Systematic assessment of machine learning-based variant annotation methods for rare variant association testing

Machine learning-based annotation methods are increasingly used to assess the pathogenicity of genetic variants, but their performance at prioritizing variants for gene-level association testing remains poorly characterized. Here, we systematically benchmark five annotation methods -- CADD v1.6, CADD v1.7, AlphaMissense, ESM-1b, and GPN-MSA -- using four primary gene-based tests and six annotation-level aggregation tests across 14 quantitative traits measured in up to 350,377 UK Biobank participants. Using a novel framework based on Wasserstein dis-tances, we quantify how annotation choice affects test calibration and power. Tests using CADD annotations achieve the highest signal separation, while tests using AlphaMissense annotations exhibit systematically lower calibration. All combinations of methods produced significant re-sults that were enriched (1.8-5.8-fold) for loss-of-function intolerant genes, though tests using GPN-MSA annotations displayed the highest such enrichment. Replication across symmetric phenotypes and loss-of-function burden tests was generally similar across methods. Our anal-ysis provides practical guidance for annotation method selection in rare variant studies and establishes a distributional framework for calibration assessment.