Quantifying the pathogenicity of protein variants in human disease-related genes would have a profound impact on clinical decisions, yet the overwhelming majority (over 98%) of these variants still have unknown consequences [1][2][3] . In principle, computational methods could support the largescale interpretation of genetic variants. However, prior methods 4-7 have relied on training machine learning models on available clinical labels. Since these labels are sparse, biased, and of variable quality, the resulting models have been considered insufficiently reliable 8 . By contrast, our approach leverages deep generative models to predict the clinical significance of protein variants without relying on labels. The natural distribution of protein sequences we observe across organisms is the result of billions of evolutionary experiments 9,10 . By modeling that distribution, we implicitly capture constraints on the protein sequences that maintain fitness. Our model EVE (Evolutionary model of Variant Effect) not only outperforms computational approaches that rely on labelled data, but also performs on par, if not better than, high-throughput assays which are increasingly used as strong evidence for variant classification [11][12][13][14][15][16][17][18][19][20][21][22][23] . After thorough validation on clinical labels, we predict the pathogenicity of 11 million variants across 1,081 disease genes, and assign high-confidence reclassification for 72k Variants of Unknown Significance 8 . Our work suggests that models of evolutionary information can provide a strong source of independent evidence for variant interpretation and that the approach will be widely useful in research and clinical settings.
Modeling the fitness landscape of protein sequences has historically relied on training models on family-specific sets of homologous sequences called Multiple Sequence Alignments. Many proteins are however difficult to align or have shallow alignments which limits the potential scope of alignment-based methods. Not subject to these limitations, large protein language models trained on non-aligned sequences across protein families have achieved increasingly high predictive performance – but have not yet fully bridged the gap with their alignment-based counterparts. In this work, we introduce TranceptEVE – a hybrid method between family-specific and family-agnostic models that seeks to build on the relative strengths from each approach. Our method gracefully adapts to the depth of the alignment, fully relying on its autoregressive transformer when dealing with shallow alignments and leaning more heavily on the family-specifc models for proteins with deeper alignments. Besides its broader application scope, it achieves state-ofthe-art performance for mutation effects prediction, both in terms of correlation with experimental assays and with clinical annotations from ClinVar.
From early detection of variants of concern to vaccine and therapeutic design, pandemic preparedness depends on identifying viral mutations that escape the response of the host immune system. While experimental scans are useful for quantifying escape potential, they remain laborious and impractical for exploring the combinatorial space of mutations. Here we introduce a biologically grounded model to quantify the viral escape potential of mutations at scale. Our method - EVEscape - brings together fitness predictions from evolutionary models, structure-based features that assess antibody binding potential, and distances between mutated and wild-type residues. Unlike other models that predict variants of concern based on newly observed variants, EVEscape has no reliance on recent community prevalence, and is applicable before surveillance sequencing or experimental scans are broadly available. We validate EVEscape predictions against experimental data on H1N1, HIV and SARS-CoV-2, including data on immune escape. For SARS-CoV-2, we show that EVEscape anticipates mutation frequency, strain prevalence, and escape mutations. Drawing from GISAID, we provide continually updated escape predictions for all current strains of SARS-CoV-2.
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