Insertions and deletions (indels) make a critical contribution to human genetic variation. While indel calling has improved significantly, it lags dramatically in performance relative to single-nucleotide variant calling, something of particular concern for clinical genomics where larger scale disruption of the open reading frame can commonly cause disease. Here, we present a machine learning-based approach to the detection of indel breakpoints called Scotch . This novel approach improves sensitivity to larger variants dramatically by leveraging sequencing metrics and signatures of poor read alignment. We also introduce a meta-analytic indel caller, called Metal, that performs a “smart intersection” of Scotch and currently available tools to be maximally sensitive to large variants. We use new benchmark datasets and Sanger sequencing to compare Scotch and Metal to current gold standard indel callers, achieving unprecedented levels of precision and recall. We demonstrate the impact of these improvements by applying this tool to a cohort of patients with undiagnosed disease, generating plausible novel candidates in 21 out of 26 undiagnosed cases. We highlight the diagnosis of one patient with a 498-bp deletion in HNRNPA1 missed by traditional indel-detection tools.

Machine learning-based detection of insertions and deletions in the human genome