Benchmarking fragmentation-derived artificial cfDNA reference standards

An important step toward clinical implementation of (epi-)genomic assays on liquid biopsies is their validation on identical samples within and across laboratories. For these validation studies, there is a need for cell-free DNA (cfDNA) samples with defined tumor fractions and (epi-)genomic aberrations. However, the amount of circulating cfDNA isolated from patient samples is often limited, especially in pediatric cases. Additionally, patient samples contain a high degree of variability in cfDNA yield and tumor fraction. Several commercial artificial cfDNA products are available for validation studies, however their use is restricted to specific assays, aberrations and/or tumor entities. Alternatively, artificial cfDNA samples can be produced by fragmenting genomic DNA to mimic highly fragmented cfDNA derived from both tumor and healthy blood, followed by mixing artificial tumoral and healthy cfDNA at defined fractions. In this study, we compared native cfDNA with artificial cfDNA generated by three different fragmentation methods, including sonication and two enzymatic digestions using micrococcal nuclease and double-stranded deoxyribonuclease (dsDNase). We assessed fragment length profiles, end motifs and nucleosome occupancy patterns from shallow whole-genome sequencing data, as well as coverage profiles from targeted panel sequencing, together with a small-scale mixing experiment of tumor and healthy cell derived artificial cfDNA. Although sonication remains a convenient high-throughput approach to generate artificial cfDNA for certain downstream applications, enzymatic fragmentation, particularly the dsDNase-based method, more faithfully reproduced native cfDNA characteristics.