Cited by 0Genetic Neurodegenerative DiseasesGenomics and Rare DiseasesGenetics and Neurodevelopmental Disorders

The genetic architecture of pentanucleotide repeat variation and disease association

Xu, Isaac R.L., Pellerin, David, Van De Vondel, Liedewei, Weisburd, Ben, Dolzhenko, Egor, Danzi, Matt C., Zuchner, Stephan·2026·The American Journal of Human Genetics

Abstract

Pentanucleotide tandem repeats (PNTRs) are associated with at least eleven neurological disorders in which pathogenic alleles are defined by both large repeat expansions and disease-specific non-reference motifs. However, population-scale, sequence-resolved datasets of PNTR variation have not been available, limiting interpretation of repeat alleles identified through long-read sequencing. Here, we genotyped 47,952 PNTR loci in 543 high-coverage PacBio HiFi genomes spanning five ancestry superpopulations, with validation in 500 Oxford Nanopore genomes. Using base-pair-resolved decomposition, we generated a genome-wide reference of PNTR length and sequence variation. Disease-associated PNTR loci emerged as extreme outliers for repeat-length variability, extreme allele length, and motif diversity. Sequence-resolved analyses further revealed that repeat length and sequence composition are frequently coupled, whereby alleles of distinct motif and interruption configurations occupy discrete length ranges. Finally, haplotype-resolved analyses showed that repeat variability and disease association converge on specific chromosomal backgrounds, exemplified by the SAMD12 locus. Together, these findings establish principles of PNTR variation for interpreting repeat alleles, prioritizing candidate loci, and discovering novel repeat expansion disorders.

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Crossref · 10.1016/j.ajhg.2026.09.017

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Authors
Xu, I. R. L., Pellerin, D., Van De Vondel, L., Weisburd, B., Dolzhenko, E., Danzi, M. C., & Zuchner, S.
Affiliations
  • University of Miami (US)
  • Montreal Neurological Institute and Hospital (CA)
  • Broad Institute (US)
  • Pacific Biosciences (United States) (US)
Corresponding author
Zuchner, Stephan
Venue
The American Journal of Human Genetics
Publisher
Elsevier BV
Published
2026-10
ISSN
0002-9297 (ISSN-L)
OpenAlex
W7222496565
Cited by
0
References
42
FWCI
0.00
Type
journal article
Language
en
Open access
closed
Locations
  • The American Journal of Human Genetics (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Genetic Neurodegenerative Diseases
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genomics and Rare Diseases
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetics and Neurodevelopmental Disorders
Keywords
repeat expansion disorders, neurological disorders, long-read sequencing

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