Aberrant splicing prediction across human tissues

Aberrant splicing is a major cause of genetic disorders but its direct detection in transcriptomes is limited to clinically accessible tissues such as skin or body fluids. While DNA-based machine learning models allow prioritizing rare variants for affecting splicing, their performance on predicting tissue-specific aberrant splicing remains unassessed. Here, we generated the first aberrant splicing benchmark dataset, spanning over 8.8 million rare variants in 49 human tissues. At 20% recall, state-of-the-art DNA-based models cap at 10% precision. By mapping and quantifying tissue-specific splice site usage transcriptome-wide and modeling isoform competition, we increased precision by three-fold at the same recall. Integrating RNA-sequencing data of clinically accessible tissues brought precision to 60%. These results, replicated in two independent cohorts, substantially contribute to non-coding loss-of-function variant identification and to genetic diagnostics design and analytics.