleic acid and not maternal nucleic acid (e.g., differential epigenetic biomarkers (e.g., methylation; described in further detail below) between mother and fetus, or fetal RNA markers in maternal blood plasma (see e.g., Lo, 2005, Journal of Histochemistry and Cytochemistry 53 (3): 293-296)).

[0060] Determination of fetal nucleic acid content (e.g., fetal fraction) sometimes is performed using a fetal quantifier assay (FQA) as described, for example, in U.S. Patent Application Publication No. 2010 / 0105049. This type of assay allows for the detection and quantification of fetal nucleic acid in a maternal sample based on the methylation status of the nucleic acid in the sample. The amount of fetal nucleic acid from a maternal sample can be determined relative to the total amount of nucleic acid present, thereby providing the percentage of fetal nucleic acid in the sample. The copy number of fetal nucleic acid can be determined in a maternal sample. The amount of fetal nucleic acid can be determined in a sequence-specific (or portion-specific) manner and sometimes with sufficient sensitivity to allow for accurate chromosomal dosage analysis (for example, to detect the presence or absence of a fetal aneuploidy, microduplication or microdeletion).

[0061] A fetal quantifier assay (FQA) can be performed in conjunction with any of the methods described herein. Such an assay can be performed by any method known in the art and / or described in U.S. Patent Application Publication No. 2010 / 0105049, such as, for example, by a method that can distinguish between maternal and fetal DNA based on differential methylation status, and quantify (i.e. determine the amount of) the fetal DNA. Methods for differentiating nucleic acid based on methylation status include, but are not limited to, methylation sensitive capture, for example, using a MBD2-Fc fragment in which the methyl binding domain of MBD2 is fused to the Fc fragment of an antibody (MBD-FC) (Gebhard et al. (2006) Cancer Res. 66(12):6118-28); methylation specific antibodies; bisulfite conversion methods, for example, MSP (methylation-sensitive PCR), COBRA, methylation-sensitive single nucleotide primer extension (Ms-SNuPE) or Sequenom MassCLEAVE ™< technology; and the use of methylation sensitive restriction enzymes (e.g., digestion of maternal DNA in a maternal sample using one or more methylation sensitive restriction enzymes thereby enriching the fetal DNA). Methyl-sensitive enzymes also can be used to differentiate nucleic acid based on methylation status, which, for example, can preferentially or substantially cleave or digest at their DNA recognition sequence if the latter is non-methylated. Thus, an unmethylated DNA sample will be cut into smaller fragments than a methylated DNA sample and a hypermethylated DNA sample will not be cleaved. Except where explicitly stated, any method for differentiating nucleic acid based on methylation status can be used with the compositions and methods of the technology herein. The amount of fetal DNA can be determined, for example, by introducing one or more competitors at known concentrations during an amplification reaction. Determining the amount of fetal DNA also can be done, for example, by RT-PCR, primer extension, sequencing and / or counting. In certain instances, the amount of nucleic acid can be determined using BEAMing technology as described in U.S. Patent Application Publication No. 2007 / 0065823. The restriction efficiency can be determined and the efficiency rate may be used to further determine the amount of fetal DNA.

[0062] A fetal quantifier assay (FQA) can be used to determine the concentration of fetal DNA in a maternal sample, for example, by the following method: a) determine the total amount of DNA present in a maternal sample; b) selectively digest the maternal DNA in a maternal sample using one or more methylation sensitive restriction enzymes thereby enriching the fetal DNA; c) determine the amount of fetal DNA from step b); and d) compare the amount of fetal DNA from step c) to the total amount of DNA from step a), thereby determining the concentration of fetal DNA in the maternal sample. The absolute copy number of fetal nucleic acid in a maternal sample can be determined, for example, using mass spectrometry and / or a system that uses a competitive PCR approach for absolute copy number measurements. See for example, Ding and Cantor (2003) Proc.Natl.Acad.Sci. USA 100:3059-3064, and U.S. Patent Application Publication No. 2004 / 0081993.

[0063] Fetal fraction can be determined based on allelic ratios of polymorphic sequences (e.g., single nucleotide polymorphisms (SNPs)), such as, for example, using a method described in U.S. Patent Application Publication No. 2011 / 0224087. In such a method, nucleotide sequence reads are obtained for a maternal sample and fetal fraction is determined by comparing the total number of nucleotide sequence reads that map to a first allele and the total number of nucleotide sequence reads that map to a second allele at an informative polymorphic site (e.g., SNP) in a reference genome. Fetal alleles may be identified, for example, by their relative minor contribution to the mixture of fetal and maternal nucleic acids in the sample when compared to the major contribution to the mixture by the maternal nucleic acids. Accordingly, the relative abundance of fetal nucleic acid in a maternal sample can be determined as a parameter of the total number of unique sequence reads mapped to a target nucleic acid sequence on a reference genome for each of the two alleles of a polymorphic site.

[0064] Fetal fraction can be determined using methods that incorporate information derived from maternal chromosomal aberrations as described, for example, in International Application Publication No. WO2014 / 055774. Fetal fraction can be determined using methods that incorporate information derived from sex chromosomes as described, for example, in U.S. Patent Application Publication No. US 2013-0288244.

[0065] Fetal fraction can be determined using methods that incorporate fragment length information (e.g., fragment length ratio (FLR) analysis, fetal ratio statistic (FRS) analysis as described in International Application Publication No. WO2013 / 177086). Cell-free fetal nucleic acid fragments generally are shorter than maternally-derived nucleic acid fragments (see e.g., Chan et al. (2004) Clin. Chem. 50:88-92; Lo et al. (2010) Sci. Transl. Med. 2:61ra91). Thus, fetal fraction can be determined by counting fragments under a particular length threshold and comparing the counts, for example, to counts from fragments over a particular length threshold and / or to the amount of total nucleic acid in the sample. Methods for counting nucleic acid fragments of a particular length are described in further detail in International Application Publication No. WO2013 / 177086.

[0066] Fetal fraction can be determined according to portion-specific fetal fraction estimates (e.g., as described in International Application Publication No. WO 2014 / 205401). Without being limited to theory, the amount of reads from fetal CCF fragments (e.g., fragments of a particular length, or range of lengths) often map with ranging frequencies to portions (e.g., within the same sample, e.g., within the same sequencing run). Also, without being limited to theory, certain portions, when compared among multiple samples, tend to have a similar representation of reads from fetal CCF fragments (e.g., fragments of a particular length, or range of lengths), and that the representation correlates with portion-specific fetal fractions (e.g., the relative amount, percentage or ratio of CCF fragments originating from a fetus).

[0067] Portion-specific fetal fraction estimates may be determined based in part on portion-specific parameters and their relation to fetal fraction. Portion-specific parameters can be any suitable parameter that is reflective of (e.g., correlates with) the amount or proportion of reads from CCF fragment lengths of a particular size (e.g., size range) in a portion. A portion-specific parameter can be an average, mean or median of portion-specific parameters determined for multiple samples. Any suitable portion-specific parameter can be used. Non-limiting examples of portion-specific parameters include FLR (e.g., FRS), an amount of reads having a length less than a selected fragment length, genomic coverage (i.e., coverage), mappability, counts (e.g., counts of sequence reads mapped to the portion, e.g., normalized counts, PERUN normalized counts, ChAl normalized counts), DNasel-sensitivity, methylation state, acetylation, histone distribution, guanine-cytosine (GC) content, chromatin structure, the like or combinations thereof. A portion-specific parameter can be any suitable parameter that correlates with FLR and / or FRS in a portion-specific manner. Some or all portion-specific parameters may be a direct or indirect representation of an FLR for a portion. A portion-specific parameter is not guanine-cytosine (GC) content.

[0068] A portion-specific parameter may be any suitable value representing, correlated with or proportional to an amount of reads from CCF fragments where the reads mapped to a portion have a length less than a selected fragment length. A portion-specific parameter may be a representation of the amount of reads derived from relatively short CCF fragments (e.g., about 200 base pairs or less) that map to a portion. CCF fragments having a length less than a selected fragment length often are relatively short CCF fragments, and sometimes a selected fragment length is about 200 base pairs or less (e.g., CCF fragments that are about 190, 180, 170, 160, 150, 140, 130, 120, 110, 100, 90, 80, 70, 60 or 50 bases in length). The length of a CCF fragment or a read derived from a CCF fragment can be determined (e.g., deduced or inferred) by any suitable method (e.g., a sequencing method, a hybridization approach). The length of a CCF fragment may be determined (e.g., deduced or inferred) by a read obtained from a paired end sequencing method. The length of a CCF fragment template may be determined directly from the length of a read derived from the CCF fragment (e.g., single-end read).

[0069] Portion-specific parameters can be weighted or adjusted by one or more weighting factors. Weighted or adjusted portion-specific parameters can provide portion-specific fetal fraction estimates for a sample (e.g., a test sample). Weighting or adjusting may generally convert the counts of a portion (e.g., reads mapped to a portion) or another portion-specific parameter into a portion-specific fetal fraction estimate, and such a conversion sometimes may be considered a transformation.

[0070] A weighting factor may be a coefficient or constant that, in part, describes and / or defines a relation between a fetal fraction (e.g., a fetal fraction determined from multiple samples) and a portion-specific parameter for multiple samples (e.g., a training set). A weighting factor may be determined according to a relation for multiple fetal fraction determinations and multiple portion-specific parameters. A relation may be defined by one or more weighting factors and one or more weighting factors may be determined from a relation. A weighting factor (e.g., one or more weighting factors) may be determined from a fitted relation for a portion according to (i) a fraction of fetal nucleic acid determined for each of multiple samples, and (ii) a portion-specific parameter for multiple samples.

[0071] A weighting factor can be any suitable coefficient, estimated coefficient or constant derived from a suitable relation (e.g., a suitable mathematical relation, an algebraic relation, a fitted relation, a regression, a regression analysis, a regression model). A weighting factor can be determined according to, derived from, or estimated from a suitable relation. Weighting factors may be estimated coefficients from a fitted relation. Fitting a relation for multiple samples is sometimes referred to as training a model. Any suitable model and / or method of fitting a relationship (e.g., training a model to a training set) can be used. Non-limiting examples of a suitable model that can be used include a regression model, linear regression model, simple regression model, ordinary least squares regression model, multiple regression model, general multiple regression model, polynomial regression model, general linear model, generalized linear model, discrete choice regression model, logistic regression model, multinomial logit model, mixed logit model, probit model, multinomial probit model, ordered logit model, ordered probit model, Poisson model, multivariate response regression model, multilevel model, fixed effects model, random effects model, mixed model, nonlinear regression model, nonparametric model, semiparametric model, robust model, quantile model, isotonic model, principal components model, least angle model, local model, segmented model, and errors-in-variables model. A fitted relation may not be a regression model. A fitted relation may be chosen from a decision tree model, support-vector machine model and neural network model. The result of training a model (e.g., a regression model, a relation) is often a relation that can be described mathematically where the relation comprises one or more coefficients (e.g., weighting factors). More complex multivariate models may determine one, two, three or more weighting factors. A model may be trained according to fetal fraction and two or more portion-specific parameters (e.g., coefficients) obtained from multiple samples (e.g., fitted relationships fitted to multiple samples, e.g., by a matrix).

[0072] A weighting factor can be derived from a suitable relation (e.g., a suitable mathematical relation, an algebraic relation, a fitted relation, a regression, a regression analysis, a regression model) by a suitable method. Fitted relations may be fitted by an estimation, non-limiting examples of which include least squares, ordinary least squares, linear, partial, total, generalized, weighted, nonlinear, iteratively reweighted, ridge regression, least absolute deviations, Bayesian, Bayesian multivariate, reduced-rank, LASSO, Weighted Rank Selection Criteria (WRSC), Rank Selection Criteria (RSC), an elastic net estimator (e.g., an elastic net regression) and combinations thereof.

[0073] A weighting factor can be determined for or associated with any suitable portion of a genome. A weighting factor can be determined for or associated with any suitable portion of any suitable chromosome. A weighting factor may be determined for or associated with some or all portions in a genome. A weighting factor may be determined for or associated with portions of some or all chromosomes in a genome. A weighting factor is sometimes determined for or associated with portions of selected chromosomes. A weighting factor can be determined for or associated with portions of one or more autosomes. A weighting factor can be determined for or associated with portions in a plurality of portions that include portions in autosomes or a subset thereof. A weighting factor may be determined for or associated with portions of a sex chromosome (e.g. ChrX and / or ChrY). A weighting factor can be determined for or associated with portions of one or more autosomes and one or more sex chromosomes. A weighting factor may be determined for or associated with portions in a plurality of portions in all autosomes and chromosomes X and Y. A weighting factor can be determined for or associated with portions in a plurality of portions that does not include portions in an X and / or Y chromosome. A weighting factor may be determined for or associated with portions of a chromosome where the chromosome comprises an aneuploidy (e.g., a whole chromosome aneuploidy). A weighting factor may be determined for or associated only with portions of a chromosome where the chromosome is not aneuploid (e.g., a euploid chromosome). A weighting factor can be determined for or associated with portions in a plurality of portions that does not include portions in chromosomes 13, 18 and / or 21.

[0074] A weighting factor may be determined for a portion according to one or more samples (e.g., a training set of samples). Weighting factors are often specific to a portion. One or more weighting factors may be independently assigned to a portion. A weighting factor may be determined according to a relation for a fetal fraction determination (e.g., a sample specific fetal fraction determination) for multiple samples and a portion-specific parameter determined according to multiple samples. Weighting factors are often determined from multiple samples, for example, from about 20 to about 100,000 or more, from about 100 to about 100,000 or more, from about 500 to about 100,000 or more, from about 1000 to about 100,000 or more, or from about 10,000 to about 100,000 or more samples. Weighting factors can be determined from samples that are euploid (e.g., samples from subjects comprising a euploid fetus, e.g., samples where no aneuploid chromosome is present). Weighting factors may be obtained from samples comprising an aneuploid chromosome (e.g., samples from subjects comprising a euploid fetus). Weighting factors may be determined from multiple samples from subjects having a euploid fetus and from subjects having a trisomy fetus. Weighting factors can be derived from multiple samples where the samples are from subjects having a male fetus and / or a female fetus.

[0075] A fetal fraction is often determined for one or more samples of a training set from which a weighting factor is derived. A fetal fraction from which a weighting factor is determined is sometimes a sample specific fetal fraction determination. A fetal fraction from which a weighting factor is determined can be determined by any suitable method described herein or known in the art. A determination of fetal nucleic acid content (e.g., fetal fraction) may be performed using a suitable fetal quantifier assay (FQA) described herein or known in the art, non-limiting examples of which include fetal fraction determinations according to markers specific to a male fetus, based on allelic ratios of polymorphic sequences, according to one or more markers specific to fetal nucleic acid and not maternal nucleic acid, by use of methylation-based DNA discrimination (e.g., A. Nygren, et al., (2010) Clinical Chemistry 56(10):1627-1635), by a mass spectrometry method and / or a system that uses a competitive PCR approach, by a method described in U.S. Patent Application Publication No. 2010 / 0105049, the like or combinations thereof. Often a fetal fraction is determined, in part, according to a level (e.g., one or more genomic section levels, a level of a profile) of a Y chromosome. A fetal fraction may be determined according to a suitable assay of a Y chromosome (e.g., by comparing the amount of fetal-specific locus (such as the SRY locus on chromosome Y in male pregnancies) to that of a locus on any autosome that is common to both the mother and the fetus by using quantitative real-time PCR (e.g., Lo YM, et al. (1998) Am J Hum Genet 62:768-775).

[0076] Portion-specific parameters (e.g., for a test sample) can be weighted or adjusted by one or more weighting factors (e.g., weighting factors derived from a training set). For example, a weighting factor can be derived for a portion according to a relation of a portion-specific parameter and a fetal fraction determination for a training set of multiple samples. A portion-specific parameter of a test sample can then be adjusted and / or weighted according to the weighting factor derived from the training set. AS portion-specific parameter from which a weighting factor is derived, may be the same as the portion-specific parameter (e.g., of a test sample) that is adjusted or weighted (e.g., both parameters are an FLR). A portion-specific parameter, from which a weighting factor is derived, may be different than the portion-specific parameter (e.g., of a test sample) that is adjusted or weighted. For example, a weighting factor may be determined from a relation between coverage (i.e., a portion-specific parameter) and fetal fraction for a training set of samples, and an FLR (i.e., another portion-specific parameter) for a portion of a test sample can be adjusted according to the weighting factor derived from coverage. Without being limited by theory, a portion-specific parameter (e.g., for a test sample) can sometimes be adjusted and / or weighted by a weighting factor derived from a different portion-specific parameter (e.g., of a training set) due to a relation and / or correlation between each portion-specific parameter and a common portion-specific FLR.

[0077] A portion-specific fetal fraction estimate can be determined for a sample (e.g., a test sample) by weighting a portion-specific parameter by a weighting factor determined for that portion. Weighting can comprise adjusting, converting and / or transforming a portion-specific parameter according to a weighting factor by applying any suitable mathematical manipulation, non-limiting examples of which include multiplication, division, addition, subtraction, integration, symbolic computation, algebraic computation, algorithm, trigonometric or geometric function, transformation (e.g., a Fourier transform), the like or combinations thereof. Weighting can comprise adjusting, converting and / or transforming a portion-specific parameter according to a weighting factor a suitable mathematical model.

[0078] A fetal fraction may be determined for a sample according to one or more portion-specific fetal fraction estimates. A fetal fraction may be determined (e.g., estimated) for a sample (e.g., a test sample) according to weighting or adjusting a portion-specific parameter for one or more portions. A fraction of fetal nucleic acid for a test sample may be estimated based on adjusted counts or an adjusted subset of counts. A fraction of fetal nucleic acid for a test sample may be estimated based on an adjusted FLR, an adjusted FRS, adjusted coverage, and / or adjusted mappability for a portion. About 1 to about 500,000, about 100 to about 300,000, about 500 to about 200,000, about 1000 to about 200,000, about 1500 to about 200,000, or about 1500 to about 50,000 portion-specific parameters may be weighted or adjusted.

[0079] A fetal fraction (e.g., for a test sample) can be determined according to multiple portion-specific fetal fraction estimates (e.g., for the same test sample) by any suitable method. A method for increasing the accuracy of the estimation of a fraction of fetal nucleic acid in a test sample from a pregnant female may comprise determining one or more portion-specific fetal fraction estimates where the estimate of fetal fraction for the sample may be determined according to the one or more portion-specific fetal fraction estimates. Estimating or determining a fraction of fetal nucleic acid for a sample (e.g., a test sample) may comprise summing one or more portion-specific fetal fraction estimates. Summing can comprise determining an average, mean, median, AUC, or integral value according to multiple portion-specific fetal fraction estimates.

[0080] A method for increasing the accuracy of the estimation of a fraction of fetal nucleic acid in a test sample from a pregnant female, may comprise obtaining counts of sequence reads mapped to portions of a reference genome, which sequence reads may be reads of circulating cell-free nucleic acid from a test sample from a pregnant female, where at least a subset of the counts obtained are derived from a region of the genome that contributes a greater number of counts derived from fetal nucleic acid relative to total counts from the region than counts of fetal nucleic acid relative to total counts of another region of the genome. An estimate of the fraction of fetal nucleic acid may be determined according to a subset of the portions, where the subset of the portions may be selected according to portions to which are mapped a greater number of counts derived from fetal nucleic acid than counts of fetal nucleic acid of another portion. The subset of the portions may be selected according to portions to which may be mapped a greater number of counts derived from fetal nucleic acid, relative to non-fetal nucleic acid, than counts of fetal nucleic acid, relative to non-fetal nucleic acid, of another portion. The counts mapped to all or a subset of the portions can be weighted, thereby providing weighted counts. The weighted counts can be utilized for estimating the fraction of fetal nucleic acid, and the counts can be weighted according to portions to which are mapped a greater number of counts derived from fetal nucleic acid than counts of fetal nucleic acid of another portion. The counts may be weighted according to portions to which may be mapped a greater number of counts derived from fetal nucleic acid, relative to non-fetal nucleic acid, than counts of fetal nucleic acid, relative to non-fetal nucleic acid, of another portion.

[0081] A fetal fraction can be determined for a sample (e.g., a test sample) according to multiple portion-specific fetal fraction estimates for the sample where the portions-specific estimates are from portions of any suitable region or segment of a genome. Portion-specific fetal fraction estimates can be determined for one or more portions of a suitable chromosome (e.g., one or more selected chromosomes, one or more autosomes, a sex chromosome (e.g. ChrX and / or ChrY), an aneuploid chromosome, a euploid chromosome, the like or combinations thereof).

[0082] Determining fetal fraction may comprise (a) obtaining counts of sequence reads mapped to portions of a reference genome, which sequence reads are reads of circulating cell-free nucleic acid from a test sample from a pregnant female; (b) weighting, using a microprocessor, (i) the counts of the sequence reads mapped to each portion, or (ii) other portion-specific parameter, to a portion-specific fraction of fetal nucleic acid according to a weighting factor independently associated with each portion, thereby providing portion-specific fetal fraction estimates according to the weighting factors, where each of the weighting factors have been determined from a fitted relation for each portion between (i) a fraction of fetal nucleic acid for each of multiple samples, and (ii) counts of sequence reads mapped to each portion, or other portion-specific parameter, for the multiple samples; and (c) estimating a fraction of fetal nucleic acid for the test sample based on the portion-specific fetal fraction estimates.

[0083] The amount of fetal nucleic acid in extracellular nucleic acid can be quantified and used in conjunction with a method provided herein. Thus, methods of the technology described herein may comprise an additional step of determining the amount of fetal nucleic acid. The amount of fetal nucleic acid can be determined in a nucleic acid sample from a subject before or after processing to prepare sample nucleic acid. The amount of fetal nucleic acid may be determined in a sample after sample nucleic acid is processed and prepared, which amount is utilized for further assessment. An outcome may comprise factoring the fraction of fetal nucleic acid in the sample nucleic acid (e.g., adjusting counts, removing samples, making a call or not making a call).

[0084] The determination step can be performed before, during, at any one point in a method described herein, or after certain (e.g., aneuploidy detection, microduplication or microdeletion detection, fetal gender determination) methods described herein. For example, to achieve a fetal gender or aneuploidy, microduplication or microdeletion determination method with a given sensitivity or specificity, a fetal nucleic acid quantification method may be implemented prior to, during or after fetal gender or aneuploidy, microduplication or microdeletion determination to identify those samples with greater than about 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 11%, 12%, 13%, 14%,15%,16%, 17%, 18%, 19%, 20%, 21%, 22%, 23%, 24%, 25% or more fetal nucleic acid. Samples determined as having a certain threshold amount of fetal nucleic acid (e.g., about 15% or more fetal nucleic acid; about 4% or more fetal nucleic acid) may be further analyzed for fetal gender or aneuploidy, microduplication or microdeletion determination, or the presence or absence of aneuploidy or genetic variation, for example. Determinations of, for example, fetal gender or the presence or absence of aneuploidy, microduplication or microdeletion may be selected (e.g., selected and communicated to a patient) only for samples having a certain threshold amount of fetal nucleic acid (e.g., about 15% or more fetal nucleic acid; about 4% or more fetal nucleic acid).

[0085] The determination of fetal fraction or determining the amount of fetal nucleic acid may not be required or necessary for identifying the presence or absence of a chromosome aneuploidy, microduplication or microdeletion. Identifying the presence or absence of a chromosome aneuploidy, microduplication or microdeletion may not require the sequence differentiation of fetal versus maternal DNA. This may be because the summed contribution of both maternal and fetal sequences in a particular chromosome, chromosome portion or segment thereof is analyzed. Identifying the presence or absence of a chromosome aneuploidy, microduplication or microdeletion may not rely on a priori sequence information that would distinguish fetal DNA from maternal DNA.Enriching nucleic acids

[0086] Nucleic acid (e.g., extracellular nucleic acid) may be enriched or relatively enriched for a subpopulation or species of nucleic acid. Nucleic acid subpopulations can include, for example, fetal nucleic acid, maternal nucleic acid, cancer cell nucleic acid, non-cancer cell nucleic acid, nucleic acid comprising fragments of a particular length or range of lengths, or nucleic acid from a particular genome region (e.g., single chromosome, set of chromosomes, and / or certain chromosome regions). Such enriched samples can be used in conjunction with a method provided herein. Thus, methods of the technology may comprise an additional step of enriching for a subpopulation of nucleic acid in a sample, such as, for example, fetal nucleic acid or cancer cell nucleic acid. A method for determining fetal fraction described above also can be used to enrich for fetal nucleic acid or cancer cell nucleic acid. Maternal nucleic acid may be selectively removed (partially, substantially, almost completely or completely) from the sample. Enriching for a particular low copy number species nucleic acid (e.g., fetal nucleic acid, cancer cell nucleic acid) may improve quantitative sensitivity. Methods for enriching a sample for a particular species of nucleic acid are described, for example, in United States Patent No. 6,927,028, International Patent Application Publication No. WO2007 / 140417, International Patent Application Publication No. WO2007 / 147063, International Patent Application Publication No. WO2009 / 032779, International Patent Application Publication No. WO2009 / 032781, International Patent Application Publication No. WO2010 / 033639, International Patent Application Publication No. WO2011 / 034631, International Patent Application Publication No. WO2006 / 056480, International Patent Application Publication No. WO2011 / 143659, and International Patent Application Publication No. WO2008 / 045505.

[0087] Nucleic acid may be enriched for certain target fragment species and / or reference fragment species. Nucleic acid may be enriched for a specific nucleic acid fragment length or range of fragment lengths using one or more length-based separation methods described below. Nucleic acid may be enriched for fragments from a select genomic region (e.g., chromosome) using one or more sequence-based separation methods described herein and / or known in the art. Certain methods for enriching for a nucleic acid subpopulation (e.g., fetal nucleic acid) in a sample are described in detail below. Certain methods for enriching fetal nucleic acid may be used for enriching cancer cell nucleic acid.

[0088] Some methods for enriching for a nucleic acid subpopulation (e.g., fetal nucleic acid, cancer cell nucleic acid) that can be used with a method described herein include methods that exploit epigenetic differences between maternal and fetal nucleic acid or cancer cell and non-cancer cell nucleic acid. For example, fetal nucleic acid can be differentiated and separated from maternal nucleic acid based on methylation differences. Methylation-based fetal nucleic acid enrichment methods are described in U.S. Patent Application Publication No. 2010 / 0105049. Such methods sometimes involve binding a sample nucleic acid to a methylation-specific binding agent (methyl-CpG binding protein (MBD), methylation specific antibodies, and the like) and separating bound nucleic acid from unbound nucleic acid based on differential methylation status. Such methods also can include the use of methylation-sensitive restriction enzymes (as described above; e.g., Hhal and Hpall), which allow for the enrichment of fetal nucleic acid regions in a maternal sample by selectively digesting nucleic acid from the maternal sample with an enzyme that selectively and completely or substantially digests the maternal nucleic acid to enrich the sample for at least one fetal nucleic acid region.

[0089] Another method for enriching for a nucleic acid subpopulation (e.g., fetal nucleic acid) that can be used with a method described herein is a restriction endonuclease enhanced polymorphic sequence approach, such as a method described in U.S. Patent Application Publication No. 2009 / 0317818. Such methods include cleavage of nucleic acid comprising a non-target allele with a restriction endonuclease that recognizes the nucleic acid comprising the non-target allele but not the target allele; and amplification of uncleaved nucleic acid but not cleaved nucleic acid, where the uncleaved, amplified nucleic acid represents enriched target nucleic acid (e.g., fetal nucleic acid) relative to non-target nucleic acid (e.g., maternal nucleic acid). Nucleic acid may be selected such that it comprises an allele having a polymorphic site that is susceptible to selective digestion by a cleavage agent, for example.

[0090] Some methods for enriching for a nucleic acid subpopulation (e.g., fetal nucleic acid) that can be used with a method described herein include selective enzymatic degradation approaches. Such methods involve protecting target sequences from exonuclease digestion thereby facilitating the elimination in a sample of undesired sequences (e.g., maternal DNA). For example, in one approach, sample nucleic acid is denatured to generate single stranded nucleic acid, single stranded nucleic acid is contacted with at least one target-specific primer pair under suitable annealing conditions, annealed primers are extended by nucleotide polymerization generating double stranded target sequences, and digesting single stranded nucleic acid using a nuclease that digests single stranded (i.e. non-target) nucleic acid. The method can be repeated for at least one additional cycle. The same target-specific primer pair may be used to prime each of the first and second cycles of extension, and also, different target-specific primer pairs may be used for the first and second cycles.

[0091] Some methods for enriching for a nucleic acid subpopulation (e.g., fetal nucleic acid) that can be used with a method described herein include massively parallel signature sequencing (MPSS) approaches. MPSS typically is a solid phase method that uses adapter (i.e. tag) ligation, followed by adapter decoding, and reading of the nucleic acid sequence in small increments. Tagged PCR products are typically amplified such that each nucleic acid generates a PCR product with a unique tag. Tags are often used to attach the PCR products to microbeads. After several rounds of ligation-based sequence determination, for example, a sequence signature can be identified from each bead. Each signature sequence (MPSS tag) in a MPSS dataset is analyzed, compared with all other signatures, and all identical signatures are counted.

[0092] Certain enrichment methods (e.g., certain MPS and / or MPSS-based enrichment methods) can include amplification (e.g., PCR)-based approaches. Loci-specific amplification methods can be used (e.g., using loci-specific amplification primers). A multiplex SNP allele PCR approach can be used. A multiplex SNP allele PCR approach can be used in combination with uniplex sequencing. For example, such an approach can involve the use of multiplex PCR (e.g., MASSARRAY system) and incorporation of capture probe sequences into the amplicons followed by sequencing using, for example, the Illumina MPSS system. A multiplex SNP allele PCR approach can be used in combination with a three-primer system and indexed sequencing. For example, such an approach can involve the use of multiplex PCR (e.g., MASSARRAY system) with primers having a first capture probe incorporated into certain loci-specific forward PCR primers and adapter sequences incorporated into loci-specific reverse PCR primers, to thereby generate amplicons, followed by a secondary PCR to incorporate reverse capture sequences and molecular index barcodes for sequencing using, for example, the Illumina MPSS system. A multiplex SNP allele PCR approach can be used in combination with a four-primer system and indexed sequencing. For example, such an approach can involve the use of multiplex PCR (e.g., MASSARRAY system) with primers having adaptor sequences incorporated into both loci-specific forward and loci-specific reverse PCR primers, followed by a secondary PCR to incorporate both forward and reverse capture sequences and molecular index barcodes for sequencing using, for example, the Illumina MPSS system. A microfluidics approach can be used. An array-based microfluidics approach can be used. For example, such an approach can involve the use of a microfluidics array (e.g., Fluidigm) for amplification at low plex and incorporation of index and capture probes, followed by sequencing. An emulsion microfluidics approach can be used, such as, for example, digital droplet PCR.

[0093] Universal amplification methods can be used (e.g., using universal or non-loci-specific amplification primers). Universal amplification methods can be used in combination with pull-down approaches. A method can include biotinylated ultramer pull-down (e.g., biotinylated pull-down assays from Agilent or IDT) from a universally amplified sequencing library. For example, such an approach can involve preparation of a standard library, enrichment for selected regions by a pull-down assay, and a secondary universal amplification step. Pull-down approaches can be used in combination with ligation-based methods. A method can include biotinylated ultramer pull down with sequence specific adapter ligation (e.g., HALOPLEX PCR, Halo Genomics). For example, such an approach can involve the use of selector probes to capture restriction enzyme-digested fragments, followed by ligation of captured products to an adaptor, and universal amplification followed by sequencing. Pull-down approaches can be used in combination with extension and ligation-based methods. A method can include molecular inversion probe (MIP) extension and ligation. For example, such an approach can involve the use of molecular inversion probes in combination with sequence adapters followed by universal amplification and sequencing. Complementary DNA can be synthesized and sequenced without amplification.

[0094] Extension and ligation approaches can be performed without a pull-down component. A method can include loci-specific forward and reverse primer hybridization, extension and ligation. Such methods can further include universal amplification or complementary DNA synthesis without amplification, followed by sequencing. Such methods can reduce or exclude background sequences during analysis.

[0095] Pull-down approaches can be used with an optional amplification component or with no amplification component. A method can include a modified pull-down assay and ligation with full incorporation of capture probes without universal amplification. For example, such an approach can involve the use of modified selector probes to capture restriction enzyme-digested fragments, followed by ligation of captured products to an adaptor, optional amplification, and sequencing. A method can include a biotinylated pull-down assay with extension and ligation of adaptor sequence in combination with circular single stranded ligation. For example, such an approach can involve the use of selector probes to capture regions of interest (i.e. target sequences), extension of the probes, adaptor ligation, single stranded circular ligation, optional amplification, and sequencing. The analysis of the sequencing result can separate target sequences form background.

[0096] Nucleic acid may be enriched for fragments from a select genomic region (e.g., chromosome) using one or more sequence-based separation methods described herein. Sequence-based separation generally is based on nucleotide sequences present in the fragments of interest (e.g., target and / or reference fragments) and substantially not present in other fragments of the sample or present in an insubstantial amount of the other fragments (e.g., 5% or less). Sequence-based separation can generate separated target fragments and / or separated reference fragments. Separated target fragments and / or separated reference fragments often are isolated away from the remaining fragments in the nucleic acid sample. The separated target fragments and the separated reference fragments also may be isolated away from each other (e.g., isolated in separate assay compartments). The separated target fragments and the separated reference fragments may be isolated together (e.g., isolated in the same assay compartment). Unbound fragments can be differentially removed or degraded or digested.

[0097] A selective nucleic acid capture process may be used to separate target and / or reference fragments away from the nucleic acid sample. Commercially available nucleic acid capture systems include, for example, Nimblegen sequence capture system (Roche NimbleGen, Madison, WI); Illumina BEADARRAY platform (Illumina, San Diego, CA); Affymetrix GENECHIP platform (Affymetrix, Santa Clara, CA); Agilent SureSelect Target Enrichment System (Agilent Technologies, Santa Clara, CA); and related platforms. Such methods typically involve hybridization of a capture oligonucleotide to a segment or all of the nucleotide sequence of a target or reference fragment and can include use of a solid phase (e.g., solid phase array) and / or a solution based platform. Capture oligonucleotides (sometimes referred to as "bait") can be selected or designed such that they preferentially hybridize to nucleic acid fragments from selected genomic regions or loci (e.g., one of chromosomes 21, 18, 13, X or Y, or a reference chromosome). A hybridization-based method (e.g., using oligonucleotide arrays) can be used to enrich for nucleic acid sequences from certain chromosomes (e.g., a potentially aneuploid chromosome, reference chromosome or other chromosome of interest) or segments of interest thereof.

[0098] Nucleic acid may be enriched for a particular nucleic acid fragment length, range of lengths, or lengths under or over a particular threshold or cutoff using one or more length-based separation methods. Nucleic acid fragment length typically refers to the number of nucleotides in the fragment. Nucleic acid fragment length also is sometimes referred to as nucleic acid fragment size. A length-based separation method may be performed without measuring lengths of individual fragments. A length based separation method may be performed in conjunction with a method for determining length of individual fragments. Length-based separation may refer to a size fractionation procedure where all or part of the fractionated pool can be isolated (e.g., retained) and / or analyzed. Size fractionation procedures are known in the art (e.g., separation on an array, separation by a molecular sieve, separation by gel electrophoresis, separation by column chromatography (e.g., size-exclusion columns), and microfluidics-based approaches). Length-based separation approaches can include fragment circularization, chemical treatment (e.g., formaldehyde, polyethylene glycol (PEG)), mass spectrometry and / or size-specific nucleic acid amplification, for example. Length-based separation approaches can include an anion exchange method, such as, for example a method described in International Patent Application Publication No. WO2008 / 045505.

[0099] Nucleic acid fragments of a certain length, range of lengths, or lengths under or over a particular threshold or cutoff may be separated from the sample. Fragments having a length under a particular threshold or cutoff (e.g., 500 bp, 400 bp, 300 bp, 200 bp, 175 bp, 150 bp, 135 bp, 100 bp, 90 bp, 50 bp, 30 bp) may be referred to as "short" fragments and fragments having a length over a particular threshold or cutoff (e.g., 500 bp, 400 bp, 300 bp, 200 bp, 175 bp, 150 bp, 135 bp, 100 bp, 90 bp, 50 bp, 30 bp) may be referred to as "long" fragments. Fragments of a certain length, range of lengths, or lengths under or over a particular threshold or cutoff may be retained for analysis while fragments of a different length or range of lengths, or lengths over or under the threshold or cutoff may not be retained for analysis. Fragments that are less than about 500 bp may be retained. Fragments that are less than about 400 bp may be retained. Fragments that are less than about 300 bp are retained. Fragments that are less than about 200 bp may be retained. Fragments that are less than about 150 bp may be retained. For example, fragments that are less than about 190 bp, 180 bp, 175 bp, 170 bp, 160 bp, 150 bp, 140 bp, 135 bp, 130 bp, 120 bp, 110 bp, 100 bp, 90 bp, 50 bp or 30 bp are retained. Fragments that are about 100 bp to about 200 bp may be retained. For example, fragments that are about 190 bp, 180 bp, 175 bp, 170 bp, 160 bp, 150 bp, 140 bp, 135 bp, 130 bp, 120 bp or 110 bp are retained. Fragments that are in the range of about 100 bp to about 200 bp may be retained. For example, fragments that are in the range of about 110 bp to about 190 bp, 130 bp to about 180 bp, 170 bp to about 180 bp, 140 bp to about 170 bp, 130 bp to about 140 bp, 140 bp to about 150 bp, 150 bp to about 160 bp, or 145 bp to about 155 bp are retained. Fragments that are about 10 bp to about 100 bp may be retained. For example, fragments that are about 90 bp, 80 bp, 70 bp, 60 bp, 50 bp, 40 bp, 30 bp, 20 bp or 10 bp are retained. Fragments that are about 30 bp may be retained. Fragments that are in the range of about 10 bp to about 100 bp may be retained. For example, fragments that are in the range of about 10 bp to about 90 bp, 30 bp to about 80 bp, 70 bp to about 80 bp, 40 bp to about 70 bp, 20 bp to about 50 bp, 20 bp to about 40 bp, 30 bp to about 40 bp, 40 bp to about 50 bp, or 50 bp to about 60 bp are retained. Fragments that are between about 50 base pairs to about 100 base pairs may be retained. Fragments that are between about 20 base pairs to about 50 base pairs may be retained. Fragments that are more than about 500 bp may be retained. Fragments that are about 10 bp to about 30 bp shorter than other fragments of a certain length or range of lengths may be retained. Fragments that are about 10 bp to about 20 bp shorter than other fragments of a certain length or range of lengths may be retained. Fragments that are about 10 bp to about 15 bp shorter than other fragments of a certain length or range of lengths may be retained.

[0100] Nucleic acid may be enriched for a particular nucleic acid fragment length, range of lengths, or lengths under or over a particular threshold or cutoff using one or more bioinformatics-based (e.g., in silico) methods. For example, nucleotide sequence reads can be obtained for nucleic acid fragments using a suitable nucleotide sequencing process. In some instances, such as when a paired end sequencing method is used, the length of a particular fragment can be determined based on the positions of mapped sequence reads obtained from each terminus of the fragment. Sequence reads used for a particular analysis (e.g., determining the presence or absence of a genetic variation) can be enriched or filtered according to one or more selected fragment lengths or fragment length threshold values of corresponding fragments, as described herein.

[0101] As defined in the claims, bioinformatics-based enrichment methods are performed prior to or in conjunction with a method for determining the presence or absence of a chromosome aneuploidy, microduplication or microdeletion in a fetus as described herein. Additional methods, which may be used, include decision tree analysis or decision analysis, maximum entropy segmentation, log odds ratio detection, convolution with edge detection kernel, Jensen Shannon Divergence, Binary Recursive Segmentation, Fourier transform, CLuster Along Chromosomes (CLAC; see e.g., Wang et al. (2005) Biostatistics 6:45-58), median smoothing (MS) median absolute deviation (MAD) method (MSMAD; see e.g., Budinska et al. (2009) Bioinformatics 25:703-713), and the like, and combinations thereof). A method for determining the presence or absence of a chromosome aneuploidy, microduplication or microdeletion in a fetus is defined in claim 1. The selected fragment length may be between about 100 bp to about 199 bp. The selected fragment length may be between about 130 bp to about 140 bp. The selected fragment length may be between about 170 bp to about 180 bp. The selected fragment length may be about 135 bp. The selected fragment length may be about 175 bp.

[0102] Certain length-based separation methods that can be used with methods described herein employ a selective sequence tagging approach, for example. The term "sequence tagging" refers to incorporating a recognizable and distinct sequence into a nucleic acid or population of nucleic acids. The term "sequence tagging" as used herein has a different meaning than the term "sequence tag" described later herein. In such sequence tagging methods, a fragment size species (e.g., short fragments) nucleic acids are subjected to selective sequence tagging in a sample that includes long and short nucleic acids. Such methods typically involve performing a nucleic acid amplification reaction using a set of nested primers which include inner primers and outer primers. One or both of the inner can be tagged to thereby introduce a tag onto the target amplification product. The outer primers generally do not anneal to the short fragments that carry the (inner) target sequence. The inner primers can anneal to the short fragments and generate an amplification product that carries a tag and the target sequence. Typically, tagging of the long fragments is inhibited through a combination of mechanisms which include, for example, blocked extension of the inner primers by the prior annealing and extension of the outer primers. Enrichment for tagged fragments can be accomplished by any of a variety of methods, including for example, exonuclease digestion of single stranded nucleic acid and amplification of the tagged fragments using amplification primers specific for at least one tag.

[0103] Another length-based separation method that can be used with methods described herein involves subjecting a nucleic acid sample to polyethylene glycol (PEG) precipitation. Examples of methods include those described in International Patent Application Publication Nos. WO2007 / 140417 and WO2010 / 115016. This method in general entails contacting a nucleic acid sample with PEG in the presence of one or more monovalent salts under conditions sufficient to substantially precipitate large nucleic acids without substantially precipitating small (e.g., less than 300 nucleotides) nucleic acids.

[0104] Another size-based enrichment method that can be used with methods described herein involves circularization by ligation, for example, using circligase. Short nucleic acid fragments typically can be circularized with higher efficiency than long fragments. Non-circularized sequences can be separated from circularized sequences, and the enriched short fragments can be used for further analysis.Nucleic acid library

[0105] A nucleic acid library may be a plurality of polynucleotide molecules (e.g., a sample of nucleic acids) that are prepared, assemble and / or modified for a specific process, non-limiting examples of which include immobilization on a solid phase (e.g., a solid support, e.g., a flow cell, a bead), enrichment, amplification, cloning, detection and / or for nucleic acid sequencing. A nucleic acid library may be prepared prior to or during a sequencing process. A nucleic acid library (e.g., sequencing library) can be prepared by a suitable method as known in the art. A nucleic acid library can be prepared by a targeted or a non-targeted preparation process.

[0106] A library of nucleic acids may be modified to comprise a chemical moiety (e.g., a functional group) configured for immobilization of nucleic acids to a solid support. A library of nucleic acids may be modified to comprise a biomolecule (e.g., a functional group) and / or member of a binding pair configured for immobilization of the library to a solid support, non-limiting examples of which include thyroxin-binding globulin, steroid-binding proteins, antibodies, antigens, haptens, enzymes, lectins, nucleic acids, repressors, protein A, protein G, avidin, streptavidin, biotin, complement component C1q, nucleic acid-binding proteins, receptors, carbohydrates, oligonucleotides, polynucleotides, complementary nucleic acid sequences, the like and combinations thereof. Some examples of specific binding pairs include, without limitation: an avidin moiety and a biotin moiety; an antigenic epitope and an antibody or immunologically reactive fragment thereof; an antibody and a hapten; a digoxigen moiety and an anti-digoxigen antibody; a fluorescein moiety and an anti-fluorescein antibody; an operator and a repressor; a nuclease and a nucleotide; a lectin and a polysaccharide; a steroid and a steroid-binding protein; an active compound and an active compound receptor; a hormone and a hormone receptor; an enzyme and a substrate; an immunoglobulin and protein A; an oligonucleotide or polynucleotide and its corresponding complement; the like or combinations thereof.

[0107] A library of nucleic acids may be modified to comprise one or more polynucleotides of known composition, non-limiting examples of which include an identifier (e.g., a tag, an indexing tag), a capture sequence, a label, an adapter, a restriction enzyme site, a promoter, an enhancer, an origin of replication, a stem loop, a complimentary sequence (e.g., a primer binding site, an annealing site), a suitable integration site (e.g., a transposon, a viral integration site), a modified nucleotide, the like or combinations thereof. Polynucleotides of known sequence can be added at a suitable position, for example on the 5' end, 3' end or within a nucleic acid sequence. Polynucleotides of known sequence can be the same or different sequences. A polynucleotide of known sequence may be configured to hybridize to one or more oligonucleotides immobilized on a surface (e.g., a surface in flow cell). For example, a nucleic acid molecule comprising a 5' known sequence may hybridize to a first plurality of oligonucleotides while the 3' known sequence may hybridize to a second plurality of oligonucleotides. A library of nucleic acid can comprise chromosome-specific tags, capture sequences, labels and / or adaptors. A library of nucleic acids may comprise one or more detectable labels. One or more detectable labels may be incorporated into a nucleic acid library at a 5' end, at a 3' end, and / or at any nucleotide position within a nucleic acid in the library. A library of nucleic acids may comprise hybridized oligonucleotides. Hybridized oligonucleotides may be labeled probes. A library of nucleic acids may comprise hybridized oligonucleotide probes prior to immobilization on a solid phase.

[0108] A polynucleotide of known sequence may comprise a universal sequence. A universal sequence is a specific nucleotide acid sequence that is integrated into two or more nucleic acid molecules or two or more subsets of nucleic acid molecules where the universal sequence is the same for all molecules or subsets of molecules that it is integrated into. A universal sequence is often designed to hybridize to and / or amplify a plurality of different sequences using a single universal primer that is complementary to a universal sequence. Two (e.g., a pair) or more universal sequences and / or universal primers may be used. A universal primer often comprises a universal sequence. Adapters (e.g., universal adapters) may comprise universal sequences. One or more universal sequences may be used to capture, identify and / or detect multiple species or subsets of nucleic acids.

[0109] In certain aspects of preparing a nucleic acid library, (e.g., in certain sequencing by synthesis procedures), nucleic acids are size selected and / or fragmented into lengths of several hundred base pairs, or less (e.g., in preparation for library generation). Library preparation may be performed without fragmentation (e.g., when using ccfDNA).

[0110] A ligation-based library preparation method may be used (e.g., ILLUMINA TRUSEQ, Illumina, San Diego CA). Ligation-based library preparation methods often make use of an adaptor (e.g., a methylated adaptor) design which can incorporate an index sequence at the initial ligation step and often can be used to prepare samples for single-read sequencing, paired end sequencing and multiplexed sequencing. For example, sometimes nucleic acids (e.g., fragmented nucleic acids or ccfDNA) are end repaired by a fill-in reaction, an exonuclease reaction or a combination thereof. The resulting blunt-end repaired nucleic acid can then be extended by a single nucleotide, which is complementary to a single nucleotide overhang on the 3' end of an adapter / primer. Any nucleotide can be used for the extension / overhang nucleotides. Nucleic acid library preparation may comprise ligating an adapter oligonucleotide. Adapter oligonucleotides are often complementary to flow-cell anchors, and sometimes are utilized to immobilize a nucleic acid library to a solid support, such as the inside surface of a flow cell, for example. An adapter oligonucleotide may comprise an identifier, one or more sequencing primer hybridization sites (e.g., sequences complementary to universal sequencing primers, single end sequencing primers, paired end sequencing primers, multiplexed sequencing primers, and the like), or combinations thereof (e.g., adapter / sequencing, adapter / identifier, adapter / identifier / sequencing).

[0111] An identifier can be a suitable detectable label incorporated into or attached to a nucleic acid (e.g., a polynucleotide) that allows detection and / or identification of nucleic acids that comprise the identifier. An identifier may be incorporated into or attached to a nucleic acid during a sequencing method (e.g., by a polymerase). Non-limiting examples of identifiers include nucleic acid tags, nucleic acid indexes or barcodes, a radiolabel (e.g., an isotope), metallic label, a fluorescent label, a chemiluminescent label, a phosphorescent label, a fluorophore quencher, a dye, a protein (e.g., an enzyme, an antibody or part thereof, a linker, a member of a binding pair), the like or combinations thereof. An identifier (e.g., a nucleic acid index or barcode) may be a unique, known and / or identifiable sequence of nucleotides or nucleotide analogues. Identifiers may be six or more contiguous nucleotides. A multitude of fluorophores are available with a variety of different excitation and emission spectra. Any suitable type and / or number of fluorophores can be used as an identifier. 1 or more, 2 or more, 3 or more, 4 or more, 5 or more, 6 or more, 7 or more, 8 or more, 9 or more, 10 or more, 20 or more, 30 or more or 50 or more different identifiers may be utilized in a method described herein (e.g., a nucleic acid detection and / or sequencing method). One or two types of identifiers (e.g., fluorescent labels) may be linked to each nucleic acid in a library. Detection and / or quantification of an identifier can be performed by a suitable method or apparatus, non-limiting examples of which include flow cytometry, quantitative polymerase chain reaction (qPCR), gel electrophoresis, a luminometer, a fluorometer, a spectrophotometer, a suitable gene-chip or microarray analysis, Western blot, mass spectrometry, chromatography, cytofluorimetric analysis, fluorescence microscopy, a suitable fluorescence or digital imaging method, confocal laser scanning microscopy, laser scanning cytometry, affinity chromatography, manual batch mode separation, electric field suspension, a suitable nucleic acid sequencing method and / or nucleic acid sequencing apparatus, the like and combinations thereof.

[0112] A transposon-based library preparation method may be used (e.g., EPICENTRE NEXTERA, Epicentre, Madison WI). Transposon-based methods typically use in vitro transposition to simultaneously fragment and tag DNA in a single-tube reaction (often allowing incorporation of platform-specific tags and optional barcodes), and prepare sequencer-ready libraries.

[0113] A nucleic acid library or parts thereof may be amplified (e.g., amplified by a PCR-based method). A sequencing method may comprise amplification of a nucleic acid library. A nucleic acid library can be amplified prior to or after immobilization on a solid support (e.g., a solid support in a flow cell). Nucleic acid amplification includes the process of amplifying or increasing the numbers of a nucleic acid template and / or of a complement thereof that are present (e.g., in a nucleic acid library), by producing one or more copies of the template and / or its complement. Amplification can be carried out by a suitable method. A nucleic acid library can be amplified by a thermocycling method or by an isothermal amplification method. A rolling circle amplification method may be used. Amplification may take place on a solid support (e.g., within a flow cell) where a nucleic acid library or portion thereof is immobilized. In certain sequencing methods, a nucleic acid library is added to a flow cell and immobilized by hybridization to anchors under suitable conditions. This type of nucleic acid amplification is often referred to as solid phase amplification. In some aspects of solid phase amplification, all or a portion of the amplified products are synthesized by an extension initiating from an immobilized primer. Solid phase amplification reactions are analogous to standard solution phase amplifications except that at least one of the amplification oligonucleotides (e.g., primers) is immobilized on a solid support.

[0114] Solid phase amplification may comprise a nucleic acid amplification reaction comprising only one species of oligonucleotide primer immobilized to a surface. Solid phase amplification may comprise a plurality of different immobilized oligonucleotide primer species. Solid phase amplification may comprise a nucleic acid amplification reaction comprising one species of oligonucleotide primer immobilized on a solid surface and a second different oligonucleotide primer species in solution. Multiple different species of immobilized or solution based primers can be used. Non-limiting examples of solid phase nucleic acid amplification reactions include interfacial amplification, bridge amplification, emulsion PCR, WildFire amplification (e.g., US patent publication US20130012399), the like or combinations thereof.Sequencing

[0115] Nucleic acids (e.g., nucleic acid fragments, sample nucleic acid, cell-free nucleic acid) may be sequenced. A full or substantially full sequence may be obtained and sometimes a partial sequence is obtained.

[0116] Fragment length may be determined using a sequencing method. Fragment length may be determined using a paired end sequencing platform. Such platforms involve sequencing of both ends of a nucleic acid fragment. Generally, the sequences corresponding to both ends of the fragment can be mapped to a reference genome (e.g., a reference human genome). Both ends may be sequenced at a read length that is sufficient to map, individually for each fragment end, to a reference genome. Examples of paired end sequence read lengths are described below. All or a portion of the sequence reads can be mapped to a reference genome without mismatch. Each read may be mapped independently. Information from both sequence reads (i.e., from each end) may be factored in the mapping process. The length of a fragment can be determined, for example, by calculating the difference between genomic coordinates assigned to each mapped paired end read.

[0117] Fragment length can be determined using a sequencing process whereby a complete, or substantially complete, nucleotide sequence is obtained for the fragment. Such sequencing processes include platforms that generate relatively long read lengths (e.g., Roche 454, Ion Torrent, single molecule (Pacific Biosciences), real-time SMRT technology, and the like).

[0118] Some or all nucleic acids in a sample may be enriched and / or amplified (e.g., non-specifically, e.g., by a PCR based method) prior to or during sequencing. Specific nucleic acid portions or subsets in a sample may be enriched and / or amplified prior to or during sequencing. A portion or subset of a pre-selected pool of nucleic acids may be sequenced randomly. Nucleic acids in a sample may not be enriched and / or amplified prior to or during sequencing.

[0119] As used herein, "reads" (i.e., "a read", "a sequence read") are short nucleotide sequences produced by any sequencing process described herein or known in the art. Reads can be generated from one end of nucleic acid fragments ("single-end reads"), and sometimes are generated from both ends of nucleic acids (e.g., paired end reads, double-end reads).

[0120] The length of a sequence read is often associated with the particular sequencing technology. High-throughput methods, for example, provide sequence reads that can vary in size from tens to hundreds of base pairs (bp). Nanopore sequencing, for example, can provide sequence reads that can vary in size from tens to hundreds to thousands of base pairs. Sequence reads may be of a mean, median, average or absolute length of about 15 bp to about 900 bp long. Sequence reads may be of a mean, median, average or absolute length about 1000 bp or more.

[0121] The nominal, average, mean or absolute length of single-end reads sometimes may be about 15 contiguous nucleotides to about 50 or more contiguous nucleotides, about 15 contiguous nucleotides to about 40 or more contiguous nucleotides, and sometimes about 15 contiguous nucleotides or about 36 or more contiguous nucleotides. The nominal, average, mean or absolute length of single-end reads may be about 20 to about 30 bases, or about 24 to about 28 bases in length. The nominal, average, mean or absolute length of single-end reads may be about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 21, 22, 23, 24, 25, 26, 27, 28 or about 29 bases or more in length.

[0122] The nominal, average, mean or absolute length of paired end reads sometimes may be about 10 contiguous nucleotides to about 25 contiguous nucleotides or more (e.g., about 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24 or 25 nucleotides in length or more), about 15 contiguous nucleotides to about 20 contiguous nucleotides or more, and sometimes is about 17 contiguous nucleotides, about 18 contiguous nucleotides, about 20 contiguous nucleotides, about 25 contiguous nucleotides, about 36 contiguous nucleotides or about 45 contiguous nucleotides.

[0123] Reads generally are representations of nucleotide sequences in a physical nucleic acid. For example, in a read containing an ATGC depiction of a sequence, "A" represents an adenine nucleotide, "T" represents a thymine nucleotide, "G" represents a guanine nucleotide and "C" represents a cytosine nucleotide, in a physical nucleic acid. Sequence reads obtained from the blood of a pregnant female can be reads from a mixture of fetal and maternal nucleic acid. A mixture of relatively short reads can be transformed by processes described herein into a representation of a genomic nucleic acid present in the pregnant female and / or in the fetus. A mixture of relatively short reads can be transformed into a representation of a copy number variation (e.g., a maternal and / or fetal copy number variation), genetic variation or an aneuploidy, microduplication or microdeletion, for example. Reads of a mixture of maternal and fetal nucleic acid can be transformed into a representation of a composite chromosome or a segment thereof comprising features of one or both maternal and fetal chromosomes. "Obtaining" nucleic acid sequence reads of a sample from a subject and / or "obtaining" nucleic acid sequence reads of a biological specimen from one or more reference persons can involve directly sequencing nucleic acid to obtain the sequence information. "Obtaining" can involve receiving sequence information obtained directly from a nucleic acid by another.

[0124] A representative fraction of a genome may be sequenced and is sometimes referred to as "coverage" or "fold coverage". For example, a 1-fold coverage indicates that roughly 100% of the nucleotide sequences of the genome are represented by reads. "Fold coverage" may be a relative term referring to a prior sequencing run as a reference. For example, a second sequencing run may have 2-fold less coverage than a first sequencing run. A genome may be sequenced with redundancy, where a given region of the genome can be covered by two or more reads or overlapping reads (e.g., a "fold coverage" greater than 1, e.g., a 2-fold coverage).

[0125] One nucleic acid sample from one individual may be sequenced. Nucleic acids from each of two or more samples may be sequenced, where samples are from one individual or from different individuals. Nucleic acid samples from two or more biological samples may be pooled, where each biological sample is from one individual or two or more individuals, and the pool is sequenced. In the latter case, a nucleic acid sample from each biological sample often is identified by one or more unique identifiers.

[0126] A sequencing method may utilize identifiers that allow multiplexing of sequence reactions in a sequencing process. The greater the number of unique identifiers, the greater the number of samples and / or chromosomes for detection, for example, that can be multiplexed in a sequencing process. A sequencing process can be performed using any suitable number of unique identifiers (e.g., 4, 8, 12, 24, 48, 96, or more).

[0127] A sequencing process sometimes makes use of a solid phase, and sometimes the solid phase comprises a flow cell on which nucleic acid from a library can be attached and reagents can be flowed and contacted with the attached nucleic acid. A flow cell sometimes includes flow cell lanes, and use of identifiers can facilitate analyzing a number of samples in each lane. A flow cell often is a solid support that can be configured to retain and / or allow the orderly passage of reagent solutions over bound analytes. Flow cells frequently are planar in shape, optically transparent, generally in the millimeter or sub-millimeter scale, and often have channels or lanes in which the analyte / reagent interaction occurs. The number of samples analyzed in a given flow cell lane may dependent on the number of unique identifiers utilized during library preparation and / or probe design. Multiplexing using 12 identifiers, for example, allows simultaneous analysis of 96 samples (e.g., equal to the number of wells in a 96 well microwell plate) in an 8 lane flow cell. Similarly, multiplexing using 48 identifiers, for example, allows simultaneous analysis of 384 samples (e.g., equal to the number of wells in a 384 well microwell plate) in an 8 lane flow cell. Non-limiting examples of commercially available multiplex sequencing kits include Illumina's multiplexing sample preparation oligonucleotide kit and multiplexing sequencing primers and PhiX control kit (e.g., Illumina's catalog numbers PE-400-1001 and PE-400-1002, respectively).

[0128] Any suitable method of sequencing nucleic acids can be used, non-limiting examples of which include Maxim & Gilbert, chain-termination methods, sequencing by synthesis, sequencing by ligation, sequencing by mass spectrometry, microscopy-based techniques, the like or combinations thereof. A first generation technology, such as, for example, Sanger sequencing methods including automated Sanger sequencing methods, including microfluidic Sanger sequencing, can be used in a method provided herein. Sequencing technologies including the use of nucleic acid imaging technologies (e.g. transmission electron microscopy (TEM) and atomic force microscopy (AFM)), can be used. A high-throughput sequencing method may be used. High-throughput sequencing methods generally involve clonally amplified DNA templates or single DNA molecules that are sequenced in a massively parallel fashion, sometimes within a flow cell. Next generation (e.g., 2nd and 3rd generation) sequencing techniques capable of sequencing DNA in a massively parallel fashion can be used for methods described herein and are collectively referred to herein as "massively parallel sequencing" (MPS). MPS sequencing methods may utilize a targeted approach, where specific chromosomes, genes or regions of interest are sequences. A non-targeted approach may be used where most or all nucleic acids in a sample are sequenced, amplified and / or captured randomly.

[0129] A targeted enrichment, amplification and / or sequencing approach may be used. A targeted approach often isolates, selects and / or enriches a subset of nucleic acids in a sample for further processing by use of sequence-specific oligonucleotides. A library of sequence-specific oligonucleotides may be utilized to target (e.g., hybridize to) one or more sets of nucleic acids in a sample. Sequence-specific oligonucleotides and / or primers are often selective for particular sequences (e.g., unique nucleic acid sequences) present in one or more chromosomes, genes, exons, introns, and / or regulatory regions of interest. Any suitable method or combination of methods can be used for enrichment, amplification and / or sequencing of one or more subsets of targeted nucleic acids. Targeted sequences may be isolated and / or enriched by capture to a solid phase (e.g., a flow cell, a bead) using one or more sequence-specific anchors. Targeted sequences may be enriched and / or amplified by a polymerase-based method (e.g., a PCR-based method, by any suitable polymerase based extension) using sequence-specific primers and / or primer sets. Sequence specific anchors often can be used as sequence-specific primers.

[0130] MPS sequencing sometimes makes use of sequencing by synthesis and certain imaging processes. A nucleic acid sequencing technology that may be used in a method described herein is sequencing-by-synthesis and reversible terminator-based sequencing (e.g. Illumina's Genome Analyzer; Genome Analyzer II; HISEQ 2000; HISEQ 2500 (Illumina, San Diego CA)). With this technology, millions of nucleic acid (e.g. DNA) fragments can be sequenced in parallel. In one example of this type of sequencing technology, a flow cell is used which contains an optically transparent slide with 8 individual lanes on the surfaces of which are bound oligonucleotide anchors (e.g., adaptor primers). A flow cell often is a solid support that can be configured to retain and / or allow the orderly passage of reagent solutions over bound analytes. Flow cells frequently are planar in shape, optically transparent, generally in the millimeter or sub-millimeter scale, and often have channels or lanes in which the analyte / reagent interaction occurs.

[0131] Sequencing by synthesis, may comprise iteratively adding (e.g., by covalent addition) a nucleotide to a primer or preexisting nucleic acid strand in a template directed manner. Each iterative addition of a nucleotide is detected and the process is repeated multiple times until a sequence of a nucleic acid strand is obtained. The length of a sequence obtained depends, in part, on the number of addition and detection steps that are performed. In some aspects of sequencing by synthesis, one, two, three or more nucleotides of the same type (e.g., A, G, C or T) are added and detected in a round of nucleotide addition. Nucleotides can be added by any suitable method (e.g., enzymatically or chemically). For example, a polymerase or a ligase adds a nucleotide to a primer or to a preexisting nucleic acid strand in a template directed manner. In some aspects of sequencing by synthesis, different types of nucleotides, nucleotide analogues and / or identifiers are used. Reversible terminators and / or removable (e.g., cleavable) identifiers may be used. Fluorescent labeled nucleotides and / or nucleotide analogues may be used. Sequencing by synthesis may comprise a cleavage (e.g., cleavage and removal of an identifier) and / or a washing step. Te addition of one or more nucleotides may be detected by a suitable method described herein or known in the art, non-limiting examples of which include any suitable imaging apparatus, a suitable camera, a digital camera, a CCD (Charge Couple Device) based imaging apparatus (e.g., a CCD camera), a CMOS (Complementary Metal Oxide Silicon) based imaging apparatus (e.g., a CMOS camera), a photo diode (e.g., a photomultiplier tube), electron microscopy, a field-effect transistor (e.g., a DNA field-effect transistor), an ISFET ion sensor (e.g., a CHEMFET sensor), the like or combinations thereof. Other sequencing methods that may be used to conduct methods herein include digital PCR and sequencing by hybridization.

[0132] Other sequencing methods that may be used to conduct methods herein include digital PCR and sequencing by hybridization. Digital polymerase chain reaction (digital PCR or dPCR) can be used to directly identify and quantify nucleic acids in a sample. Digital PCR can be performed in an emulsion. For example, individual nucleic acids are separated, e.g., in a microfluidic chamber device, and each nucleic acid is individually amplified by PCR. Nucleic acids can be separated such that there is no more than one nucleic acid per well. Different probes can be used to distinguish various alleles (e.g. fetal alleles and maternal alleles). Alleles can be enumerated to determine copy number.

[0133] Sequencing by hybridization can be used. The method involves contacting a plurality of polynucleotide sequences with a plurality of polynucleotide probes, where each of the plurality of polynucleotide probes can be optionally tethered to a substrate. The substrate can be a flat surface with an array of known nucleotide sequences. The pattern of hybridization to the array can be used to determine the polynucleotide sequences present in the sample. Each probe may be tethered to a bead, e.g., a magnetic bead or the like. Hybridization to the beads can be identified and used to identify the plurality of polynucleotide sequences within the sample.

[0134] Nanopore sequencing can be used in a method described herein. Nanopore sequencing is a single-molecule sequencing technology whereby a single nucleic acid molecule (e.g. DNA) is sequenced directly as it passes through a nanopore.

[0135] A suitable MPS method, system or technology platform for conducting methods described herein can be used to obtain nucleic acid sequencing reads. Non-limiting examples of MPS platforms include Illumina / Solex / HiSeq (e.g., Illumina's Genome Analyzer; Genome Analyzer II; HISEQ 2000; HISEQ), SOLiD, Roche / 454, PACBIO and / or SMRT, Helicos True Single Molecule Sequencing, Ion Torrent and Ion semiconductor-based sequencing (e.g., as developed by Life Technologies), WildFire, 5500, 5500xl W and / or 5500xl W Genetic Analyzer based technologies (e.g., as developed and sold by Life Technologies, US patent publication no. US20130012399); Polony sequencing, Pyrosequencing, Massively Parallel Signature Sequencing (MPSS), RNA polymerase (RNAP) sequencing, LaserGen systems and methods , Nanopore-based platforms, chemical-sensitive field effect transistor (CHEMFET) array, electron microscopy-based sequencing (e.g., as developed by ZS Genetics, Halcyon Molecular), nanoball sequencing

[0136] Chromosome-specific sequencing may be performed. Chromosome-specific sequencing may be performed utilizing DANSR (digital analysis of selected regions). Digital analysis of selected regions enables simultaneous quantification of hundreds of loci by cfDNA-dependent catenation of two locus-specific oligonucleotides via an intervening 'bridge' oligonucleotide to form a PCR template. Chromosome-specific sequencing may be performed by generating a library enriched in chromosome-specific sequences. Sequence reads may be obtained only for a selected set of chromosomes. Sequence reads may be obtained only for chromosomes 21, 18 and 13.Mapping reads

[0137] Sequence reads can be mapped and the number of reads mapping to a specified nucleic acid region (e.g., a chromosome, portion or segment thereof) are referred to as counts. Any suitable mapping method (e.g., process, algorithm, program, software, module, the like or combination thereof) can be used. Certain aspects of mapping processes are described hereafter.

[0138] Mapping nucleotide sequence reads (i.e., sequence information from a fragment whose physical genomic position is unknown) can be performed in a number of ways, and often comprises alignment of the obtained sequence reads with a matching sequence in a reference genome. In such alignments, sequence reads generally are aligned to a reference sequence and those that align are designated as being "mapped", "a mapped sequence read" or "a mapped read". A mapped sequence read may be referred to as a "hit" or "count". Mapped sequence reads may be grouped together according to various parameters and assigned to particular portions, which are discussed in further detail below.

[0139] As used herein, the terms "aligned", "alignment", or "aligning" refer to two or more nucleic acid sequences that can be identified as a match (e.g., 100% identity) or partial match. Alignments can be done manually or by a computer (e.g., a software, program, module, or algorithm), non-limiting examples of which include the Efficient Local Alignment of Nucleotide Data (ELAND) computer program distributed as part of the Illumina Genomics Analysis pipeline. Alignment of a sequence read can be a 100% sequence match. In some cases, an alignment is less than a 100% sequence match (i.e., non-perfect match, partial match, partial alignment). An alignment may be about a 99%, 98%, 97%, 96%, 95%, 94%, 93%, 92%, 91%, 90%, 89%, 88%, 87%, 86%, 85%, 84%, 83%, 82%, 81%, 80%, 79%, 78%, 77%, 76% or 75% match. An alignment may comprise a mismatch. An alignment may comprise 1, 2, 3, 4 or 5 mismatches. Two or more sequences can be aligned using either strand. A nucleic acid sequence may be aligned with the reverse complement of another nucleic acid sequence.

[0140] Various computational methods can be used to map each sequence read to a portion. Non-limiting examples of computer algorithms that can be used to align sequences include, without limitation, BLAST, BLITZ, FASTA, BOWTIE 1, BOWTIE 2, ELAND, MAQ, PROBEMATCH, SOAP or SEQMAP, or variations thereof or combinations thereof. Sequence reads can be aligned with sequences in a reference genome. The sequence reads can be found and / or aligned with sequences in nucleic acid databases known in the art including, for example, GenBank, dbEST, dbSTS, EMBL (European Molecular Biology Laboratory) and DDBJ (DNA Databank of Japan). BLAST or similar tools can be used to search the identified sequences against a sequence database. Search hits can then be used to sort the identified sequences into appropriate portions (described hereafter), for example.

[0141] In some aspects mapped sequence reads and / or information associated with a mapped sequence read are stored on and / or accessed from a non-transitory computer-readable storage medium in a suitable computer-readable format. A "computer-readable format" is sometimes referred to generally herein as a format. Mapped sequence reads may be stored and / or accessed in a suitable binary format, a text format, the like or a combination thereof. A binary format is sometimes a BAM format. A text format is sometimes a sequence alignment / map (SAM) format. Non-limiting examples of binary and / or text formats include BAM, SAM, SRF, FASTQ, Gzip, the like, or combinations thereof. Mapped sequence reads may be stored in and / or are converted to a format that requires less storage space (e.g., less bytes) than a traditional format (e.g., a SAM format or a BAM format). Mapped sequence reads in a first format may be compressed into a second format requiring less storage space than the first format. The term "compressed" as used herein refers to a process of data compression, source coding, and / or bit-rate reduction where a computer readable data file is reduced in size. Mapped sequence reads may be compressed from a SAM format in a binary format. Some data sometimes is lost after a file is compressed. Sometimes no data is lost in a compression process. In some file compression aspects some data is replaced with an index and / or a reference to another data file comprising information regarding a mapped sequence read. A mapped sequence read may be stored in a binary format comprising or consisting of a read count, a chromosome identifier (e.g., that identifies a chromosome to which a read is mapped) and a chromosome position identifier (e.g., that identifies a position on a chromosome to which a read is mapped). A binary format may comprise a 20 byte array, a 16 byte array, an 8 byte array, a 4 byte array or a 2 byte array. Mapped read information may be stored in an array in a 10 byte format, 9 byte format, 8 byte format, 7 byte format, 6 byte format, 5 byte format, 4 byte format, 3 byte format or 2 byte format. Sometimes mapped read data is stored in a 4 byte array comprising a 5 byte format. A binary format may comprise a 5-byte format comprising a 1-byte chromosome ordinal and a 4-byte chromosome position. Mapped reads may be stored in a compressed binary format that is about 100 times, about 90 times, about 80 times, about 70 times, about 60 times, about 55 times, about 50 times, about 45 times, about 40 times or about 30 times smaller than a sequence alignment / map (SAM) format. Mapped reads may be stored in a compress binary format that is about 2 times smaller to about 50 times smaller than (e.g., about 30, 25, 20, 19, 18, 17, 16, 15, 14, 13, 12, 11, 10, 9, 8, 7, 6, or about 5 times smaller than) a GZip format.

[0142] A system may comprise a compression module (e.g., 4, FIG. 42A). Mapped sequence read information stored on a non-transitory computer-readable storage medium in a computer-readable format may be compressed by a compression module. A compression module sometimes converts mapped sequence reads to and from a suitable format. A compression module can accept mapped sequence reads in a first format (e.g., 1, FIG. 42A), convert them into a compressed format (e.g., a binary format, 5) and transfer the compressed reads to another module (e.g., a bias density module 6). A compression module often provides sequence reads in a binary format 5 (e.g., a BReads format). Non-limiting examples of a compression module include GZIP, BGZF, and BAM, the like or modifications thereof).

[0143] The following provides an example of converting an integer into a 4-byte array using java: public static final byte[ ] convertToByteArray(int value) { return new byte[ ] { (byte)(value >>> 24), (byte)(value >>> 16), (byte)(value >>> 8), (byte)value}; }

[0144] A read may uniquely or non-uniquely map to portions in a reference genome. A read is considered as "uniquely mapped" if it aligns with a single sequence in the reference genome. A read is considered as "non-uniquely mapped" if it aligns with two or more sequences in the reference genome. Non-uniquely mapped reads may be eliminated from further analysis (e.g. quantification). A certain, small degree of mismatch (0-1) may be allowed to account for single nucleotide polymorphisms that may exist between the reference genome and the reads from individual samples being mapped. No degree of mismatch may be allowed for a read mapped to a reference sequence.

[0145] As used herein, the term "reference genome" can refer to any particular known, sequenced or characterized genome, whether partial or complete, of any organism or virus which may be used to reference identified sequences from a subject. For example, a reference genome used for human subjects as well as many other organisms can be found at the National Center for Biotechnology Information at World Wide Web URL ncbi.nlm.nih.gov. A "genome" refers to the complete genetic information of an organism or virus, expressed in nucleic acid sequences. As used herein, a reference sequence or reference genome often is an assembled or partially assembled genomic sequence from an individual or multiple individuals. A reference genome may be an assembled or partially assembled genomic sequence from one or more human individuals. A reference genome may comprise sequences assigned to chromosomes.

[0146] Where a sample nucleic acid is from a pregnant female, a reference sequence sometimes may not be from the fetus, the mother of the fetus or the father of the fetus, and may be referred to herein as an "external reference." A maternal reference may be prepared and used. When a reference from the pregnant female is prepared ("maternal reference sequence") based on an external reference, reads from DNA of the pregnant female that contains substantially no fetal DNA often are mapped to the external reference sequence and assembled. The external reference may be from DNA of an individual having substantially the same ethnicity as the pregnant female. A maternal reference sequence may not completely cover the maternal genomic DNA (e.g., it may cover about 50%, 60%, 70%, 80%, 90% or more of the maternal genomic DNA), and the maternal reference may not perfectly match the maternal genomic DNA sequence (e.g., the maternal reference sequence may include multiple mismatches).

[0147] Mappability may be assessed for a genomic region (e.g., portion, genomic portion, portion). Mappability is the ability to unambiguously align a nucleotide sequence read to a portion of a reference genome, typically up to a specified number of mismatches, including, for example, 0, 1, 2 or more mismatches. For a given genomic region, the expected mappability can be estimated using a sliding-window approach of a preset read length and averaging the resulting read-level mappability values. Genomic regions comprising stretches of unique nucleotide sequence sometimes have a high mappability value.Portions

[0148] Mapped sequence reads (i.e. sequence tags) may be grouped together according to various parameters and assigned to particular portions (e.g., portions of a reference genome). Often, individual mapped sequence reads can be used to identify a portion (e.g., the presence, absence or amount of a portion) present in a sample. The amount of a portion may be indicative of the amount of a larger sequence (e.g. a chromosome) in the sample. The term "portion" can also be referred to herein as a "genomic section", "bin", "region", "partition", "portion of a reference genome", "portion of a chromosome" or "genomic portion." A portion may be an entire chromosome, a segment of a chromosome, a segment of a reference genome, a segment spanning multiple chromosome, multiple chromosome segments, and / or combinations thereof. A portion may be predefined based on specific parameters. A portion may be arbitrarily defined based on partitioning of a genome (e.g., partitioned by size, GC content, contiguous regions, contiguous regions of an arbitrarily defined size, and the like).

[0149] A portion may be delineated based on one or more parameters which include, for example, length or a particular feature or features of the sequence. Portions can be selected, filtered and / or removed from consideration using any suitable criteria know in the art or described herein. A portion may be based on a particular length of genomic sequence. A method can include analysis of multiple mapped sequence reads to a plurality of portions. Portions can be approximately the same length or portions can be different lengths. Portions may be of about equal length. Portions of different lengths may be adjusted or weighted. A portion may be about 10 kilobases (kb) to about 100 kb, about 20 kb to about 80 kb, about 30 kb to about 70 kb, about 40 kb to about 60 kb, and sometimes about 50 kb. A portion may be about 10 kb to about 20 kb. A portion is not limited to contiguous runs of sequence. Thus, portions can be made up of contiguous and / or non-contiguous sequences. A portion is not limited to a single chromosome. A portion may include all or part of one chromosome or all or part of two or more chromosomes. Portions may span one, two, or more entire chromosomes. In addition, portions may span jointed or disjointed regions of multiple chromosomes.

[0150] Portions can be particular chromosome segments in a chromosome of interest, such as, for example, a chromosome where a genetic variation is assessed (e.g. an aneuploidy of chromosomes 13, 18 and / or 21 or a sex chromosome). A portion can also be a pathogenic genome (e.g. bacterial, fungal or viral) or fragment thereof. Portions can be genes, gene fragments, regulatory sequences, introns, exons, and the like.

[0151] A genome (e.g. human genome) may be partitioned into portions based on information content of particular regions. Partitioning a genome may eliminate similar regions (e.g., identical or homologous regions or sequences) across the genome and only keep unique regions. Regions removed during partitioning may be within a single chromosome or may span multiple chromosomes. A partitioned genome may be trimmed down and optimized for faster alignment, often allowing for focus on uniquely identifiable sequences.

[0152] Partitioning may down weight similar regions. A process for down weighting a portion is discussed in further detail below.

[0153] Partitioning of a genome into regions transcending chromosomes may be based on information gain produced in the context of classification. For example, information content may be quantified using a p-value profile measuring the significance of particular genomic locations for distinguishing between groups of confirmed normal and abnormal subjects (e.g. euploid and trisomy subjects, respectively). Partitioning of a genome into regions transcending chromosomes may be based on any other criterion, such as, for example, speed / convenience while aligning tags, GC content (e.g., high or low GC content), uniformity of GC content, other measures of sequence content (e.g. fraction of individual nucleotides, fraction of pyrimidines or purines, fraction of natural vs. non-natural nucleic acids, fraction of methylated nucleotides, and CpG content), methylation state, duplex melting temperature, amenability to sequencing or PCR, uncertainty value assigned to individual portions of a reference genome, and / or a targeted search for particular features.

[0154] A "segment" of a chromosome generally is part of a chromosome, and typically is a different part of a chromosome than a portion. A segment of a chromosome sometimes is in a different region of a chromosome than a portion, sometimes does not share a polynucleotide with a portion, and sometimes includes a polynucleotide that is in a portion. A segment of a chromosome often contains a larger number of nucleotides than a portion (e.g., a segment sometimes includes a portion), and sometimes a segment of a chromosome contains a smaller number of nucleotides than a portion (e.g., a segment sometimes is within a portion).Counts

[0155] Sequence reads that are mapped or partitioned based on a selected feature or variable can be quantified to determine the number of reads that are mapped to one or more portions (e.g., portion of a reference genome). The quantity of sequence reads that are mapped to a portion may be termed counts (e.g., a count). Often a count is associated with a portion. Counts for two or more portions (e.g., a set of portions) may be mathematically manipulated (e.g., averaged, added, normalized, the like or a combination thereof). A count may be determined from some or all of the sequence reads mapped to (i.e., associated with) a portion. A count may be determined from a pre-defined subset of mapped sequence reads. Pre-defined subsets of mapped sequence reads can be defined or selected utilizing any suitable feature or variable. Pre-defined subsets of mapped sequence reads can include from 1 to n sequence reads, where n represents a number equal to the sum of all sequence reads generated from a test subject or reference subject sample.

[0156] A count is derived from sequence reads that are processed or manipulated by a suitable method, operation or mathematical process known in the art. A count (e.g., counts) can be determined by a suitable method, operation or mathematical process. A count may be derived from sequence reads associated with a portion where some or all of the sequence reads are weighted, removed, filtered, normalized, adjusted, averaged, derived as a mean, added, or subtracted or processed by a combination thereof. A count may be derived from raw sequence reads and or filtered sequence reads. A count value may be determined by a mathematical process. A count value may be an average, mean or sum of sequence reads mapped to a portion. Often a count is a mean number of counts. A count may be associated with an uncertainty value.

[0157] Counts can be manipulated or transformed (e.g., normalized, combined, added, filtered, selected, averaged, derived as a mean, the like, or a combination thereof). Counts can be transformed to produce normalized counts. Counts can be processed (e.g., normalized) by a method known in the art and / or as described herein (e.g., portion-wise normalization, normalization by GC content, linear and nonlinear least squares regression, GC LOESS, LOWESS, PERUN, ChAl, RM, GCRM, cQn and / or combinations thereof).

[0158] Counts (e.g., raw, filtered and / or normalized counts) can be processed and normalized to one or more levels. Levels and profiles are described in greater detail hereafter. Counts can be processed and / or normalized to a reference level. Reference levels are addressed later herein. Counts processed according to a level (e.g., processed counts) can be associated with an uncertainty value (e.g., a calculated variance, an error, standard deviation, Z-score, p-value, mean absolute deviation, etc.). An uncertainty value may define a range above and below a level. A value for deviation can be used in place of an uncertainty value, and non-limiting examples of measures of deviation include standard deviation, average absolute deviation, median absolute deviation, standard score (e.g., Z-score, Z-score, normal score, standardized variable) and the like.

[0159] Counts are often obtained from a nucleic acid sample from a pregnant female bearing a fetus. Counts of nucleic acid sequence reads mapped to one or more portions often are counts representative of both the fetus and the mother of the fetus (e.g., a pregnant female subject). Some of the counts mapped to a portion are from a fetal genome and some of the counts mapped to the same portion may be from a maternal genome.Data processing and normalization

[0160] Mapped sequence reads that have been counted are referred to herein as raw data, since the data represents unmanipulated counts (e.g., raw counts). Sequence read data in a data set can be processed further (e.g., mathematically and / or statistically manipulated) and / or displayed to facilitate providing an outcome. Data sets, including larger data sets, may benefit from pre-processing to facilitate further analysis. Pre-processing of data sets sometimes involves removal of redundant and / or uninformative portions or portions of a reference genome (e.g., portions of a reference genome with uninformative data, redundant mapped reads, portions with zero median counts, over represented or under represented sequences). Without being limited by theory, data processing and / or preprocessing may (i) remove noisy data, (ii) remove uninformative data, (iii) remove redundant data, (iv) reduce the complexity of larger data sets, and / or (v) facilitate transformation of the data from one form into one or more other forms. The terms "pre-processing" and "processing" when utilized with respect to data or data sets are collectively referred to herein as "processing". Processing can render data more amenable to further analysis, and can generate an outcome. One or more or all processing methods (e.g., normalization methods, portion filtering, mapping, validation, the like or combinations thereof) may be performed by a processor, a micro-processor, a computer, in conjunction with memory and / or by a microprocessor controlled apparatus.

[0161] The term "noisy data" as used herein refers to (a) data that has a significant variance between data points when analyzed or plotted, (b) data that has a significant standard deviation (e.g., greater than 3 standard deviations), (c) data that has a significant standard error of the mean, the like, and combinations of the foregoing. Noisy data sometimes occurs due to the quantity and / or quality of starting material (e.g., nucleic acid sample), and sometimes occurs as part of processes for preparing or replicating DNA used to generate sequence reads. Noise may result from certain sequences being over represented when prepared using PCR-based methods. Methods described herein can reduce or eliminate the contribution of noisy data, and therefore reduce the effect of noisy data on the provided outcome.

[0162] The terms "uninformative data", "uninformative portions of a reference genome", and "uninformative portions" as used herein refer to portions, or data derived therefrom, having a numerical value that is significantly different from a predetermined threshold value or falls outside a predetermined cutoff range of values. The terms "threshold" and "threshold value" herein refer to any number that is calculated using a qualifying data set and serves as a limit of diagnosis of a genetic variation (e.g. a copy number variation, an aneuploidy, a microduplication, a microdeletion, a chromosomal aberration, and the like). A threshold may be exceeded by results obtained by methods described herein and a subject is diagnosed with a genetic variation (e.g. trisomy 21). A threshold value or range of values often may be calculated by mathematically and / or statistically manipulating sequence read data (e.g., from a reference and / or subject), and sequence read data manipulated to generate a threshold value or range of values may be sequence read data (e.g., from a reference and / or subject). An uncertainty value may be determined. An uncertainty value generally is a measure of variance or error and can be any suitable measure of variance or error. An uncertainty value may be a standard deviation, standard error, calculated variance, p-value, or mean absolute deviation (MAD). An uncertainty value can be calculated according to a formula described herein.

[0163] Any suitable procedure can be utilized for processing data sets described herein. Non-limiting examples of procedures suitable for use for processing data sets include filtering, normalizing, weighting, monitoring peak heights, monitoring peak areas, monitoring peak edges, determining area ratios, mathematical processing of data, statistical processing of data, application of statistical algorithms, analysis with fixed variables, analysis with optimized variables, plotting data to identify patterns or trends for additional processing, the like and combinations of the foregoing. Sata sets may be processed based on various features (e.g., GC content, redundant mapped reads, centromere regions, telomere regions, the like and combinations thereof) and / or variables (e.g., fetal gender, maternal age, maternal ploidy, percent contribution of fetal nucleic acid, the like or combinations thereof). Orocessing data sets as described herein can reduce the complexity and / or dimensionality of large and / or complex data sets. A non-limiting example of a complex data set includes sequence read data generated from one or more test subjects and a plurality of reference subjects of different ages and ethnic backgrounds. Data sets can include from thousands to millions of sequence reads for each test and / or reference subject.

[0164] Data processing can be performed in any number of steps. For example, data may be processed using only a single processing procedure, and may be processed using 1 or more, 5 or more, 10 or more or 20 or more processing steps (e.g., 1 or more processing steps, 2 or more processing steps, 3 or more processing steps, 4 or more processing steps, 5 or more processing steps, 6 or more processing steps, 7 or more processing steps, 8 or more processing steps, 9 or more processing steps, 10 or more processing steps, 11 or more processing steps, 12 or more processing steps, 13 or more processing steps, 14 or more processing steps, 15 or more processing steps, 16 or more processing steps, 17 or more processing steps, 18 or more processing steps, 19 or more processing steps, or 20 or more processing steps). Processing steps may be the same step repeated two or more times (e.g., filtering two or more times, normalizing two or more times), and processing steps may be two or more different processing steps (e.g., filtering, normalizing; normalizing, monitoring peak heights and edges; filtering, normalizing, normalizing to a reference, statistical manipulation to determine p-values, and the like), carried out simultaneously or sequentially. Any suitable number and / or combination of the same or different processing steps can be utilized to process sequence read data to facilitate providing an outcome. Processing data sets by the criteria described herein may reduce the complexity and / or dimensionality of a data set.

[0165] One or more processing steps can comprise one or more filtering steps. The term "filtering" as used herein refers to removing portions or portions of a reference genome from consideration. Portions of a reference genome can be selected for removal based on any suitable criteria, including but not limited to redundant data (e.g., redundant or overlapping mapped reads), non-informative data (e.g., portions of a reference genome with zero median counts), portions of a reference genome with over represented or under represented sequences, noisy data, the like, or combinations of the foregoing. A filtering process often involves removing one or more portions of a reference genome from consideration and subtracting the counts in the one or more portions of a reference genome selected for removal from the counted or summed counts for the portions of a reference genome, chromosome or chromosomes, or genome under consideration. Portions of a reference genome can be removed successively (e.g., one at a time to allow evaluation of the effect of removal of each individual portion), and all portions of a reference genome marked for removal can be removed at the same time. Portions of a reference genome characterized by a variance above or below a certain level may be removed, which sometimes is referred to herein as filtering "noisy" portions of a reference genome. A filtering process may comprise obtaining data points from a data set that deviate from the mean profile level of a portion, a chromosome, or segment of a chromosome by a predetermined multiple of the profile variance, and a filtering process may comprise removing data points from a data set that do not deviate from the mean profile level of a portion, a chromosome or segment of a chromosome by a predetermined multiple of the profile variance. A filtering process may be utilized to reduce the number of candidate portions of a reference genome analyzed for the presence or absence of a genetic variation. Reducing the number of candidate portions of a reference genome analyzed for the presence or absence of a genetic variation (e.g., micro-deletion, micro-duplication) often reduces the complexity and / or dimensionality of a data set, and sometimes increases the speed of searching for and / or identifying genetic variations and / or genetic aberrations by two or more orders of magnitude.

[0166] One or more processing steps can comprise one or more normalization steps. Normalization can be performed by a suitable method described herein or known in the art. Normalization may comprise adjusting values measured on different scales to a notionally common scale. Normalization may comprise a sophisticated mathematical adjustment to bring probability distributions of adjusted values into alignment. Normalization may comprise aligning distributions to a normal distribution. Normalization may comprise mathematical adjustments that allow comparison of corresponding normalized values for different datasets in a way that eliminates the effects of certain gross influences (e.g., error and anomalies). Normalization may comprise scaling. Normalization sometimes comprises division of one or more data sets by a predetermined variable or formula. Normalization sometimes comprises subtraction of one or more data sets by a predetermined variable or formula. Non-limiting examples of normalization methods include portion-wise normalization, normalization by GC content, median count (median bin count, median portion count) normalization, linear and nonlinear least squares regression, LOESS, GC LOESS, LOWESS (locally weighted scatterplot smoothing), PERUN, ChAl, principal component normalization, repeat masking (RM), GC-normalization and repeat masking (GCRM), cQn and / or combinations thereof. The determination of a presence or absence of a genetic variation (e.g., an aneuploidy, a microduplication, a microdeletion) may utilize a normalization method (e.g., portion-wise normalization, normalization by GC content, median count (median bin count, median portion count) normalization, linear and nonlinear least squares regression, LOESS, GC LOESS, LOWESS (locally weighted scatterplot smoothing), PERUN, ChAl, principal component normalization, repeat masking (RM), GC-normalization and repeat masking (GCRM), cQn, a normalization method known in the art and / or a combination thereof). The determination of a presence or absence of a copy number variation (e.g., an aneuploidy, a microduplication, a microdeletion) may utilize one or more of LOESS, median count (median bin count, median portion count) normalization, and principal component normalization. The determination of a presence or absence of a copy number variation may utilize LOESS followed by median count (median bin count, median portion count) normalization. The determination of a presence or absence of a copy number variation may utilize LOESS followed by median count (median bin count, median portion count) normalization followed by principal component normalization. Aspects of certain normalization processes (e.g., ChAl normalization, principal component normalization, PERUN normalization) are described, for example, in patent application no. PCT / US2014 / 039389 filed on May 23, 2014 and published as WO 2014 / 190286 on November 27, 2014; and patent application no. PCT / US2014 / 058885 filed on October 2, 2014 and published as WO 2015 / 051163 on April 9, 2015.

[0167] Any suitable number of normalizations can be used. Data sets can be normalized 1 or more, 5 or more, 10 or more or even 20 or more times. Data sets can be normalized to values (e.g., normalizing value) representative of any suitable feature or variable (e.g., sample data, reference data, or both). Non-limiting examples of types of data normalizations that can be used include normalizing raw count data for one or more selected test or reference portions to the total number of counts mapped to the chromosome or the entire genome on which the selected portion or sections are mapped; normalizing raw count data for one or more selected portions to a median reference count for one or more portions or the chromosome on which a selected portion or segments is mapped; normalizing raw count data to previously normalized data or derivatives thereof; and normalizing previously normalized data to one or more other predetermined normalization variables. Normalizing a data set sometimes has the effect of isolating statistical error, depending on the feature or property selected as the predetermined normalization variable. Normalizing a data set sometimes also allows comparison of data characteristics of data having different scales, by bringing the data to a common scale (e.g., predetermined normalization variable). One or more normalizations to a statistically derived value can be utilized to minimize data differences and diminish the importance of outlying data. Normalizing portions, or portions of a reference genome, with respect to a normalizing value sometimes is referred to as "portion-wise normalization".

[0168] A processing step comprising normalization may include normalizing to a static window, and a processing step comprising normalization may include normalizing to a moving or sliding window. The term "window" as used herein refers to one or more portions chosen for analysis, and sometimes used as a reference for comparison (e.g., used for normalization and / or other mathematical or statistical manipulation). The term "normalizing to a static window" as used herein refers to a normalization process using one or more portions selected for comparison between a test subject and reference subject data set. The selected portions may be utilized to generate a profile. A static window generally includes a predetermined set of portions that do not change during manipulations and / or analysis. The terms "normalizing to a moving window" and "normalizing to a sliding window" as used herein refer to normalizations performed to portions localized to the genomic region (e.g., immediate genetic surrounding, adjacent portion or sections, and the like) of a selected test portion, where one or more selected test portions are normalized to portions immediately surrounding the selected test portion. The selected portions may be utilized to generate a profile. A sliding or moving window normalization often includes repeatedly moving or sliding to an adjacent test portion, and normalizing the newly selected test portion to portions immediately surrounding or adjacent to the newly selected test portion, where adjacent windows have one or more portions in common. A plurality of selected test portions and / or chromosomes can be analyzed by a sliding window process.

[0169] Normalizing to a sliding or moving window can generate one or more values, where each value represents normalization to a different set of reference portions selected from different regions of a genome (e.g., chromosome). The one or more values generated may be cumulative sums (e.g., a numerical estimate of the integral of the normalized count profile over the selected portion, domain (e.g., part of chromosome), or chromosome). The values generated by the sliding or moving window process can be used to generate a profile and facilitate arriving at an outcome. Cumulative sums of one or more portions can be displayed as a function of genomic position. Moving or sliding window analysis sometimes is used to analyze a genome for the presence or absence of micro-deletions and / or micro-insertions. Displaying cumulative sums of one or more portions may be used to identify the presence or absence of regions of genetic variation (e.g., micro-deletions, micro-duplications). Moving or sliding window analysis may be used to identify genomic regions containing micro-deletions and in certain aspects, moving or sliding window analysis may be used to identify genomic regions containing micro-duplications.

[0170] Described in greater detail hereafter are certain examples of normalization processes that can be utilized, such as LOESS, PERUN, ChAl and principal component normalization methods, for example.

[0171] A processing step may comprise a weighting. The terms "weighted", "weighting" or "weight function" or grammatical derivatives or equivalents thereof, as used herein, refer to a mathematical manipulation of a portion or all of a data set sometimes utilized to alter the influence of certain data set features or variables with respect to other data set features or variables (e.g., increase or decrease the significance and / or contribution of data contained in one or more portions or portions of a reference genome, based on the quality or usefulness of the data in the selected portion or portions of a reference genome). A weighting function can be used to increase the influence of data with a relatively small measurement variance, and / or to decrease the influence of data with a relatively large measurement variance. For example, portions of a reference genome with under represented or low quality sequence data can be "down weighted" to minimize the influence on a data set, whereas selected portions of a reference genome can be "up weighted" to increase the influence on a data set. A non-limiting example of a weighting function is [1 / (standard deviation) 2< ]. A weighting step sometimes is performed in a manner substantially similar to a normalizing step. A data set may be divided by a predetermined variable (e.g., weighting variable). A predetermined variable (e.g., minimized target function, Phi) often is selected to weigh different parts of a data set differently (e.g., increase the influence of certain data types while decreasing the influence of other data types).

[0172] A processing step can comprise one or more mathematical and / or statistical manipulations. Any suitable mathematical and / or statistical manipulation, alone or in combination, may be used to analyze and / or manipulate a data set described herein. Any suitable number of mathematical and / or statistical manipulations can be used. A data set can be mathematically and / or statistically manipulated 1 or more, 5 or more, 10 or more or 20 or more times. Non-limiting examples of mathematical and statistical manipulations that can be used include addition, subtraction, multiplication, division, algebraic functions, least squares estimators, curve fitting, differential equations, rational polynomials, double polynomials, orthogonal polynomials, z-scores, p-values, chi values, phi values, analysis of peak levels, determination of peak edge locations, calculation of peak area ratios, analysis of median chromosomal level, calculation of mean absolute deviation, sum of squared residuals, mean, standard deviation, standard error, the like or combinations thereof. A mathematical and / or statistical manipulation can be performed on all or a portion of sequence read data, or processed products thereof. Non-limiting examples of data set variables or features that can be statistically manipulated include raw counts, filtered counts, normalized counts, peak heights, peak widths, peak areas, peak edges, lateral tolerances, P-values, median levels, mean levels, count distribution within a genomic region, relative representation of nucleic acid species, the like or combinations thereof.

[0173] A processing step can comprise the use of one or more statistical algorithms. Any suitable statistical algorithm, alone or in combination, may be used to analyze and / or manipulate a data set described herein. Any suitable number of statistical algorithms can be used. A data set can be analyzed using 1 or more, 5 or more, 10 or more or 20 or more statistical algorithms. Non-limiting examples of statistical algorithms suitable for use with methods described herein include decision trees, counternulls, multiple comparisons, omnibus test, Behrens-Fisher problem, bootstrapping, Fisher's method for combining independent tests of significance, null hypothesis, type I error, type II error, exact test, one-sample Z test, two-sample Z test, one-sample t-test, paired t-test, two-sample pooled t-test having equal variances, two-sample unpooled t-test having unequal variances, one-proportion z-test, two-proportion z-test pooled, two-proportion z-test unpooled, one-sample chi-square test, two-sample F test for equality of variances, confidence interval, credible interval, significance, meta analysis, simple linear regression, robust linear regression, the like or combinations of the foregoing. Non-limiting examples of data set variables or features that can be analyzed using statistical algorithms include raw counts, filtered counts, normalized counts, peak heights, peak widths, peak edges, lateral tolerances, P-values, median levels, mean levels, count distribution within a genomic region, relative representation of nucleic acid species, the like or combinations thereof.

[0174] A data set can be analyzed by utilizing multiple (e.g., 2 or more) statistical algorithms (e.g., least squares regression, principle component analysis, linear discriminant analysis, quadratic discriminant analysis, bagging, neural networks, support vector machine models, random forests, classification tree models, K-nearest neighbors, logistic regression and / or loss smoothing) and / or mathematical and / or statistical manipulations (e.g., referred to herein as manipulations). The use of multiple manipulations can generate an N-dimensional space that can be used to provide an outcome. Analysis of a data set by utilizing multiple manipulations can reduce the complexity and / or dimensionality of the data set. For example, the use of multiple manipulations on a reference data set can generate an N-dimensional space (e.g., probability plot) that can be used to represent the presence or absence of a genetic variation, depending on the genetic status of the reference samples (e.g., positive or negative for a selected genetic variation). Analysis of test samples using a substantially similar set of manipulations can be used to generate an N-dimensional point for each of the test samples. The complexity and / or dimensionality of a test subject data set sometimes is reduced to a single value or N-dimensional point that can be readily compared to the N-dimensional space generated from the reference data. Test sample data that fall within the N-dimensional space populated by the reference subject data are indicative of a genetic status substantially similar to that of the reference subjects. Test sample data that fall outside of the N-dimensional space populated by the reference subject data are indicative of a genetic status substantially dissimilar to that of the reference subjects. References may be euploid or may not otherwise have a genetic variation or medical condition.

[0175] After data sets have been counted, optionally filtered and normalized, the processed data sets can be further manipulated by one or more filtering and / or normalizing procedures. A data set that may have been further manipulated by one or more filtering and / or normalizing procedures can be used to generate a profile. The one or more filtering and / or normalizing procedures sometimes can reduce data set complexity and / or dimensionality. An outcome can be provided based on a data set of reduced complexity and / or dimensionality.

[0176] Portions may be filtered according to a measure of error (e.g., standard deviation, standard error, calculated variance, p-value, mean absolute error (MAE), average absolute deviation and / or mean absolute deviation (MAD). A measure of error may refer to count variability. Portions may be filtered according to count variability. Count variability may be a measure of error determined for counts mapped to a portion (i.e., portion) of a reference genome for multiple samples (e.g., multiple sample obtained from multiple subjects, e.g., 50 or more, 100 or more, 500 or more 1000 or more, 5000 or more or 10,000 or more subjects). Portions with a count variability above a pre-determined upper range may be filtered (e.g., excluded from consideration). A pre-determined upper range may be a MAD value equal to or greater than about 50, about 52, about 54, about 56, about 58, about 60, about 62, about 64, about 66, about 68, about 70, about 72, about 74 or equal to or greater than about 76. Portions with a count variability below a pre-determined lower range may be filtered (e.g., excluded from consideration). A pre-determined lower range may be a MAD value equal to or less than about 40, about 35, about 30, about 25, about 20, about 15, about 10, about 5, about 1, or equal to or less than about 0. In some aspects portions with a count variability outside a pre-determined range are filtered (e.g., excluded from consideration). A pre-determined range may be a MAD value greater than zero and less than about 76, less than about 74, less than about 73, less than about 72, less than about 71, less than about 70, less than about 69, less than about 68, less than about 67, less than about 66, less than about 65, less than about 64, less than about 62, less than about 60, less than about 58, less than about 56, less than about 54, less than about 52 or less than about 50. A pre-determined range may be a MAD value greater than zero and less than about 67.7. Portions with a count variability within a pre-determined range may be selected (e.g., used for determining the presence or absence of a genetic variation).

[0177] The count variability of portions may represent a distribution (e.g., a normal distribution). Portions may be selected within a quantile of the distribution. Portions within a quantile equal to or less than about 99.9%, 99.8%, 99.7%, 99.6%, 99.5%, 99.4%, 99.3%, 99.2%, 99.1%, 99.0%, 98.9%, 98.8%, 98.7%, 98.6%, 98.5%, 98.4%, 98.3%, 98.2%, 98.1%, 98.0%, 97%, 96%, 95%, 94%, 93%, 92%, 91%, 90%, 85%, 80%, or equal to or less than a quantile of about 75% for the distribution may be selected. Portions within a 99% quantile of the distribution of count variability my be selected. Portions with a MAD > 0 and a MAD < 67.725 a within the 99% quantile and may be selected, resulting in the identification of a set of stable portions of a reference genome.

[0178] Non-limiting examples of portion filtering with respect to PERUN, for example, is provided herein and in international patent application no. PCT / US12 / 59123 (WO2013 / 052913). Portions may be filtered based on, or based on part on, a measure of error. A measure of error comprising absolute values of deviation, such as an R-factor, can be used for portion removal or weighting. An R-factor may be defined as the sum of the absolute deviations of the predicted count values from the actual measurements divided by the predicted count values from the actual measurements (e.g., Equation B herein). While a measure of error comprising absolute values of deviation may be used, a suitable measure of error may be alternatively employed. A measure of error not comprising absolute values of deviation, such as a dispersion based on squares, may be utilized. Portions may be filtered or weighted according to a measure of mappability (e.g., a mappability score). A portion sometimes is filtered or weighted according to a relatively low number of sequence reads mapped to the portion (e.g., 0, 1, 2, 3, 4, 5 reads mapped to the portion). Portions can be filtered or weighted according to the type of analysis being performed. For example, for chromosome 13, 18 and / or 21 aneuploidy analysis, sex chromosomes may be filtered, and only autosomes, or a subset of autosomes, may be analyzed.

[0179] In particular, the following filtering process may be employed. The same set of portions (e.g., portions of a reference genome) within a given chromosome (e.g., chromosome 21) is selected and the number of reads in affected and unaffected samples are compared. The gap relates trisomy 21 and euploid samples and it involves a set of portions covering most of chromosome 21. The set of portions is the same between euploid and T21 samples. The distinction between a set of portions and a single section is not crucial, as a portion can be defined. The same genomic region is compared in different patients. This process can be utilized for a trisomy analysis, such as for T13 or T18 in addition to, or instead of, T21.

[0180] After data sets have been counted, optionally filtered and normalized, the processed data sets can be manipulated by weighting. One or more portions can be selected for weighting to reduce the influence of data (e.g., noisy data, uninformative data) contained in the selected portions, and one or more portions can be selected for weighting to enhance or augment the influence of data (e.g., data with small measured variance) contained in the selected portions. A data set may be weighted utilizing a single weighting function that decreases the influence of data with large variances and increases the influence of data with small variances. A weighting function sometimes is used to reduce the influence of data with large variances and augment the influence of data with small variances (e.g., [1 / (standard deviation) 2< ]). A profile plot of processed data further manipulated by weighting may be generated to facilitate classification and / or providing an outcome. An outcome can be provided based on a profile plot of weighted data

[0181] Filtering or weighting of portions can be performed at one or more suitable points in an analysis. For example, portions may be filtered or weighted before or after sequence reads are mapped to portions of a reference genome. Portions may be filtered or weighted before or after an experimental bias for individual genome portions is determined. Portions may be filtered or weighted before or after genomic section levels are calculated.

[0182] After data sets may have been counted, optionally filtered, normalized, and optionally weighted, the processed data sets can be manipulated by one or more mathematical and / or statistical (e.g., statistical functions or statistical algorithm) manipulations. Processed data sets can be further manipulated by calculating Z-scores for one or more selected portions, chromosomes, or portions of chromosomes. Processed data sets can be further manipulated by calculating P-values. One example of an equation for calculating a Z-score and a p-value is presented in Equation 1 (Example 2). Mathematical and / or statistical manipulations include one or more assumptions pertaining to ploidy and / or fetal fraction. A profile plot of processed data further manipulated by one or more statistical and / or mathematical manipulations may be generated to facilitate classification and / or providing an outcome. An outcome can be provided based on a profile plot of statistically and / or mathematically manipulated data. An outcome provided based on a profile plot of statistically and / or mathematically manipulated data often includes one or more assumptions pertaining to ploidy and / or fetal fraction.

[0183] Multiple manipulations may be performed on processed data sets to generate an N-dimensional space and / or N-dimensional point, after data sets have been counted, optionally filtered and normalized. An outcome can be provided based on a profile plot of data sets analyzed in N-dimensions.

[0184] Data sets may be processed utilizing one or more peak level analysis, peak width analysis, peak edge location analysis, peak lateral tolerances, the like, derivations thereof, or combinations of the foregoing, as part of or after data sets have processed and / or manipulated. A profile plot of data processed utilizing one or more peak level analysis, peak width analysis, peak edge location analysis, peak lateral tolerances, the like, derivations thereof, or combinations of the foregoing may be generated to facilitate classification and / or providing an outcome. An outcome can be provided based on a profile plot of data that has been processed utilizing one or more peak level analysis, peak width analysis, peak edge location analysis, peak lateral tolerances, the like, derivations thereof, or combinations of the foregoing.

[0185] The use of one or more reference samples that are substantially free of a genetic variation in question can be used to generate a reference median count profile, which may result in a predetermined value representative of the absence of the genetic variation, and often deviates from a predetermined value in areas corresponding to the genomic location in which the genetic variation is located in the test subject, if the test subject possessed the genetic variation. In test subjects at risk for, or suffering from a medical condition associated with a genetic variation, the numerical value for the selected portion or sections is expected to vary significantly from the predetermined value for non-affected genomic locations. The use of one or more reference samples known to carry the genetic variation in question can be used to generate a reference median count profile, which may result in a predetermined value representative of the presence of the genetic variation, and often deviates from a predetermined value in areas corresponding to the genomic location in which a test subject does not carry the genetic variation. In test subjects not at risk for, or suffering from a medical condition associated with a genetic variation, the numerical value for the selected portion or sections is expected to vary significantly from the predetermined value for affected genomic locations.

[0186] Analysis and processing of data can include the use of one or more assumptions. A suitable number or type of assumptions can be utilized to analyze or process a data set. Non-limiting examples of assumptions that can be used for data processing and / or analysis include maternal ploidy, fetal contribution, prevalence of certain sequences in a reference population, ethnic background, prevalence of a selected medical condition in related family members, parallelism between raw count profiles from different patients and / or runs after GC-normalization and repeat masking (e.g., GCRM), identical matches represent PCR artifacts (e.g., identical base position), assumptions inherent in a fetal quantifier assay (e.g., FQA), assumptions regarding twins (e.g., if 2 twins and only 1 is affected the effective fetal fraction is only 50% of the total measured fetal fraction (similarly for triplets, quadruplets and the like)), fetal cell free DNA (e.g., cfDNA) uniformly covers the entire genome, the like and combinations thereof.

[0187] In those instances where the quality and / or depth of mapped sequence reads does not permit an outcome prediction of the presence or absence of a genetic variation at a desired confidence level (e.g., 95% or higher confidence level), based on the normalized count profiles, one or more additional mathematical manipulation algorithms and / or statistical prediction algorithms, can be utilized to generate additional numerical values useful for data analysis and / or providing an outcome. The term "normalized count profile" as used herein refers to a profile generated using normalized counts. Examples of methods that can be used to generate normalized counts and normalized count profiles are described herein. As noted, mapped sequence reads that have been counted can be normalized with respect to test sample counts or reference sample counts. A normalized count profile can be presented as a plot.LOESS Normalization

[0188] LOESS is a regression modeling method known in the art that combines multiple regression models in a k-nearest-neighbor-based meta-model. LOESS is sometimes referred to as a locally weighted polynomial regression. GC LOESS may apply an LOESS model to the relationship between fragment count (e.g., sequence reads, counts) and GC composition for portions of a reference genome. Plotting a smooth curve through a set of data points using LOESS is sometimes called an LOESS curve, particularly when each smoothed value is given by a weighted quadratic least squares regression over the span of values of the y-axis scattergram criterion variable. For each point in a data set, the LOESS method fits a low-degree polynomial to a subset of the data, with explanatory variable values near the point whose response is being estimated. The polynomial is fitted using weighted least squares, giving more weight to points near the point whose response is being estimated and less weight to points further away. The value of the regression function for a point is then obtained by evaluating the local polynomial using the explanatory variable values for that data point. The LOESS fit is sometimes considered complete after regression function values have been computed for each of the data points. Many of the details of this method, such as the degree of the polynomial model and the weights, are flexible.PERUN Normalization

[0189] A normalization methodology for reducing error associated with nucleic acid indicators is referred to herein as Parameterized Error Removal and Unbiased Normalization (PERUN) described herein and in international patent application no. PCT / US12 / 59123 (WO2013 / 052913). PERUN methodology can be applied to a variety of nucleic acid indicators (e.g., nucleic acid sequence reads) for the purpose of reducing effects of error that confound predictions based on such indicators.

[0190] For example, PERUN methodology can be applied to nucleic acid sequence reads from a sample and reduce the effects of error that can impair genomic section level determinations. Such an application is useful for using nucleic acid sequence reads to determine the presence or absence of a genetic variation in a subject manifested as a varying level of a nucleotide sequence (e.g., a portion, a genomic section level). Non-limiting examples of variations in portions are chromosome aneuploidies (e.g., trisomy 21, trisomy 18, trisomy 13) and presence or absence of a sex chromosome (e.g., XX in females versus XY in males). A trisomy of an autosome (e.g., a chromosome other than a sex chromosome) can be referred to as an affected autosome. Other non-limiting examples of variations in genomic section levels include microdeletions, microinsertions, duplications and mosaicism.

[0191] In certain applications, PERUN methodology can reduce experimental bias by normalizing nucleic acid reads mapped to particular portions of a reference genome, the latter of which are referred to as portions and sometimes as portions of a reference genome. In such applications, PERUN methodology generally normalizes counts of nucleic acid reads at particular portions of a reference genome across a number of samples in three dimensions. A detailed description of PERUN and applications thereof is provided in the Examples section herein, in international patent application no. PCT / US12 / 59123 (WO2013 / 052913) and U.S. patent application publication no. US20130085681.

[0192] PERUN methodology may include calculating a genomic section level for portions of a reference genome from (a) sequence read counts mapped to a portion of a reference genome for a test sample, (b) experimental bias (e.g., GC bias) for the test sample, and (c) one or more fit parameters (e.g., estimates of fit) for a fitted relationship between (i) experimental bias for a portion of a reference genome to which sequence reads are mapped and (ii) counts of sequence reads mapped to the portion. Experimental bias for each of the portions of a reference genome can be determined across multiple samples according to a fitted relationship for each sample between (i) the counts of sequence reads mapped to each of the portions of a reference genome, and (ii) a mapping feature for each of the portions of a reference genome. This fitted relationship for each sample can be assembled for multiple samples in three dimensions. The assembly can be ordered according to the experimental bias, although PERUN methodology may be practiced without ordering the assembly according to the experimental bias. The fitted relationship for each sample and the fitted relationship for each portion of the reference genome can be fitted independently to a linear function or non-linear function by a suitable fitting process known in the art.

[0193] A relationship may be a geometric and / or graphical relationship. A relationship may be a mathematical relationship. A relationship may be plotted. A relationship may be a linear relationship. A relationship may be a non-linear relationship. A relationship may be a regression (e.g., a regression line). A regression can be a linear regression or a non-linear regression. A relationship can be expressed by a mathematical equation. Often a relationship is defined, in part, by one or more constants. A relationship can be generated by a method known in the art. A relationship in two dimensions can be generated for one or more samples, and a variable probative of error, or possibly probative of error, can be selected for one or more of the dimensions. A relationship can be generated, for example, using graphing software known in the art that plots a graph using values of two or more variables provided by a user. A relationship can be fitted using a method known in the art (e.g., graphing software). Certain relationships can be fitted by linear regression, and the linear regression can generate a slope value and intercept value. Certain relationships sometimes are not linear and can be fitted by a non-linear function, such as a parabolic, hyperbolic or exponential function (e.g., a quadratic function), for example.

[0194] In PERUN methodology, one or more of the fitted relationships may be linear. For an analysis of cell-free circulating nucleic acid from pregnant females, where the experimental bias is GC bias and the mapping feature is GC content, a fitted relationship for a sample between the (i) the counts of sequence reads mapped to each portion, and (ii) GC content for each of the portions of a reference genome, can be linear. For the latter fitted relationship, the slope pertains to GC bias, and a GC bias coefficient can be determined for each sample when the fitted relationships are assembled across multiple samples. In such applications, the fitted relationship for multiple samples and a portion between (i) GC bias coefficient for the portion, and (ii) counts of sequence reads mapped to portion, also can be linear. An intercept and slope can be obtained from the latter fitted relationship. In such applications, the slope addresses sample-specific bias based on GC-content and the intercept addresses a portion-specific attenuation pattern common to all samples. PERUN methodology can significantly reduce such sample-specific bias and portion-specific attenuation when calculating genomic section levels for providing an outcome (e.g., presence or absence of genetic variation; determination of fetal sex).

[0195] PERUN normalization may make use of fitting to a linear function and may be described by Equation A, Equation B or a derivation thereof. Equation A: M = LI + GS Equation B: L = M − GS / I

[0196] L may be a PERUN normalized level or profile. L may be the desired output from the PERUN normalization procedure. L may be portion specific. L may be determined according to multiple portions of a reference genome and represents a PERUN normalized level of a genome, chromosome, portions or segment thereof. The level L is often used for further analyses (e.g., to determine Z-values, maternal deletions / duplications, fetal microdeletions / microduplications, fetal gender, sex aneuploidies, and so on). The method of normalizing according to Equation B is named Parameterized Error Removal and Unbiased Normalization (PERUN).

[0197] G may be a GC bias coefficient measured using a linear model, LOESS, or any equivalent approach. G may be a slope. The GC bias coefficient G may be evaluated as the slope of the regression for counts M (e.g., raw counts) for portion i and the GC content of portion i determined from a reference genome. G may represent secondary information, extracted from M and determined according to a relationship. G may represent a relationship for a set of portion-specific counts and a set of portion-specific GC content values for a sample (e.g., a test sample). Portion-specific GC content may be derived from a reference genome. Portion-specific GC content may be derived from observed or measured GC content (e.g., measured from the sample). A GC bias coefficient often is determined for each sample in a group of samples and generally is determined for a test sample. A GC bias coefficient often is sample specific. A GC bias coefficient may be a constant. A GC bias coefficient, once derived for a sample, may not change.

[0198] I may be an intercept and S may be a slope derived from a linear relationship. The relationship from which I and S are derived my be different than the relationship from which G is derived. The relationship from which I and S are derived may be fixed for a given experimental setup. I and S may be derived from a linear relationship according to counts (e.g., raw counts) and a GC bias coefficient according to multiple samples. I and S may be derived independently of the test sample. I and S may be derived from multiple samples. I and S often may be portion specific. I and S may be determined with the assumption that L = 1 for all portions of a reference genome in euploid samples. A linear relationship may be determined for euploid samples and I and S values specific for a selected portion (assuming L = 1) may be determined. The same procedure may be applied to all portions of a reference genome in a human genome and a set of intercepts I and slopes S is determined for every portion.

[0199] A cross-validation approach may be applied. Cross-validation, sometimes is referred to as rotation estimation. A cross-validation approach may be applied to assess how accurately a predictive model (e.g., such as PERUN) will perform in practice using a test sample. One round of cross-validation may comprise partitioning a sample of data into complementary subsets, performing a cross validation analysis on one subset (e.g., sometimes referred to as a training set), and validating the analysis using another subset (e.g., sometimes called a validation set or test set). Multiple rounds of cross-validation may be performed using different partitions and / or different subsets). Non-limiting examples of cross-validation approaches include leave-one-out, sliding edges, K-fold, 2-fold, repeat random sub-sampling, the like or combinations thereof. A cross-validation may randomly select a work set containing 90% of a set of samples comprising known euploid fetuses and uses that subset to train a model. The random selection may be repeated 100 times, yielding a set of 100 slopes and 100 intercepts for every portion.

[0200] The value of M may be a measured value derived from a test sample. M may be measured raw counts for a portion. Where the values I and S may be available for a portion, measurement M is determined from a test sample and is used to determine the PERUN normalized level L for a genome, chromosome, segment or portion thereof according to Equation B

[0201] Thus, application of PERUN methodology to sequence reads across multiple samples in parallel can significantly reduce error caused by (i) sample-specific experimental bias (e.g., GC bias) and (ii) portion-specific attenuation common to samples. Other methods in which each of these two sources of error are addressed separately or serially often are not able to reduce these as effectively as PERUN methodology. Without being limited by theory, it is expected that PERUN methodology reduces error more effectively in part because its generally additive processes do not magnify spread as much as generally multiplicative processes utilized in other normalization approaches (e.g., GC-LOESS).

[0202] Additional normalization and statistical techniques may be utilized in combination with PERUN methodology. An additional process can be applied before, after and / or during employment of PERUN methodology. Non-limiting examples of processes that can be used in combination with PERUN methodology are described hereafter.

[0203] A secondary normalization or adjustment of a genomic section level for GC content can be utilized in conjunction with PERUN methodology. A suitable GC content adjustment or normalization procedure can be utilized (e.g., GC-LOESS, GCRM). A particular sample can be identified for application of an additional GC normalization process. For example, application of PERUN methodology can determine GC bias for each sample, and a sample associated with a GC bias above a certain threshold can be selected for an additional GC normalization process. A predetermined threshold level can be used to select such samples for additional GC normalization.

[0204] A portion filtering or weighting process can be utilized in conjunction with PERUN methodology. A suitable portion filtering or weighting process can be utilized, non-limiting examples are described herein, in international patent application no. PCT / US12 / 59123 (WO2013 / 052913) and U.S. patent application publication no. US20130085681. A normalization technique that reduces error associated with maternal insertions, duplications and / or deletions (e.g., maternal and / or fetal copy number variations), may be utilized in conjunction with PERUN methodology.

[0205] Genomic section levels calculated by PERUN methodology can be utilized directly for providing an outcome. Genomic section levels can be utilized directly to provide an outcome for samples in which fetal fraction is about 2% to about 6% or greater (e.g., fetal fraction of about 4% or greater). Genomic section levels calculated by PERUN methodology sometimes are further processed for the provision of an outcome. Calculated genomic section levels may be standardized. The sum, mean or median of calculated genomic section levels for a test portion (e.g., chromosome 21) can be divided by the sum, mean or median of calculated genomic section levels for portions other than the test portion (e.g., autosomes other than chromosome 21), to generate an experimental genomic section level. An experimental genomic section level or a raw genomic section level can be used as part of a standardization analysis, such as calculation of a Z-score or Z-score. A Z-score can be generated for a sample by subtracting an expected genomic section level from an experimental genomic section level or raw genomic section level and the resulting value may be divided by a standard deviation for the samples. Resulting Z-scores can be distributed for different samples and analyzed, or can be related to other variables, such as fetal fraction and others, and analyzed, to provide an outcome.

[0206] As noted herein, PERUN methodology is not limited to normalization according to GC bias and GC content per se, and can be used to reduce error associated with other sources of error. A non-limiting example of a source of non-GC content bias is mappability. When normalization parameters other than GC bias and content are addressed, one or more of the fitted relationships may be non-linear (e.g., hyperbolic, exponential). Where experimental bias is determined from a non-linear relationship, for example, an experimental bias curvature estimation may be analyzed.

[0207] PERUN methodology can be applied to a variety of nucleic acid indicators. Non-limiting examples of nucleic acid indicators are nucleic acid sequence reads and nucleic acid levels at a particular location on a microarray. Non-limiting examples of sequence reads include those obtained from cell-free circulating DNA, cell-free circulating RNA, cellular DNA and cellular RNA. PERUN methodology can be applied to sequence reads mapped to suitable reference sequences, such as genomic reference DNA, cellular reference RNA (e.g., transcriptome), and portions thereof (e.g., part(s) of a genomic complement of DNA or RNA transcriptome, part(s) of a chromosome).

[0208] Thus, cellular nucleic acid (e.g., DNA or RNA) can serve as a nucleic acid indicator. Cellular nucleic acid reads mapped to reference genome portions can be normalized using PERUN methodology. Cellular nucleic acid bound to a particular protein sometimes are referred to chromatin immunoprecipitation (ChIP) processes. ChIP-enriched nucleic acid is a nucleic acid in association with cellular protein, such as DNA or RNA for example. Reads of ChIP-enriched nucleic acid can be obtained using technology known in the art. Reads of ChIP-enriched nucleic acid can be mapped to one or more portions of a reference genome, and results can be normalized using PERUN methodology for providing an outcome.

[0209] Cellular RNA can serve as nucleic acid indicators. Cellular RNA reads can be mapped to reference RNA portions and normalized using PERUN methodology for providing an outcome. Known sequences for cellular RNA, referred to as a transcriptome, or a segment thereof, can be used as a reference to which RNA reads from a sample can be mapped. Reads of sample RNA can be obtained using technology known in the art. Results of RNA reads mapped to a reference can be normalized using PERUN methodology for providing an outcome.

[0210] Microarray nucleic acid levels can serve as nucleic acid indicators. Nucleic acid levels across samples for a particular address, or hybridizing nucleic acid, on an array can be analyzed using PERUN methodology, thereby normalizing nucleic acid indicators provided by microarray analysis. In this manner, a particular address or hybridizing nucleic acid on a microarray is analogous to a portion for mapped nucleic acid sequence reads, and PERUN methodology can be used to normalize microarray data to provide an improved outcome.ChAl Normalization

[0211] Another normalization methodology that can be used to reduce error associated with nucleic acid indicators is referred to herein as ChAl and often makes use of a principal component analysis. A principal component analysis may include (a) filtering, according to a read density distribution, portions of a reference genome, thereby providing a read density profile for a test sample comprising read densities of filtered portions, where the read densities comprise sequence reads of circulating cell-free nucleic acid from a test sample from a pregnant female, and the read density distribution is determined for read densities of portions for multiple samples, (b) adjusting the read density profile for the test sample according to one or more principal components, which principal components are obtained from a set of known euploid samples by a principal component analysis, thereby providing a test sample profile comprising adjusted read densities, and (c) comparing the test sample profile to a reference profile, thereby providing a comparison. A principal component analysis may include (d) determining the presence or absence of a genetic variation for the test sample according to the comparison.Filtering Portions

[0212] One or more portions (e.g., portions of a genome) may be removed from consideration by a filtering process. One or more portions may be filtered (e.g., subjected to a filtering process) thereby providing filtered portions. A filtering process may remove certain portions and retains portions (e.g., a subset of portions). Following a filtering process, retained portions are often referred to herein as filtered portions. Portions of a reference genome may be filtered. Portions of a reference genome that are removed by a filtering process may not be included in a determination of the presence or absence of a genetic variation (e.g., a chromosome aneuploidy, microduplication, microdeletion). Portions associated with read densities (e.g., where a read density is for a portion) may be removed by a filtering process and read densities associated with removed portions may not be included in a determination of the presence or absence of a genetic variation (e.g., a chromosome aneuploidy, microduplication, microdeletion). A read density profile may comprise and / or consist of read densities of filtered portions. Portions can be selected, filtered, and / or removed from consideration using any suitable criteria and / or method known in the art or described herein. Non-limiting examples of criteria used for filtering portions include redundant data (e.g., redundant or overlapping mapped reads), non-informative data (e.g., portions of a reference genome with zero mapped counts), portions of a reference genome with over represented or under represented sequences, GC content, noisy data, mappability, counts, count variability, read density, variability of read density, a measure of uncertainty, a repeatability measure, the like, or combinations of the foregoing. Portions are sometimes filtered according to a distribution of counts and / or a distribution of read densities. Portions may be filtered according to a distribution of counts and / or read densities where the counts and / or read densities are obtained from one or more reference samples. One or more reference samples is sometimes referred to herein as a training set. Portions may be filtered according to a distribution of counts and / or read densities where the counts and / or read densities are obtained from one or more test samples. Portions may be filtered according to a measure of uncertainty for a read density distribution. Portions that demonstrate a large deviation in read densities may be removed by a filtering process. For example, a distribution of read densities (e.g., a distribution of average mean, or median read densities e.g., FIG. 37A) can be determined, where each read density in the distribution maps to the same portion. A measure of uncertainty (e.g., a MAD) can be determined by comparing a distribution of read densities for multiple samples where each portion of a genome is associated with measure of uncertainty. According to the foregoing example, portions can be filtered according to a measure of uncertainty (e.g., a standard deviation (SD), a MAD) associated with each portion and a predetermined threshold. FIG. 37B shows a distribution of MAD values for portions, determined according to read density distributions for multiple samples. A predetermined threshold is indicated by the dashed vertical lines enclosing a range of acceptable MAD values. In the example of FIG. 37B, portions comprising MAD values within the acceptable range are retained and portions comprising MAD values outside of the acceptable range are removed from consideration by a filtering process. According to the foregoing example, portions comprising read densities values (e.g., median, average or mean read densities) outside a pre-determined measure of uncertainty are often removed from consideration by a filtering process. Portions comprising read densities values (e.g., median, average or mean read densities) outside an inter-quartile range of a distribution may be removed from consideration by a filtering process. Portions comprising read densities values outside more than 2 times, 3 times, 4 times or 5 times an inter-quartile range of a distribution may be removed from consideration by a filtering process. Portions comprising read densities values outside more than 2 sigma, 3 sigma, 4 sigma, 5 sigma, 6 sigma, 7 sigma or 8 sigma (e.g., where sigma is a range defined by a standard deviation) may be removed from consideration by a filtering process.

[0213] A system may comprise a filtering module (18, FIG. 42A). A filtering module often accepts, retrieves and / or stores portions (e.g., portions of pre-determined sizes and / or overlap, portion locations within a reference genome) and read densities associated with portions, often from another suitable module (e.g., a distribution module 12, FIG. 42A). Selected portions (e.g., 20 (FIG. 42A), e.g., filtered portions) may be provided by a filtering module. A filtering module may be required to provide filtered portions and / or to remove portions from consideration. A filtering module may remove read densities from consideration where read densities are associated with removed portions. A filtering module often provides selected portions (e.g., filtered portions) to another suitable module (e.g., a distribution module 12, FIG. 42A). A non-limiting example of a filtering module is provided in Example 7.Bias Estimates

[0214] Sequencing technologies can be vulnerable to multiple sources of bias. Sometimes sequencing bias is a local bias (e.g., a local genome bias). Local bias often is manifested at the level of a sequence read. A local genome bias can be any suitable local bias. Non-limiting examples of a local bias include sequence bias (e.g., GC bias, AT bias, and the like), bias correlated with DNase I sensitivity, entropy, repetitive sequence bias, chromatin structure bias, polymerase error-rate bias, palindrome bias, inverted repeat bias, PCR related bias, the like or combinations thereof. The source of a local bias may not be determined or known.

[0215] A local genome bias estimate may be determined. A local genome bias estimate is sometimes referred to herein as a local genome bias estimation. A local genome bias estimate can be determined for a reference genome, a segment or a portion thereof. A local genome bias estimate may be determined for one or more sequence reads (e.g., some or all sequence reads of a sample). A local genome bias estimate is often determined for a sequence read according to a local genome bias estimation for a corresponding location and / or position of a reference (e.g., a reference genome). A local genome bias estimate may comprise a quantitative measure of bias of a sequence (e.g., a sequence read, a sequence of a reference genome). A local genome bias estimation can be determined by a suitable method or mathematical process. A local genome bias estimate may be determined by a suitable distribution and / or a suitable distribution function (e.g., a PDF). A local genome bias estimate may comprise a quantitative representation of a PDF. A local genome bias estimate (e.g., a probability density estimation (PDE), a kernel density estimation) may be determined by a probability density function (e.g., a PDF, e.g., a kernel density function) of a local bias content. A density estimation may comprise a kernel density estimation. A local genome bias estimate is sometimes expressed as an average, mean, or median of a distribution. Sometimes a local genome bias estimate is expressed as a sum or an integral (e.g., an area under a curve (AUC) of a suitable distribution.

[0216] A PDF (e.g., a kernel density function, e.g., an Epanechnikov kernel density function) often comprises a bandwidth variable (e.g., a bandwidth). A bandwidth variable often defines the size and / or length of a window from which a probability density estimate (PDE) is derived when using a PDF. A window from which a PDE is derived often comprises a defined length of polynucleotides. A window from which a PDE may be derived is a portion. A portion (e.g., a portion size, a portion length) is often determined according to a bandwidth variable. A bandwidth variable determines the length or size of the window used to determine a local genome bias estimate. A length of a polynucleotide segment (e.g., a contiguous segment of nucleotide bases) from which a local genome bias estimate is determined. A PDE (e.g., read density, local genome bias estimate (e.g., a GC density)) can be determined using any suitable bandwidth, non-limiting examples of which include a bandwidth of about 5 bases to about 100,000 bases, about 5 bases to about 50,000 bases, about 5 bases to about 25,000 bases, about 5 bases to about 10,000 bases, about 5 bases to about 5,000 bases, about 5 bases to about 2,500 bases, about 5 bases to about 1000 bases, about 5 bases to about 500 bases, about 5 bases to about 250 bases, about 20 bases to about 250 bases, or the like. A local genome bias estimate (e.g., a GC density) may be determined using a bandwidth of about 400 bases or less, about 350 bases or less, about 300 bases or less, about 250 bases or less, about 225 bases or less, about 200 bases or less, about 175 bases or less, about 150 bases or less, about 125 bases or less, about 100 bases or less, about 75 bases or less, about 50 bases or less or about 25 bases or less. A local genome bias estimate (e.g., a GC density) may be determined using a bandwidth determined according to an average, mean, median, or maximum read length of sequence reads obtained for a given subject and / or sample. Sometimes a local genome bias estimate (e.g., a GC density) is determined using a bandwidth about equal to an average, mean, median, or maximum read length of sequence reads obtained for a given subject and / or sample. A local genome bias estimate (e.g., a GC density) may be determined using a bandwidth of about 250, 240, 230, 220, 210, 200, 190, 180, 160, 150, 140, 130, 120, 110, 100, 90, 80, 70, 60, 50, 40, 30, 20 or about 10 bases.

[0217] A local genome bias estimate can be determined at a single base resolution, although local genome bias estimates (e.g., local GC content) can be determined at a lower resolution. A local genome bias estimate may be determined for a local bias content. A local genome bias estimate (e.g., as determined using a PDF) often is determined using a window. A local genome bias estimate may comprises use of a window comprising a pre-selected number of bases. Sometimes a window comprises a segment of contiguous bases. Sometimes a window comprises one or more portions of non-contiguous bases. Sometimes a window comprises one or more portions (e.g., portions of a genome). A window size or length is often determined by a bandwidth and according to a PDF. A window may be about 10 or more, 8 or more, 7 or more, 6 or more, 5 or more, 4 or more, 3 or more, or about 2 or more times the length of a bandwidth. A window is sometimes twice the length of a selected bandwidth when a PDF (e.g., a kernel density function) is used to determine a density estimate. A window may comprise any suitable number of bases. A window may comprise about 5 bases to about 100,000 bases, about 5 bases to about 50,000 bases, about 5 bases to about 25,000 bases, about 5 bases to about 10,000 bases, about 5 bases to about 5,000 bases, about 5 bases to about 2,500 bases, about 5 bases to about 1000 bases, about 5 bases to about 500 bases, about 5 bases to about 250 bases, or about 20 bases to about 250 bases. A genome, or segments thereof, may be partitioned into a plurality of windows. Windows encompassing regions of a genome may or may not overlap. Windows may be positioned at equal distances from each other. Windows may be positioned at different distances from each other. A genome, or segment thereof, may be partitioned into a plurality of sliding windows, where a window is slid incrementally across a genome, or segment thereof, where each window at each increment comprises a local genome bias estimate (e.g., a local GC density). A window can be slid across a genome at any suitable increment, according to any numerical pattern or according to any athematic defined sequence. For a local genome bias estimate determination, a window may be slid across a genome, or a segment thereof, at an increment of about 10,000 bp or more about 5,000 bp or more, about 2,500 bp or more, about 1,000 bp or more, about 750 bp or more, about 500 bp or more, about 400 bases or more, about 250 bp or more, about 100 bp or more, about 50 bp or more, or about 25 bp or more. For a local genome bias estimate determination, a window may be slid across a genome, or a segment thereof, at an increment of about 25, 24, 23, 22, 21, 20, 19, 18, 17, 16, 15, 14, 13, 12, 11, 10, 9, 8, 7, 6, 5, 4, 3, 2, or about 1 bp. For example, for a local genome bias estimate determination, a window may comprise about 400 bp (e.g., a bandwidth of 200 bp) and may be slid across a genome in increments of 1 bp. A local genome bias estimate may be determined for each base in a genome, or segment thereof, using a kernel density function and a bandwidth of about 200 bp.

[0218] A local genome bias estimate may be a local GC content and / or a representation of local GC content. The term "local" as used herein (e.g., as used to describe a local bias, local bias estimate, local bias content, local genome bias, local GC content, and the like) refers to a polynucleotide segment of 10,000 bp or less. The term "local" may refer to a polynucleotide segment of 5000 bp or less, 4000 bp or less, 3000 bp or less, 2000 bp or less, 1000 bp or less, 500 bp or less, 250 bp or less, 200 bp or less, 175 bp or less, 150 bp or less, 100 bp or less, 75 bp or less, or 50 bp or less. A local GC content is often a representation (e.g., a mathematical, a quantitative representation) of GC content for a local segment of a genome, sequence read, sequence read assembly (e.g., a contig, a profile, and the like). For example, a local GC content can be a local GC bias estimate or a GC density.

[0219] One or more GC densities are often determined for polynucleotides of a reference or sample (e.g., a test sample). A GC density may be a representation (e.g., a mathematical, a quantitative representation) of local GC content (e.g., for a polynucleotide segment of 5000 bp or less). A GC density may be a local genome bias estimate. A GC density can be determined using a suitable process described herein and / or known in the art. A GC density can be determined using a suitable PDF (e.g., a kernel density function (e.g., an Epanechnikov kernel density function, e.g., see FIG. 33)). A GC density may be a PDE (e.g., a kernel density estimation). A GC density may be defined by the presence or absence of one or more guanine (G) and / or cytosine (C) nucleotides. Inversely, a GC density can be defined by the presence or absence of one or more a adenine (A) and / or thymidine (T) nucleotides. GC densities for local GC content may be normalized according to GC densities determined for an entire genome, or segment thereof (e.g., autosomes, set of chromosomes, single chromosome, a gene e.g., see FIG. 34). One or more GC densities can be determined for polynucleotides of a sample (e.g., a test sample) or a reference sample. A GC density often is determined for a reference genome. A GC density may be determined for a sequence read according to a reference genome. A GC density of a read is often determined according to a GC density determined for a corresponding location and / or position of a reference genome to which a read is mapped. A GC density determined for a location on a reference genome may be assigned and / or provided for a read, where the read, or a segment thereof, maps to the same location on the reference genome. Any suitable method can be used to determine a location of a mapped read on a reference genome for the purpose of generating a GC density for a read. A median position of a mapped read determines a location on a reference genome from which a GC density for the read is determined. For example, where the median position of a read maps to Chromosome 12 at base number x of a reference genome, the GC density of the read is often provided as the GC density determined by a kernel density estimation for a position located on Chromosome 12 at or near base number x of the reference genome. A GC density may be determined for some or all base positions of a read according to a reference genome. Sometimes a GC density of a read comprises an average, sum, median or integral of two or more GC densities determined for a plurality of base positions on a reference genome.

[0220] A local genome bias estimation (e.g., a GC density) may be quantitated and / or is provided a value. A local genome bias estimation (e.g., a GC density) is sometimes expressed as an average, mean, and / or median. A local genome bias estimation (e.g., a GC density) is sometimes expressed as a maximum peak height of a PDE. Sometimes a local genome bias estimation (e.g., a GC density) is expressed as a sum or an integral (e.g., an area under a curve (AUC)) of a suitable PDE. A GC density may comprise a kernel weight. A GC density of a read may comprise a value about equal to an average, mean, sum, median, maximum peak height or integral of a kernel weight.Bias Frequencies

[0221] Bias frequencies are sometimes determined according to one or more local genome bias estimates (e.g., GC densities). A bias frequency is sometimes a count or sum of the number of occurrences of a local genome bias estimate for a sample, reference (e.g., a reference genome, a reference sequence) or part thereof. A bias frequency is sometimes a count or sum of the number of occurrences of a local genome bias estimate (e.g., each local genome bias estimate) for a sample, reference, or part thereof. A bias frequency may be a GC density frequency. A GC density frequency is often determined according to one or more GC densities. For example, a GC density frequency may represent the number of times a GC density of value x is represented over an entire genome, or a segment thereof. A bias frequency is often a distribution of local genome bias estimates, where the number of occurrences of each local genome bias estimate is represented as a bias frequency (e.g., see FIG. 35). Bias frequencies are sometimes mathematically manipulated and / or normalized. Bias frequencies can be mathematically manipulated and / or normalized by a suitable method. Bias frequencies may be normalized according to a representation (e.g., a fraction, a percentage) of each local genome bias estimate for a sample, reference or part thereof (e.g., autosomes, a subset of chromosomes, a single chromosome, or reads thereof). Bias frequencies can be determined for some or all local genome bias estimates of a sample or reference. Bias frequencies can be determined for local genome bias estimates for some or all sequence reads of a test sample.

[0222] A system may comprise a bias density module 6. A bias density module can accept, retrieve and / or store mapped sequence reads 5 and reference sequences 2 in any suitable format and generate local genome bias estimates, local genome bias distributions, bias frequencies, GC densities, GC density distributions and / or GC density frequencies (collectively represented by box 7). A bias density module may transfer data and / or information (e.g., 7) to another suitable module (e.g., a relationship module 8).Relationships

[0223] One or more relationships may be generated between local genome bias estimates and bias frequencies. The term "relationship" as used herein refers to a mathematical and / or a graphical relationship between two or more variables or values. A relationship can be generated by a suitable mathematical and / or graphical process. Non-limiting examples of a relationship include a mathematical and / or graphical representation of a function, a correlation, a distribution, a linear or non-linear equation, a line, a regression, a fitted regression, the like or a combination thereof. Sometimes a relationship comprises a fitted relationship. A fitted relationship may comprise a fitted regression. Sometimes a relationship comprises two or more variables or values that are weighted. A relationship may comprise a fitted regression where one or more variables or values of the relationship a weighted. Sometimes a regression is fitted in a weighted fashion. Sometimes a regression is fitted without weighting. Generating a relationship comprises plotting or graphing.

[0224] A suitable relationship may be determined between local genome bias estimates and bias frequencies. Generating a relationship between (i) local genome bias estimates and (ii) bias frequencies for a sample may provide a sample bias relationship. Generating a relationship between (i) local genome bias estimates and (ii) bias frequencies for a reference may provide a reference bias relationship. A relationship may be generated between GC densities and GC density frequencies. Generating a relationship between (i) GC densities and (ii) GC density frequencies for a sample may provide a sample GC density relationship. Generating a relationship between (i) GC densities and (ii) GC density frequencies for a reference provides a reference GC density relationship. Where local genome bias estimates are GC densities, a sample bias relationship may be a sample GC density relationship and a reference bias relationship may be a reference GC density relationship. GC densities of a reference GC density relationship and / or a sample GC density relationship are often representations (e.g., mathematical or quantitative representation) of local GC content. A relationship between local genome bias estimates and bias frequencies may comprise a distribution. A relationship between local genome bias estimates and bias frequencies may comprise a fitted relationship (e.g., a fitted regression). A relationship between local genome bias estimates and bias frequencies may comprise a fitted linear or non-linear regression (e.g., a polynomial regression). A relationship between local genome bias estimates and bias frequencies may comprise a weighted relationship where local genome bias estimates and / or bias frequencies are weighted by a suitable process. A weighted fitted relationship (e.g., a weighted fitting) can be obtained by a process comprising a quantile regression, parameterized distributions or an empirical distribution with interpolation. A relationship between local genome bias estimates and bias frequencies for a test sample, a reference or part thereof, may comprise a polynomial regression where local genome bias estimates are weighted. A weighed fitted model may comprise weighting values of a distribution.

[0225] Values of a distribution can be weighted by a suitable process. Values located near tails of a distribution may be provided less weight than values closer to the median of the distribution. For example, for a distribution between local genome bias estimates (e.g., GC densities) and bias frequencies (e.g., GC density frequencies), a weight is determined according to the bias frequency for a given local genome bias estimate, where local genome bias estimates comprising bias frequencies closer to the mean of a distribution are provided greater weight than local genome bias estimates comprising bias frequencies further from the mean.

[0226] A system may comprise a relationship module 8. A relationship module can generate relationships as well as functions, coefficients, constants and variables that define a relationship. A relationship module can accept, store and / or retrieve data and / or information (e.g., 7) from a suitable module (e.g., a bias density module 6) and generate a relationship. A relationship module often generates and compares distributions of local genome bias estimates. A relationship module can compare data sets and sometimes generate regressions and / or fitted relationships. A relationship module may compare one or more distributions (e.g., distributions of local genome bias estimates of samples and / or references) and provides weighting factors and / or weighting assignments 9 for counts of sequence reads to another suitable module (e.g., a bias correction module). Sometimes a relationship module provides normalized counts of sequence reads directly to a distribution module 21 where the counts are normalized according to a relationship and / or a comparison.Generating a comparison and use thereof

[0227] A process for reducing local bias in sequence reads may comprise normalizing counts of sequence reads. Counts of sequence reads are often normalized according to a comparison of a test sample to a reference. For example, sometimes counts of sequence reads are normalized by comparing local genome bias estimates of sequence reads of a test sample to local genome bias estimates of a reference (e.g., a reference genome, or part thereof). Counts of sequence reads may be normalized by comparing bias frequencies of local genome bias estimates of a test sample to bias frequencies of local genome bias estimates of a reference. Counts of sequence reads may be normalized by comparing a sample bias relationship and a reference bias relationship, thereby generating a comparison.

[0228] Counts of sequence reads are often normalized according to a comparison of two or more relationships. Two or more relationships may be compared thereby providing a comparison that is used for reducing local bias in sequence reads (e.g., normalizing counts). Two or more relationships can be compared by a suitable method. A comparison may comprise adding, subtracting, multiplying and / or dividing a first relationship from a second relationship. Comparing two or more relationships may comprise a use of a suitable linear regression and / or a non-linear regression. Comparing two or more relationships may comprise a suitable polynomial regression (e.g., a 3 rd< order polynomial regression). A comparison may comprise adding, subtracting, multiplying and / or dividing a first regression from a second regression. Two or more relationships may be compared by a process comprising an inferential framework of multiple regressions. Two or more relationships may be compared by a process comprising a suitable multivariate analysis. Two or more relationships may be compared by a process comprising a basis function (e.g., a blending function, e.g., polynomial bases, Fourier bases, or the like), splines, a radial basis function and / or wavelets.

[0229] A distribution of local genome bias estimates comprising bias frequencies for a test sample and a reference may be compared by a process comprising a polynomial regression where local genome bias estimates are weighted. A polynomial regression may be generated between (i) ratios, each of which ratios comprises bias frequencies of local genome bias estimates of a reference and bias frequencies of local genome bias estimates of a sample and (ii) local genome bias estimates. A polynomial regression may be generated between (i) a ratio of bias frequencies of local genome bias estimates of a reference to bias frequencies of local genome bias estimates of a sample and (ii) local genome bias estimates. A comparison of a distribution of local genome bias estimates for reads of a test sample and a reference may comprise determining a log ratio (e.g., a log2 ratio) of bias frequencies of local genome bias estimates for the reference and the sample. A comparison of a distribution of local genome bias estimates may comprise dividing a log ratio (e.g., a log2 ratio) of bias frequencies of local genome bias estimates for the reference by a log ratio (e.g., a log2 ratio) of bias frequencies of local genome bias estimates for the sample (e.g., see Example 7 and FIG. 36).

[0230] Normalizing counts according to a comparison typically adjusts some counts and not others. Normalizing counts sometimes adjusts all counts and sometimes does not adjust any counts of sequence reads. A count for a sequence read sometimes is normalized by a process that comprises determining a weighting factor and sometimes the process does not include directly generating and utilizing a weighting factor. Normalizing counts according to a comparison sometimes comprises determining a weighting factor for each count of a sequence read. A weighting factor is often specific to a sequence read and is applied to a count of a specific sequence read. A weighting factor is often determined according to a comparison of two or more bias relationships (e.g., a sample bias relationship compared to a reference bias relationship). A normalized count is often determined by adjusting a count value according to a weighting factor. Adjusting a count according to a weighting factor sometimes includes adding, subtracting, multiplying and / or dividing a count for a sequence read by a weighting factor. A weighting factor and / or a normalized count is sometimes determined from a regression (e.g., a regression line). A normalized count is sometimes obtained directly from a regression line (e.g., a fitted regression line) resulting from a comparison between bias frequencies of local genome bias estimates of a reference (e.g., a reference genome) and a test sample. Each count of a read of a sample may be provided a normalized count value according to a comparison of (i) bias frequencies of a local genome bias estimates of reads compared to (ii) bias frequencies of a local genome bias estimates of a reference. Counts of sequence reads obtained for a sample may be normalized and bias in the sequence reads is reduced.

[0231] Sometimes a system comprises a bias correction module 10. Functions of a bias correction module may be performed by a relationship modeling module 8. A bias correction module can accept, retrieve, and / or store mapped sequence reads and weighting factors (e.g., 9) from a suitable module (e.g., a relationship module 8, a compression module 4). A bias correction module may provide a count to mapped reads. A bias correction module may apply weighting assignments and / or bias correction factors to counts of sequence reads thereby providing normalized and / or adjusted counts. A bias correction module often provides normalized counts to another suitable module (e.g., a distribution module 21).

[0232] Normalizing counts may comprise factoring one or more features in addition to GC density, and normalizing counts of the sequence reads. Normalizing counts may comprise factoring one or more different local genome bias estimates, and normalizing counts of the sequence reads. Counts of sequence reads may be weighted according to a weighting determined according to one or more features (e.g., one or more biases). Counts may be normalized according to one or more combined weights. Sometimes factoring one or more features and / or normalizing counts according to one or more combined weights is by a process comprising use of a multivariate model. Any suitable multivariate model can be used to normalize counts. Non-limiting examples of a multivariate model include a multivariate linear regression, multivariate quantile regression, a multivariate interpolation of empirical data, a non-linear multivariate model, the like, or a combination thereof.

[0233] A system may comprise a multivariate correction module 13. A multivariate correction module can perform functions of a bias density module 6, relationship module 8 and / or a bias correction module 10 multiple times thereby adjusting counts for multiple biases. A multivariate correction module may comprise one or more bias density modules 6, relationship modules 8 and / or bias correction modules 10. Sometimes a multivariate correction module provides normalized counts 11 to another suitable module (e.g., a distribution module 21).Weighted portions

[0234] Portions may be weighted. One or more portions may be weighted thereby providing weighted portions. Weighting portions sometimes removes portion dependencies. Portions can be weighted by a suitable process. In One or more portions may be weighted by an eigen function (e.g., an eigenfunction). An eigen function may comprise replacing portions with orthogonal eigen-portions. A system may comprise a portion weighting module 42. A weighting module may accept, retrieve and / or store read densities, read density profiles, and / or adjusted read density profiles. Weighted portions may be provided by a portion weighting module. A weighting module may be required to weight portions. A weighting module can weight portions by one or more weighting methods known in the art or described herein. A weighting module often provides weighted portions to another suitable module (e.g., a scoring module 46, a PCA statistics module 33, a profile generation module 26 and the like).Principal component analysis

[0235] A read density profile (e.g., a read density profile of a test sample (e.g., FIG. 39A) may be adjusted according to a principal component analysis (PCA). A read density profile of one or more reference samples and / or a read density profile of a test subject can be adjusted according to a PCA. Removing bias from a read density profile by a PCA related process is sometimes referred to herein as adjusting a profile. A PCA can be performed by a suitable PCA method, or a variation thereof. Non-limiting examples of a PCA method include a canonical correlation analysis (CCA), a Karhunen-Loève transform (KLT), a Hotelling transform, a proper orthogonal decomposition (POD), a singular value decomposition (SVD) of X, an eigenvalue decomposition (EVD) of XTX, a factor analysis, an Eckart-Young theorem, a Schmidt-Mirsky theorem, empirical orthogonal functions (EOF), an empirical eigenfunction decomposition, an empirical component analysis, quasiharmonic modes, a spectral decomposition, an empirical modal analysis, the like, variations or combinations thereof. A PCA often identifies one or more biases in a read density profile. A bias identified by a PCA is sometimes referred to herein as a principal component. One or more biases can be removed by adjusting a read density profile according to one or more principal component using a suitable method. A read density profile can be adjusted by adding, subtracting, multiplying and / or dividing one or more principal components from a read density profile. One or more biases can be removed from a read density profile by subtracting one or more principal components from a read density profile. Although bias in a read density profile is often identified and / or quantitated by a PCA of a profile, principal components are often subtracted from a profile at the level of read densities. A PCA often identifies one or more principal components. A PCA may identify a 1 st< , 2 nd< , 3 rd< , 4 th< , 5 th< 6 th< 7 th< 8 th< , 9 th< , and a 10 th< or more principal components. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 or more principal components may be used to adjust a profile. Often, principal components are used to adjust a profile in the order of there appearance in a PCA. For example, where three principal components are subtracted from a read density profile, a 1 st< , 2 nd< and 3 rd< principal component are used. Sometimes a bias identified by a principal component comprises a feature of a profile that is not used to adjust a profile. For example, a PCA may identify a genetic variation (e.g., an aneuploidy, microduplication, microdeletion, deletion, translocation, insertion) and / or a gender difference (e.g., as seen in FIG. 38C) as a principal component. Thus, one or more principal components are not used to adjust a profile. For example, sometimes a 1 st< , 2 nd< and 4 th< principal component are used to adjust a profile where a 3 rd< principal component is not used to adjust a profile. A principal component can be obtained from a PCA using any suitable sample or reference. Principal components may be obtained from a test sample (e.g., a test subject). Principal components may be obtained from one or more references (e.g., reference samples, reference sequences, a reference set). As shown, for example, in FIGs. 38A-C a PCA is performed on a median read density profile obtained from a training set (FIG. 38A) comprising multiple samples resulting in the identification of a 1 st< principal component (FIG. 38B) and a second principal component (FIG. 38C). Principal components may be obtained from a set of subjects known to be devoid of a genetic variation in question. Principal components may be obtained from a set of known euploids. Principal component are often identified according to a PCA performed using one or more read density profiles of a reference (e.g., a training set). One or more principal components obtained from a reference are often subtracted from a read density profile of a test subject (e.g., FIG. 39B) thereby providing an adjusted profile (e.g., FIG. 39C).

[0236] A system may comprise a PCA statistics module 33. A PCA statistics module can accepts and / or retrieve read density profiles from another suitable module (e.g., a profile generation module 26). A PCA is often performed by a PCA statistics module. A PCA statistics module often accepts, retrieves and / or stores read density profiles and processes read density profiles from a reference set 32, training set 30 and / or from one or more test subjects 28. A PCA statistics module can generate and / or provide principal components and / or adjust read density profiles according to one or more principal components. Adjusted read density profiles (e.g., 40, 38) are often provided by a PCA statistics module. A PCA statistics module can provide and / or transfer adjusted read density profiles (e.g., 38, 40) to another suitable module (e.g., a portion weighting module 42, a scoring module 46). A PCA statistics module can provide a gender call 36. A gender call is sometimes a determination of fetal gender determined according to a PCA and / or according to one or more principal components. A PCA statistics module may comprise some, all or a modification of the R code shown below. An R code for computing principal components generally starts with cleaning the data (e.g., subtracting median, filtering portions, and trimming extreme values):

[0237] Determining an outcome may comprise a comparison. A read density profile, or a portion thereof, may be utilized to provide an outcome. Determining an outcome (e.g., a determination of the presence or absence of a genetic variation) may comprise a comparison of two or more read density profiles. Comparing read density profiles often comprises comparing read density profiles generated for a selected segment of a genome. For example, a test profile is often compared to a reference profile where the test and reference profiles were determined for a segment of a genome (e.g., a reference genome) that is substantially the same segment. Comparing read density profiles sometimes comprises comparing two or more subsets of portions of a read density profile. A subset of portions of a read density profile may represent a segment of a genome (e.g., a chromosome, or segment thereof). A read density profile can comprise any amount of subsets of portions. Sometimes a read density profile comprises two or more, three or more, four or more, or five or more subsets. A read density profile may comprise two subsets of portions where each portion represents segments of a reference genome that are adjacent. A test profile can be compared to a reference profile where the test profile and reference profile both comprise a first subset of portions and a second subset of portions where the first and second subsets represent different segments of a genome. Some subsets of portions of a read density profile may comprise genetic variations and other subsets of portions are sometimes substantially free of genetic variations. Sometimes all subsets of portions of a profile (e.g., a test profile) are substantially free of a genetic variation. Sometimes all subsets of portions of a profile (e.g., a test profile) comprise a genetic variation. A test profile can comprise a first subset of portions that comprise a genetic variation and a second subset of portions that are substantially free of a genetic variation.

[0238] Methods described herein may comprise performing a comparison (e.g., comparing a test profile to a reference profile). Two or more data sets, two or more relationships and / or two or more profiles can be compared by a suitable method. Non-limiting examples of statistical methods suitable for comparing data sets, relationships and / or profiles include Behrens-Fisher approach, bootstrapping, Fisher's method for combining independent tests of significance, Neyman-Pearson testing, confirmatory data analysis, exploratory data analysis, exact test, F-test, Z-test, T-test, calculating and / or comparing a measure of uncertainty, a null hypothesis, counternulls and the like, a chi-square test, omnibus test, calculating and / or comparing level of significance (e.g., statistical significance), a meta analysis, a multivariate analysis, a regression, simple linear regression, robust linear regression, the like or combinations of the foregoing. Comparing two or more data sets, relationships and / or profiles may comprise determining and / or comparing a measure of uncertainty. A "measure of uncertainty" as used herein refers to a measure of significance (e.g., statistical significance), a measure of error, a measure of variance, a measure of confidence, the like or a combination thereof. A measure of uncertainty can be a value (e.g., a threshold) or a range of values (e.g., an interval, a confidence interval, a Bayesian confidence interval, a threshold range). Non-limiting examples of a measure of uncertainty include p-values, a suitable measure of deviation (e.g., standard deviation, sigma, absolute deviation, mean absolute deviation, the like), a suitable measure of error (e.g., standard error, mean squared error, root mean squared error, the like), a suitable measure of variance, a suitable standard score (e.g., standard deviations, cumulative percentages, percentile equivalents, Z-scores, T-scores, R-scores, standard nine (stanine), percent in stanine, the like), the like or combinations thereof. Determining the level of significance may comprise determining a measure of uncertainty (e.g., a p-value). Two or more data sets, relationships and / or profiles can be analyzed and / or compared by utilizing multiple (e.g., 2 or more) statistical methods (e.g., least squares regression, principle component analysis, linear discriminant analysis, quadratic discriminant analysis, bagging, neural networks, support vector machine models, random forests, classification tree models, K-nearest neighbors, logistic regression and / or loss smoothing) and / or any suitable mathematical and / or statistical manipulations (e.g., referred to herein as manipulations).

[0239] Comparing two or more read density profiles may comprise determining and / or comparing a measure of uncertainty for two or more read density profiles. Read density profiles and / or associated measures of uncertainty are sometimes compared to facilitate interpretation of mathematical and / or statistical manipulations of a data set and / or to provide an outcome. A read density profile generated for a test subject sometimes is compared to a read density profile generated for one or more references (e.g., reference samples, reference subjects, and the like). An outcome may be provided by comparing a read density profile from a test subject to a read density profile from a reference for a chromosome, portions or segments thereof, where a reference read density profile is obtained from a set of reference subjects known not to possess a genetic variation (e.g., a reference). An outcome may be provided by comparing a read density profile from a test subject to a read density profile from a reference for a chromosome, portions or segments thereof, where a reference read density profile is obtained from a set of reference subjects known to possess a specific genetic variation (e.g., a chromosome aneuploidy, a trisomy, a microduplication, a microdeletion).

[0240] A read density profile of a test subject may be compared to a predetermined value representative of the absence of a genetic variation, and sometimes deviates from a predetermined value at one or more genomic locations (e.g., portions) corresponding to a genomic location in which a genetic variation is located. For example, in test subjects (e.g., subjects at risk for, or suffering from a medical condition associated with a genetic variation), read density profiles are expected to differ significantly from read density profiles of a reference (e.g., a reference sequence, reference subject, reference set) for selected portions when a test subject comprises a genetic variation in question. Read density profiles of a test subject are often substantially the same as read density profiles of a reference (e.g., a reference sequence, reference subject, reference set) for selected portions when a test subject does not comprise a genetic variation in question. Read density profiles are often compared to a predetermined threshold and / or threshold range (e.g., see FIG. 40). The term "threshold" as used herein refers to any number that is calculated using a qualifying data set and serves as a limit of diagnosis of a genetic variation (e.g., a copy number variation, an aneuploidy, a chromosomal aberration, a microduplication, a microdeletion, and the like). A threshold may be exceeded by results obtained by methods described herein and a subject is diagnosed with a genetic variation (e.g., a trisomy). A threshold value or range of values often may be calculated by mathematically and / or statistically manipulating sequence read data (e.g., from a reference and / or subject). A predetermined threshold or threshold range of values indicative of the presence or absence of a genetic variation can vary while still providing an outcome useful for determining the presence or absence of a genetic variation. A read density profile comprising normalized read densities and / or normalized counts may be generated to facilitate classification and / or providing an outcome. An outcome can be provided based on a plot of a read density profile comprising normalized counts (e.g., using a plot of such a read density profile).

[0241] A system may comprise a scoring module 46. A scoring module can accept, retrieve and / or store read density profiles (e.g., adjusted, normalized read density profiles) from another suitable module (e.g., a profile generation module 26, a PCA statistics module 33, a portion weighting module 42, and the like). A scoring module can accept, retrieve, store and / or compare two or more read density profiles (e.g., test profiles, reference profiles, training sets, test subjects). A scoring module can often provide a score (e.g., a plot, profile statistics, a comparison (e.g., a difference between two or more profiles), a Z-score, a measure of uncertainty, a call zone, a sample call 50 (e.g., a determination of the presence or absence of a genetic variation), and / or an outcome). A scoring module can provide a score to an end user and / or to another suitable module (e.g., a display, printer, the like). A scoring module may comprise some, all or a modification of the R code shown below which comprises an R function for computing Chi-square statistics for a specific test (e.g., High-chr21 counts).

[0242] A hybrid normalization method may be used. A hybrid normalization method may reduce bias (e.g., GC bias). A hybrid normalization may comprise (i) an analysis of a relationship of two variables (e.g., counts and GC content) and (ii) selection and application of a normalization method according to the analysis. A hybrid normalization may comprise (i) a regression (e.g., a regression analysis) and (ii) selection and application of a normalization method according to the regression. Counts obtained for a first sample (e.g., a first set of samples) may be normalized by a different method than counts obtained from another sample (e.g., a second set of samples). Counts obtained for a first sample (e.g., a first set of samples) are normalized by a first normalization method and counts obtained from a second sample (e.g., a second set of samples) are normalized by a second normalization method. For example, a first normalization method may comprise use of a linear regression and a second normalization method comprises use of a non-linear regression (e.g., a LOESS, GC-LOESS, LOWESS regression, LOESS smoothing).

[0243] A hybrid normalization method may be used to normalize sequence reads mapped to portions of a genome or chromosome (e.g., counts, mapped counts, mapped reads). Raw counts may be normalized and adjusted, weighted, filtered or previously normalized counts may be normalized by a hybrid normalization method. Genomic section levels or Z-scores may be normalized. In Counts mapped to selected portions of a genome or chromosome may be normalized by a hybrid normalization approach. Counts can refer to a suitable measure of sequence reads mapped to portions of a genome, non-limiting examples of which include raw counts (e.g., unprocessed counts), normalized counts (e.g., normalized by PERUN, ChAl or a suitable method), portion levels (e.g., average levels, mean levels, median levels, or the like), Z-scores, the like, or combinations thereof. The counts can be raw counts or processed counts from one or more samples (e.g., a test sample, a sample from a pregnant female). Counts may be obtained from one or more samples obtained from one or more subjects.

[0244] A normalization method (e.g., the type of normalization method) may be selected according to a regression (e.g., a regression analysis) and / or a correlation coefficient. A regression analysis refers to a statistical technique for estimating a relationship among variables (e.g., counts and GC content). A regression may be generated according to counts and a measure of GC content for each portion of multiple portions of a reference genome. A suitable measure of GC content can be used, non-limiting examples of which include a measure of guanine, cytosine, adenine, thymine, purine (GC), or pyrimidine (AT or ATU) content, melting temperature (T m ) (e.g., denaturation temperature, annealing temperature, hybridization temperature), a measure of free energy, the like or combinations thereof. A measure of guanine (G), cytosine (C), adenine (A), thymine (T), purine (GC), or pyrimidine (AT or ATU) content can be expressed as a ratio or a percentage. Any suitable ratio or percentage may be used, non-limiting examples of which include GC / AT, GC / total nucleotide, GC / A, GC / T, AT / total nucleotide, AT / GC, AT / G, AT / C, G / A, C / A, G / T, G / A, G / AT, C / T, the like or combinations thereof. A measure of GC content may be a ratio or percentage of GC to total nucleotide content. A measure of GC content may be a ratio or percentage of GC to total nucleotide content for sequence reads mapped to a portion of reference genome. The GC content may be determined according to and / or from sequence reads mapped to each portion of a reference genome and the sequence reads are obtained from a sample (e.g., a sample obtained from a pregnant female). A measure of GC content may be not determined according to and / or from sequence reads. A measure of GC content may be determined for one or more samples obtained from one or more subjects.

[0245] Generating a regression may comprise generating a regression analysis or a correlation analysis. A suitable regression can be used, non-limiting examples of which include a regression analysis, (e.g., a linear regression analysis), a goodness of fit analysis, a Pearson's correlation analysis, a rank correlation, a fraction of variance unexplained, Nash-Sutcliffe model efficiency analysis, regression model validation, proportional reduction in loss, root mean square deviation, the like or a combination thereof. A regression line may be generated. Generating a regression may comprise generating a linear regression. Generating a regression may comprise generating a non-linear regression (e.g., an LOESS regression, an LOWESS regression).

[0246] A regression may determine the presence or absence of a correlation (e.g., a linear correlation), for example between counts and a measure of GC content. A regression (e.g., a linear regression) may be generated and a correlation coefficient is determined. A suitable correlation coefficient may be determined, non-limiting examples of which include a coefficient of determination, an R 2< value, a Pearson's correlation coefficient, or the like.

[0247] Goodness of fit may be determined for a regression (e.g., a regression analysis, a linear regression). Goodness of fit sometimes is determined by visual or mathematical analysis. An assessment sometimes includes determining whether the goodness of fit is greater for a non-linear regression or for a linear regression. A correlation coefficient may be a measure of a goodness of fit. An assessment of a goodness of fit for a regression may be determined according to a correlation coefficient and / or a correlation coefficient cutoff value. An assessment of a goodness of fit may comprise comparing a correlation coefficient to a correlation coefficient cutoff value. An assessment of a goodness of fit for a regression is indicative of a linear regression. For example, a goodness of fit may be greater for a linear regression than for a non-linear regression and the assessment of the goodness of fit is indicative of a linear regression. An assessment may be indicative of a linear regression and a linear regression is used to normalized the counts. An assessment of a goodness of fit for a regression may be indicative of a non-linear regression. For example, a goodness of fit may be greater for a non-linear regression than for a linear regression and the assessment of the goodness of fit is indicative of a non-linear regression. An assessment may be indicative of a non-linear regression and a non-linear regression is used to normalized the counts.

[0248] An assessment of a goodness of fit may be indicative of a linear regression when a correlation coefficient is equal to or greater than a correlation coefficient cutoff. An assessment of a goodness of fit may be indicative of a non-linear regression when a correlation coefficient is less than a correlation coefficient cutoff. A correlation coefficient cutoff may be pre-determined. A correlation coefficient cut-off may be about 0.5 or greater, about 0.55 or greater, about 0.6 or greater, about 0.65 or greater, about 0.7 or greater, about 0.75 or greater, about 0.8 or greater or about 0.85 or greater.

[0249] For example, a normalization method comprising a linear regression may be used when a correlation coefficient is equal to or greater than about 0.6. Counts of a sample (e.g., counts per portion of a reference genome, counts per portion) may be normalized according to a linear regression when a correlation coefficient is equal to or greater than a correlation coefficient cut-off of 0.6, otherwise the counts are normalized according to a non-linear regression (e.g., when the coefficient is less than a correlation coefficient cut-off of 0.6). A normalization process may comprise generating a linear regression or non-linear regression for the (i) the counts and (ii) the GC content, for each portion of multiple portions of a reference genome. A normalization method comprising a non-linear regression (e.g., a LOWESS, a LOESS) may be used when a correlation coefficient is less than a correlation coefficient cut-off of 0.6. A normalization method comprising a non-linear regression (e.g., a LOWESS) may be used when a correlation coefficient (e.g., a correlation coefficient) is less than a correlation coefficient cut-off of about 0.7, less than about 0.65, less than about 0.6, less than about 0.55 or less than about 0.5. For example, a normalization method comprising a non-linear regression (e.g., a LOWESS, a LOESS) may be used when a correlation coefficient is less than a correlation coefficient cut-off of about 0.6.

[0250] A specific type of regression may be selected (e.g., a linear or non-linear regression) and, after the regression is generated, counts may be normalized by subtracting the regression from the counts. Subtracting a regression from the counts may provide normalized counts with reduced bias (e.g., GC bias). A linear regression may be subtracted from the counts. A non-linear regression (e.g., a LOESS, GC-LOESS, LOWESS regression) may be subtracted from the counts. Any suitable method can be used to subtract a regression line from the counts. For example, if counts x are derived from portion i (e.g., a portion i) comprising a GC content of 0.5 and a regression line determines counts y at a GC content of 0.5, then x-y = normalized counts for portion i. Counts may be normalized prior to and / or after subtracting a regression. Counts normalized by a hybrid normalization approach may be used to generate genomic section levels, Z-cores, levels and / or profiles of a genome or a segment thereof. Counts normalized by a hybrid normalization approach may be analyzed by methods described herein to determine the presence or absence of a genetic variation (e.g., in a fetus).

[0251] A hybrid normalization method may comprise filtering or weighting one or more portions before or after normalization. A suitable method of filtering portions, including methods of filtering portions (e.g., portions of a reference genome) described herein can be used. Portions (e.g., portions of a reference genome) may be filtered prior to applying a hybrid normalization method. Only counts of sequencing reads mapped to selected portions (e.g., portions selected according to count variability) may be normalized by a hybrid normalization. Counts of sequencing reads mapped to filtered portions of a reference genome (e.g., portions filtered according to count variability) may be removed prior to utilizing a hybrid normalization method. A hybrid normalization method may comprise selecting or filtering portions (e.g., portions of a reference genome) according to a suitable method (e.g., a method described herein). A hybrid normalization method may comprise selecting or filtering portions (e.g., portions of a reference genome) according to an uncertainty value for counts mapped to each of the portions for multiple test samples. A hybrid normalization method may comprise selecting or filtering portions (e.g., portions of a reference genome) according to count variability. A hybrid normalization method may comprise selecting or filtering portions (e.g., portions of a reference genome) according to GC content, repetitive elements, repetitive sequences, introns, exons, the like or a combination thereof.

[0252] For example, multiple samples from multiple pregnant female subjects are analyzed and a subset of portions (e.g., portions of a reference genome) is selected according to count variability. A linear regression may be used to determine a correlation coefficient for (i) counts and (ii) GC content, for each of the selected portions for a sample obtained from a pregnant female subject. A correlation coefficient may be determined that is greater than a pre-determined correlation cutoff value (e.g., of about 0.6), an assessment of the goodness of fit is indicative of a linear regression and the counts are normalized by subtracting the linear regression from the counts. A correlation coefficient may be determined that is less than a pre-determined correlation cutoff value (e.g., of about 0.6), an assessment of the goodness of fit is indicative of a non-linear regression, an LOESS regression is generated and the counts are normalized by subtracting the LOESS regression from the counts.Profiles

[0253] A processing step can comprise generating one or more profiles (e.g., profile plot) from various aspects of a data set or derivation thereof (e.g., product of one or more mathematical and / or statistical data processing steps known in the art and / or described herein).

[0254] The term "profile" as used herein refers to a product of a mathematical and / or statistical manipulation of data that can facilitate identification of patterns and / or correlations in large quantities of data. A "profile" often includes values resulting from one or more manipulations of data or data sets, based on one or more criteria. A profile often includes multiple data points. Any suitable number of data points may be included in a profile depending on the nature and / or complexity of a data set. Profiles may include 2 or more data points, 3 or more data points, 5 or more data points, 10 or more data points, 24 or more data points, 25 or more data points, 50 or more data points, 100 or more data points, 500 or more data points, 1000 or more data points, 5000 or more data points, 10,000 or more data points, or 100,000 or more data points.

[0255] A profile may be representative of the entirety of a data set, a profile may be representative of a part or subset of a data set. That is, a profile sometimes includes or is generated from data points representative of data that has not been filtered to remove any data, and sometimes a profile includes or is generated from data points representative of data that has been filtered to remove unwanted data. A data point in a profile may represent the results of data manipulation for a portion. A data point in a profile may include results of data manipulation for groups of portions. Groups of portions may be adjacent to one another, and groups of portions may be from different parts of a chromosome or genome.

[0256] Data points in a profile derived from a data set can be representative of any suitable data categorization. Non-limiting examples of categories into which data can be grouped to generate profile data points include: portions based on size, portions based on sequence features (e.g., GC content, AT content, position on a chromosome (e.g., short arm, long arm, centromere, telomere), and the like), levels of expression, chromosome, the like or combinations thereof. A profile may be generated from data points obtained from another profile (e.g., normalized data profile renormalized to a different normalizing value to generate a renormalized data profile). A profile generated from data points obtained from another profile may reduce the number of data points and / or complexity of the data set. Reducing the number of data points and / or complexity of a data set often facilitates interpretation of data and / or facilitates providing an outcome.

[0257] A profile (e.g., a genomic profile, a chromosome profile, a profile of a segment of a chromosome) often is a collection of normalized or non-normalized counts for two or more portions. A profile often includes at least one level (e.g., a genomic section level), and often comprises two or more levels (e.g., a profile often has multiple levels). A level generally is for a set of portions having about the same counts or normalized counts. Levels are described in greater detail herein. A profile may comprise one or more portions, which portions can be weighted, removed, filtered, normalized, adjusted, averaged, derived as a mean, added, subtracted, processed or transformed by any combination thereof. A profile often comprises normalized counts mapped to portions defining two or more levels, where the counts are further normalized according to one of the levels by a suitable method. Often counts of a profile (e.g., a profile level) are associated with an uncertainty value.

[0258] A profile comprising one or more levels is sometimes padded (e.g., hole padding). Padding (e.g., hole padding) refers to a process of identifying and adjusting levels in a profile that are due to maternal microdeletions or maternal duplications (e.g., copy number variations). Levels may be padded that are due to fetal microduplications or fetal microdeletions. Microduplications or microdeletions in a profile can artificially raise or lower the overall level of a profile (e.g., a profile of a chromosome) leading to false positive or false negative determinations of a chromosome aneuploidy (e.g., a trisomy). Levels in a profile that are due to microduplications and / or deletions may be identified and adjusted (e.g., padded and / or removed) by a process sometimes referred to as padding or hole padding. A profile may comprise one or more first levels that are significantly different than a second level within the profile, each of the one or more first levels comprise a maternal copy number variation, fetal copy number variation, or a maternal copy number variation and a fetal copy number variation and one or more of the first levels are adjusted.

[0259] A profile comprising one or more levels can include a first level and a second level. A first level may be different (e.g., significantly different) than a second level. A first level may comprise a first set of portions, a second level comprises a second set of portions and the first set of portions is not a subset of the second set of portions. A first set of portions may be different than a second set of portions from which a first and second level are determined. A profile can have multiple first levels that ...

Claims

1. A computer-implemented method for determining the presence or absence of a chromosome aneuploidy, microduplication or microdeletion in a fetus, comprising: (a) normalizing counts of nucleotide sequence reads mapped to portions of a reference genome, which sequence reads are 1) reads of circulating cell-free nucleic acid from a test sample from a pregnant female bearing a fetus and 2) reads from nucleic acid fragments having lengths less than or equal to a selected fragment length, thereby providing normalized counts; (b) segmenting by a first segmenting process comprising a wavelet segmenting process and a second segmenting process comprising a circular binary segmentation process the normalized counts of the portions or the normalized counts in a subset of the portions, thereby providing one or more discrete segments; (c) identifying a candidate segment among the one or more discrete segments; and (d) determining the presence or absence of a chromosome aneuploidy, microduplication or microdeletion according to the candidate segment.

2. A computer-implemented method for determining the presence or absence of a chromosome aneuploidy, microduplication or microdeletion in a subject, comprising: (a) normalizing counts of nucleotide sequence reads mapped to portions of a reference genome, which sequence reads are 1) reads of circulating cell-free nucleic acid from a test sample from a subject and 2) reads from nucleic acid fragments having lengths less than or equal to a selected fragment length, thereby providing normalized counts; (b) segmenting by a first segmenting process comprising a wavelet segmenting process and a second segmenting process comprising a circular binary segmentation process the normalized counts of the portions or the normalized counts in a subset of the portions, thereby providing one or more discrete segments; (c) identifying a candidate segment among the one or more discrete segments; and (d) determining the presence or absence of a chromosome aneuploidy, microduplication or microdeletion according to the candidate segment.

3. The method of claim 2, wherein the chromosome aneuploidy, microduplication or microdeletion is from cancer cell nucleic acid in the subject.

4. The method of any one of claims 1 to 3, comprising sequencing nucleic acid by a nucleotide sequencing process to generate nucleotide sequence reads.

5. The method of claim 4, wherein the nucleotide sequencing process comprises a paired end nucleotide sequencing process.

6. The method of claim 5, wherein the nucleotide sequence reads comprise paired end nucleotide sequence reads.

7. The method of any one of claims 1 to 6, wherein the test sample is blood, blood serum, blood plasma or urine.

8. The method of any one of claims 4 to 7 as far as referring back to claim 2, wherein the chromosome aneuploidy, microduplication or microdeletion is from cancer cell nucleic acid in the subject.