Quantification of autism recurrence risk by direct assessment of paternal sperm mosaicism

De novo genetic mutations represent a major contributor to pediatric disease, including autism spectrum disorders (ASD), congenital heart disease, and muscular dystrophies1,2, but there are currently no methods to prevent or predict them. These mutations are classically thought to occur either at low levels in progenitor cells or at the time of fertilization1,3 and are often assigned a low risk of recurrence in siblings4,5. Here, we directly assess the presence of de novo mutations in paternal sperm and discover abundant, germline-restricted mosaicism. From a cohort of ASD cases, employing single molecule genotyping, we found that four out of 14 fathers were germline mosaic for a putatively causative mutation transmitted to the affected child. Three of these were enriched or exclusively present in sperm at high allelic fractions (AF; 7-15%); and one was recurrently transmitted to two additional affected children, representing clinically actionable information. Germline mosaicism was further assessed by deep (>90x) whole genome sequencing of four paternal sperm samples, which detected 12/355 transmitted de novo single nucleotide variants that were mosaic above 2% AF, and more than two dozen additional, non-transmitted mosaic variants in paternal sperm. Our results demonstrate that germline mosaicism is an underestimated phenomenon, which has important implications for clinical practice and in understanding the basis of human disease. Genetic analysis of sperm can assess individualized recurrence risk following the birth of a child with a de novo disease, as well as the risk in any male planning to have children.