Published online before print
April 14, 2003, 10.1101/gr.939903
Vol 13, Issue 5, 925-931, May 2003
METHODS
Exo-Proofreading, A Versatile SNP Scoring Technology
Patrick Cahill1,
Michele Bakis,
James Hurley,
Veena Kamath,
William Nielsen,
Dina Weymouth,
Josée Dupuis,
Lynn Doucette-Stamm and
Douglas R. Smith
Genome Therapeutics Corporation, Waltham, Massachusetts 02453,
USA
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ABSTRACT
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We report the validation of a new assay for typing single nucleotide
polymorphisms (SNPs) that takes advantage of the 3'-to-5' exonuclease
proofreading activity of many DNA polymerases. The assay uses one or
more primers labeled on the 3' nucleotide base, and can be implemented
in a variety of formats including a one-step PCR reaction that allows
SNP typing directly from genomic DNA samples. The detection of
genotypes can be accomplished by means of fluorescence detection on
assays that have been purified to remove excess primer, or by means of
fluorescence polarization without any additional cleanup. We also
demonstrate that the Exo-Proofreading SNP assay can be used on pooled
samples to obtain allele frequency data.
With the successes of the Human Genome Project
came an increasing need for low-cost, high-throughput technologies for
the accurate typing of single nucleotide polymorphisms (SNPs) on human
DNA for use in genetic inheritance or disease association studies. Many
such methods have been developed over the past decade, but there is no
clear choice in terms of cost, efficiency, speed, accuracy, and
versatility. The most widely used methods for high-throughput SNP
typing rely on allele-specific hybridization (Saiki et al. 1986 ; Pease
et al. 1994 ) or primer extension (Syvanen et al. 1990 ), but other
popular methods include allele-specific amplification (Newton et al.
1989 ), allele-specific ligation (Nickerson et al. 1990 ), flap
endonuclease cleavage (Marshall et al. 1997 ), restriction endonuclease
cleavage, pyrosequencing (Nyren et al. 1997 ), and conventional
sequencing. These core technologies can be applied in a variety of
formats, such as single or multiplexed reactions in solution (typically
carried out in multiwell plates), on the surfaces of microbeads (Uhlen
1989 ), or on the surfaces of microarrays (Chetverin and Kramer 1993 ;
Lipshutz et al. 1995 ). Several signal generation and detection methods
have been applied, with fluorescence readout being the most prevalent.
Such methods typically use labeled primers or nucleotides in
conjunction with specialized instrumentation using sensitive optical
detection deviceseither as stand-alone plate or chip readers or as
integrated electrophoretic or flow separation devices. Recently, mass
spectrometry (MS) has been gaining popularity thanks to improvements in
the instrumentation and software, and to the development of new
chemistries for sensitive detection of nucleic acids using
matrix-assisted laser desorption ionization (Braun et al. 1997 ). The
development of efficient automated sample preparation techniques has
also influenced the practice of these technologies.
In this report, we describe a fundamentally different approach for SNP
scoring that takes advantage of the 3'5' exonuclease (proofreading)
activity native to many DNA polymerases to discriminate whether the 3'
nucleoside of a primer is hybridized correctly to a template, and to
extend or remove that nucleoside in the case of a match or mismatch,
respectively. The assay described here is simple, inexpensive, and
sufficiently versatile to be used in conjunction with any of the
above-mentioned signal generation and detection methods.
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RESULTS
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The Exo-Proofreading assay is designed to detect single nucleotide
mismatches by selective incorporation or removal of a labeled test base
by 3'5' exo-nuclease activity of a proofreading DNA polymerase as
illustrated in Figure 1. The two essential
components of the assay are a 3'-end-labeled primer and a polymerase
with proofreading activity. In general, however, the assay is practiced
using two labeled primers (corresponding to both allele variants of the
polymorphic base) and a reverse primer to enable PCR amplification of
the extension products. Each forward primer has its 3' end aligned with
the polymorphic base (T and C in the example shown in Fig. 1) and is
labeled on the nucleotide base with a detectable tag such as a
fluorescent moiety. If the primer has a 3' mismatch with the template,
the labeled nucleotide is removed by the proofreading polymerase and no
tag is incorporated into the PCR product. On the other hand, when the
3' end of the primer is matched with the target; the labeled nucleotide
is extended and incorporated into the PCR product. Fluorescent imaging
or other suitable detection technology then visualizes the products.
The assay can also be practiced using a four-primer configuration, in
which each labeled primer is hybridized to a different strand and has
its own reverse primer (Fig. 1B). Finally, the assay can be performed
using linear amplification by removal of the reverse primer or primers.
In one of the standard assay formats, a primary PCR product is
generated from genomic DNA surrounding the SNP of interest, typically
between 400 and 600 bp in length, although larger fragments can be
used. The PCR product is diluted 1000-fold and subjected to the
Exo-Proofreading reaction after addition of the appropriate primers.
After thermocycling, the excess primers are removed, and the
fluorescence of the reaction products is measured using a standard
fluorescence plate reader.
To test the utility of our SNP assay, we compared the results generated
for six SNPs typed using the Exo-Proofreading Assay with previous
results obtained using allele-specific oligonucleotide (ASO)
hybridization. This set of SNPs covers the full set of possible base
variations, when both DNA strands are considered, using only the
available 3'-amino-modified cytosine and thymidine primers. The samples
were typed for SNPs 216 S2, 216 S + 1, 216 V 2, 216 M + 1, 216
ST + 4, 216 ST + 7 by the Exo-Proofreading assay and then compared
with the same samples previously typed by ASO (Van Eerdewegh et al.
2002 ). The primers used in these assays are shown in Table
1. Note that SNPs 216 S2, 216 ST + 4, and
216 S + 1 used the four-primer assay; SNPs 216 V 2 and 216
ST + 7 used the three-primer assay; and the linear amplification or
two-primer assay was used to type SNP 216 M + 1.
Exo-Proofreading genotypes for each set of samples (192432
individuals) were scored using an automated algorithm based on the raw
fluorescence values measured at each of the two maximal emission
wavelengths associated with the tags used in the assay. In addition to
the genotype, the algorithm generated a confidence value for each call
derived from the posterior probability of a correct genotype
assignment. A typical scatter plot of the data is shown in Figure
2, and a summary of the data is presented
in Table 2. The average call rate (where a
genotype could be assigned) for these samples was 98.9%. All of the
samples where genotypes were unable to be assigned were the result of
failed primary PCR reactions as determined by agarose gel analysis of
the PCR products. The percentage of calls with a confidence value of
90% or greater was 99%. The correlation between the Exo-Proofreading
reaction and the ASO assays was >99%. However, for all but one of the
SNPs, there were examples where the genotype obtained from the
Exo-Proofreading assay did not match the results of the ASO assay.
These samples were sequenced to attempt to resolve the discrepancies.
In all of the cases, the genotype obtained from the sequencing assay
corresponded to the Exo-Proofreading assay.

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Figure 2. Scatter plot of Exo-Proofreading assay results 216 V 2. Data from
96 samples assayed using the three-primer Exo-Proofreading assay. The
data are plotted as the log of the fluorescence readings from the LJL
instrument, in arbitrary relative fluorescence units (RFUs).
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Because of the exponential nature of the PCR reaction, it was assumed
that very little target DNA would be required to obtain a positive
result. To test this, we performed the assay directly on genomic DNA
using 23 ng of total genomic DNA. The results, shown in Figure
3, yielded a similar range of signal
intensities (7.18.0 log[Tamra RFU]; 6.87.8 log[Fam RFU];
RFU = relative fluorescence units) as the two-stage assay. The
grouping of samples into genotype clusters appeared to be slightly less
distinct than was the case with the two-stage assay, but the genotypes
were still clearly distinguishable and callable by the automated
genotyping software. Similar results were obtained using 12 ng of
genomic DNA (the smallest amount tested). The less distinct genotype
clustering appeared to be more experiment-dependent than
assay-dependent based on a small number of experiments (data not
shown), but this was not studied extensively.

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Figure 3. Exo-Proofreading assay performed on genomic DNA 216 S + 1. Data
obtained when the Exo-Proofreading assay was performed directly on
Genomic DNA. For the SNP assay, 22.5 ng of genomic DNA was used as a
template; all other conditions remained the same.
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All of the results described so far were obtained using a purification
step after the Exo-Proofreading reaction to remove any remaining label
associated with the primers and excision products. However, because of
the significant expected molecular size difference between the starting
primers and the resulting extension and excision products, we were
interested to see whether it would be possible to eliminate the need
for the clean-up step by using fluorescence polarization detection
(Chen et al. 1999 ). If successful, this would enable a single-step
homogenous assay in which one could go from sample to result in one
reaction vessel. Fluorescence polarization values, commonly expressed
as millipolarization units (mP), are related to the rotational freedom
and hence the molecular size of the fluorescently tagged molecules
being measured. As the population of tagged molecules within the
reaction shifts from oligonucleotide primers to extended PCR products,
a shift in average millipolarization units of the components can be
detected. Figure 4 shows the results
obtained using fluorescence polarization. In this experiment, samples
were transferred from the thermocycling plate to the fluorescence read
plate and fluorescence measurements were taken without any other
manipulations. Although the range of millipolarization values in the
resulting clusters appear larger than the corresponding range of
fluorescence values obtained with the standard assay, the elongated
shapes of the clusters are clearly defined and the separation is
sufficient to allow an unambiguous genotype to be assigned in all
cases. Other experiments (data not shown) gave similar results with
fluorescent polarization (FP) values tending to have larger spreads
than the corresponding fluorescent intensity (FI) values. In addition,
fluorescent polarization detection tends to be less reproducible than
Exo-Proofreading cleanup followed by straight fluorescent intensity
measurements, and some assay-specific variation was observed.

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Figure 4. Detection by fluorescence polarization. Data obtained when using
fluorescence polarization as a detection method with SNP 74D. FP
detection was used on samples of unpurified Exo-proofreading reactions.
This demonstrates the potential of the Exo-proofreading assay as a
homogeneous method for SNP screening.
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Another potential use for the Exo-Proofreading assay is in allele
frequency determination. To evaluate the utility for this application,
we created an artificial set of samples with different proportions of
wild-type and mutant alleles by mixing two homozygous samples. Figure
5, A and B, presents the data from those
experiments. Figure 5A presents the raw fluorescent values for samples
containing 100% C to 100% T and ratios of each of the alleles in
between in 5%10% increments. If the data are plotted as the ratio
of the two fluorescence values versus the percent of one of the
alleles, a linear relationship is observed (Fig. 5B). Comparison of the
ratio of fluorescence values of a pooled set of samples for this SNP to
the standard curve would, in principle, allow an estimate of the allele
frequency to be determined. However, further work will be required to
demonstrate the applicability of the method.

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Figure 5. Standards for allele frequency determination. (A) Fluorescence
intensity measurements obtained from samples containing known
proportions of two alleles (in this case, C and T). Each sample group
has N = 6 except 100% C, for which N = 2.
(B) Plot of the ratios of Fam and Rox fluorescence intensity
measurements against the percentage of T allele in the sample. Linear
regression analysis reveals a linear relationship.
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DISCUSSION
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Most polymerases will not efficiently catalyze extension of a primer
from a mismatched terminal base pair (although some error-prone
polymerases such as reverse transcriptase will do so; Preston et al.
1988 ). If the enzyme contains an integral 3'-to-5' exonuclease
activity, the polymerase will instead rapidly excise the mismatched
base pair and then produce a faithful extension product from a
penultimate matched pair. This process is commonly referred to as
proofreading, and is highly accurate. The error rate of proofreading
polymerases (as measured by inappropriate extension of a mismatched
nucleotide) typically falls in the range of 105 to
106 (Kunkel et al. 1984 ; Mattila et al. 1991 ; Cline et al.
1996 ). Mutant proofreading polymerases with lower error rates (such as
the "antimutator" form of T4 polymerase), have been described
(Drake et al. 1969 ), but have not yet been used in this assay. The
Exo-Proofreading assay described here takes advantage of the inherent
accuracy of proofreading polymerases to produce PCR products using
3'-end-labeled primers that accurately reflect the genotype of the
starting sample at the position of the variable base. Several
thermostable polymerases were tested in the assay, including Vent, Deep
Vent, and Tgo, but the Pfu and Pwo polymerases, which are identical in
sequence (Dabrowski and Kur 1998 ), appeared to work best in terms of
the success rate for assay development and signal strength.
Interestingly, we also found that consistent and accurate results can
be produced using a mixture of Taq (lacking proofreading activity) and
Pfu polymerases in ratios up to 16:1, respectively (results
essentially indistinguishable from Fig. 2; data not shown).
The assay has proven to be an accurate and versatile assay that can be
used to score SNPs in a cost-effective manner. We have used the assay
to type moderate numbers of SNPs in genes associated with asthma (Van
Eerdewegh et al. 2002 ), high bone density, drug metabolism, and
numerous other conditions, demonstrating the utility of the assay for
association studies and diagnostic applications. The preferred assay
format is dictated by several factors, but primarily the number and
availability of samples to be typed and the ease of assay design. For
the present work, we elected to go with a primary PCR reaction followed
by a separate Exo-Proofreading assay, rather than going directly from
the genomic DNA. This format was chosen because of the limited supply
of genomic DNA for the asthma samples. We also chose to go with a
cleanup after the Exo-Proofreading assay rather than straight FP
detection because of the higher success rate for assay design and
higher reproducibility of fluorescence intensity measurements compared
with FP measurements. In the comparison study all samples were
processed in this manner. Examples of the other formats were presented
to show the versatility and possibilities of the assay.
The use of PCR products as template introduces the chance of genotyping
error caused by sample contamination (this is a problem for most SNP
assays, the majority of which start with a PCR step). To reduce the
chance of contamination, we physically segregate sample setup and
postreaction workup in the laboratory. In addition, we use a
significant amount of input template to reduce the impact of
microdroplet cross-contamination. The data derived from over 2000
samples reported in Table 2 did not exhibit any signs of contamination,
based on comparison with the ASO data. The potential for post-PCR
contamination can be further reduced by using the linear assay format,
or by reducing the number of thermal cycles to 20 or less.
The cost of the assay is determined largely by the price of the
polymerase and the 3'-labeled primers. Although the cost of the
3'-labeled primers ($40$60) is higher than the unlabeled primers used
in some primer extension and allele-specific PCR-based assays, it is
comparable to the cost of 5'-labeled or -biotinylated primers used in
other primer extension assay formats, and less than the cost of
double-labeled probes typically used in Taqman or molecular beacon
assays. Of course, in most cases the initial cost of the primers for
any given assay (labeled and unlabeled) is amortized over a large
number of samples to be genotyped. The cost per genotype for two
labeled and two unlabeled (PCR) primers is 8 cents/sample for 2000
samples.
The labeled primers that we have used successfully all contain a linker
arm to which the label is attached at the C5 position of a pyrimidine
base. This configuration has proven successful in a number of other
polymerase-compatible nucleotide labeling schemes (Langer et al. 1981 ;
Foldes-Papp et al. 2001 ). The labeled primers could potentially be
synthesized in a very cost-effective manner starting with controlled
pore glass supports (CPGs) containing 5'-dimethoxytrityl-protected
nucleosides with fluorescently labeled bases, because conventional
primer synthesis proceeds in the 3'-to-5' direction (thus only the four
standard phosphoramidites would be required during synthesis). However,
only one of these labeled CPGs is available at the present time (3'-FAM
C6 dT CPG; Glen Research). We have discussed the feasibility of
synthesizing additional labeled CPGs with various manufacturers, and in
the future, we will be exploring this option. However, for the present
study, we used a less efficient alternative based on synthesis of
oligonucleotides starting with 3'-amino modifier CPGs
(3'-Amino-Modifier C6 dC CPG and 3'-Amino-Modifier C6 dT CPG; Glen
Research) followed by conjugation with the appropriate succinimidyl
ester dye derivatives. These CPGs were used by our oligonucleotide
suppliers to synthesize the desired oligonucleotides. One advantage to
this two-step approach is the flexibility in the choice of fluorescent
labels, because a large number of these are available commercially.
Unfortunately, there are no suitable 3'-amino- or fluorescent-modified
purine CPGs (dA or dG) available at this time. However, the assay can
still be used to type all possible base variations by typing both DNA
strands. T/C and G/A polymorphisms are assayed using two
3'-pyrimidine-labeled primers that hybridize to the same strand. T/A,
C/A, T/G, and C/G polymorphisms are assayed by using a four-primer
configuration in which two 3'-pyrimidine-labeled primers overlap the
position of the SNP on opposite strands and are flanked by two reverse
primers on either side (see Fig. 1B). Although this approach limits the
flexibility of primer design somewhat, it has proven to work
effectively. The data from SNPs 216 S2, 216 ST + 4, and 216 S + 1
given in Table 2 were derived from four-primer assays of this type.
An inexpensive plate reader is the only instrumentation required for
the assay. The potential to perform the assay directly on genomic DNA
combined with the use of fluorescence polarization to detect the
product provides one of the simplest SNP assay configurations yet
described because the assay can be set up and performed and the
products detected in a single reaction vessel in a truly homogeneous
manner. However, further development work is required to address the
apparent lack of robustness in fluorescence polarization detection. The
assay has the potential to be multiplexed by using tagged primers in
conjunction with universal tag arrays or microbeads with appropriate
capture oligonucleotides.
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METHODS
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DNA Samples
The human DNA samples used in this study have been described by Van
Eerdewegh et al. (2002) . Samples were handled and the results analyzed
using IRB-approved protocols.
Oligonucleotide Primers
The oligonucleotide primers used in this study are described in
Table 1. Primers with 3'-amino-modified nucleotides were synthesized
(Amitof Biotech) using 3'-amino modifiers having a linker attached to
the 5-position of terminal pyrimidine moiety (3'-Amino-Modifier C6 dC
CPG and 3'-Amino-Modifier C6 dT CPG; Glen Research). The resulting
oligonucleotides were labeled using the following reaction conditions:
1 µg/µL custom synthesized oligonucleotide, 2 µg/µL
succinimidyl ester dye derivative (FAM, ROX, or TAMRA; Molecular
Probes), 75 mM sodium tetraborate (pH 8.5) at room temperature for 3 h.
Labeled primers were purified by size exclusion chromatography using
NAP columns (Amersham Biosciences) as per the manufacturer's
instructions and concentrated using Nanosep microcentrators (Pall
Filtron Corp.).
Primary PCR
All reactions described below were performed in 96-well
polypropylene plates (Marsh BioMedical Products). Primary amplification
reactions, 10 µL reaction volume, contained 22.5 ng of genomic DNA,
1x reaction buffer (60 mM Tris-HCl at pH 9.5, 15 mM
[NH4]2SO4, 2mM MgCl2), 150
µM dNTPs (Roche), 500 nM forward and reverse primers (Invitrogen),
0.8 U of AmpliTaq (Applied Biosystems), and 1.6 U of TaqStart antibody
(Clontech). Plates were sealed using Sealplate adhesive polyester film
(Marsh), and reactions were performed in an MJ Research PTC-100
Thermocycler (MJ Research) using the following program: 94°C for 2
min followed by 35 cycles of 98°C for 10 sec, 68°C for 2 min, and a
final extension step at 72°C for 3 min.
Exo-Proofreading Assay
The Exo-Proofreading assay was performed using either primary PCR
amplified from genomic DNA or directly from genomic DNA. Primary PCR
products (see above) were diluted 1:1000 with H2O, and
1.3 µL of diluted sample was transferred to a 96-well plate (Marsh
BioMedical); alternatively, 22.5 ng of genomic DNA was used. Sequences
were amplified in a reaction containing 200 µM dNTPs, 1x polymerase
buffer (60 mM Tris-HCl at pH 8.5, 15 mM
[NH4]2SO4, 1.5 mM MgCl2), 300
nM each primer, and 0.625 U of Pwo DNA Polymerase (Roche). The reaction
cycle conditions were as follows: 94°C for 1 min followed by 35
cycles of 10 sec at 94°C, 30 sec at the relevant annealing
temperature (see TA in Table 1), and 35 sec at
72°C, with a final extension step of 5 min at 72°C. Two-, three-,
and four-primer assays were performed the same except that the linear
or two-primer assay used 1:100 dilution of primary PCR product.
Allele Frequency
Samples of genomic DNA were quantitated using A260 measurements and
the PicoGreen quantitation assay (Molecular Probes). Standard curves
were prepared by combining homozygous samples of each allele together
at different ratios (w/w) ranging from 100:0, 95:5, 90:10,
down to 0:100. The standard Exo-Proofreading assay was performed on
these mixed samples in groups of four. The ratio of the log(rox) values
to the log(fam) values was fitted to the known frequency using linear
regression to determine the standard curve. Then the pool frequencies
can be estimated with the following formula:
(log[rox]/log[fam] intercept estimate)/slope estimate.
Standard errors for the pool frequency estimates can be obtained using
calibration methodology (Miller 1997 , page 181.)
PCR Purification and Fluorescence Detection
After amplification, unincorporated primers and cleaved nucleotides
were removed using the QIAquick-96 PCR purification kit (QIAGEN)
according to the manufacturer's instructions. The elution volume was
65 µL, 25 µL of which was transferred into a black HE microplate
(Molecular Devices). Incorporation of the two fluorescent markers into
the PCR products was measured on an LJL Analyst HT multi-mode plate
reader (Molecular Devices) using the following filters: ROX, excitation
580 nm, emission 610 nm; FAM, excitation 490 nm, emission 520 nm;
TAMRA, excitation 550 nm, emission 580 nm.
Fluorescence Polarization
The Exo-Proofreading assay was performed exactly as described
above. The mix was transferred to a 96-well black HE microplate and
read with an LJL Analyst HT multi-mode plate reader in fluorescent
polarization mode. The machine was set with a G-factor of 0.85 for Fam
and 1 for Tamra/Rox, with the light filters as previously described.
Allele-Specific Oligonucleotide Hybridization (ASO)
Individuals were typed using an allele-specific oligonucleotide
method (Dietz et al. 1991 ). Amplicons were amplified by PCR,
using the appropriate primers (see Table 1 for allele primers), and the
PCR products were separated briefly by electrophoresis on agarose gels,
blotted to nylon membranes, and then hybridized sequentially with
radiolabeled oligonucleotide probes representing each allele.
Data Analysis
Genotypes were assigned based on the fluorescence values of both
dyes simultaneously. A Bayesian algorithm based on a mixture of
bivariate normal distributions was fitted. Prior means were determined
using data points with known genotypes, when available. In addition,
the algorithm computed a posterior probability of the correctness of
each genotype assignment used as a confidence value. Details of this
algorithm will be published separately.
Confirmation Sequencing
PCR products were diluted 1:20-fold, and 2.3 µL of the
diluted sample was added to a Big Dye terminator sequencing reaction
(Applied Biosystems). The sequencing reaction was performed according
to the manufacturer's directions with the following exceptions. Cycle
sequencing reactions were performed in one-half the standard volume and
with one-half the standard amount of reaction mix. The reaction
products were fractionated on the ABI 3700 instrument. Products were
analyzed using ABI analysis software with visual inspection used to
ascertain the nature of the genotype.
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Acknowledgements
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We thank the GenomeVision Services group for their valuable
assistance with the confirmation sequencing. Also we thank the Human
Genetics group at GENE for their assistance, especially Ziying Liu and
Kathy Falls for their help with the samples and ASO data.
The publication costs of this article were defrayed in part by payment
of page charges. This article must therefore be hereby marked
"advertisement" in accordance with 18 USC section 1734 solely to
indicate this fact.
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Footnotes
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1 Corresponding author. 
E-MAIL pcahill{at}genomecorp.com; FAX (781) 398-2472.
Article and publication are at
http://www.genome.org/cgi/doi/10.1101/gr.939903. Article published online before print in April 2003.
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Received October 30, 2002;
accepted in revised format February 18, 2003.
13:925-931 © by 2003 Cold Spring Harbor Laboratory Press ISSN 1088-9051/03 $5.00

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