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Frameshift Mutation

Frameshift mutations are genetic alterations that involve the insertion or deletion of a number of nucleotides that is not evenly divisible by three, leading to a shift in the reading frame of the genetic code.
This can result in the production of a completely different protein sequence, often with adverse effects on cellular function.
Frameshift mutations are associated with a variety of genetic disorders and are an important consideration in the study of disease genetics and the development of targeted therapies.
The PubCompare.ai platform provides a comprehensive, AI-driven approach to optimizing research protocols for the analysis of frameshift mutations, helping researchers locate the most up-to-date and reliable protocols from literature, preprints, and patents, while ensuring reproducibility and acuracy through AI-powered comparisons.
This tool can help advance research into the underlying mechanisms and clinical implications of frameshift mutations.

Most cited protocols related to «Frameshift Mutation»

DFAST accepts a FASTA-formatted file as a minimum required input, and users can customize parameters, tools and reference databases by providing command line options or defining an original configuration file (see Supplementary Notes for more details). The workflow is mainly composed of two annotation phases, i.e. structural annotation for predicting biological features such as CDSs, RNAs and CRISPRs, and functional annotation for inferring protein functions of predicted CDSs. Figure 1 shows a schematic depiction of the pipeline. Each annotation process is implemented as a module with common interfaces, allowing both flexible annotation workflows and extensions for new functions in the future.
In the default configuration, functional annotation will be processed in the following order:

Orthologous assignment (optional) All-against-all pairwise protein alignments are conducted between a query and each reference genome. Orthologous genes are identified based on a Reciprocal-Best-Hit approach. It also conducts self-to-self alignments within a query genome, in which genes scoring higher than their corresponding orthologs are considered in-paralogs and assigned with the same protein function. This process is effective in transferring annotations from closely related organisms and in reducing running time.

Homology search against the default reference database DFAST uses GHOSTX as a default aligner, which runs tens to hundred times faster than BLASTP with similar levels of sensitivity where E-values are less than 10−6 (Suzuki et al., 2014 (link)). Users can also choose BLASTP. For accurate annotation, we constructed a reference database from 124 well-curated prokaryotic genomes from public databases. See Supplementary Data for the breakdown of the database.

Pseudogene detection CDSs and their flanking regions are re-aligned to their subject protein sequences using LAST, which allows frameshift alignment (Kiełbasa et al., 2011 (link)). When stop codons or frameshifts are found in the flanking regions, the query is marked as a possible pseudogene. This also detects translation exceptions such as selenocysteine and pyrrolysine.

Profile HMM database search against TIGRFAM (Haft et al., 2013 (link)) It uses hmmscan of the HMMer software package.

Assignment of COG functional categories RPS-BLAST and the rpsbproc utility are used to search against the Clusters of Orthologous Groups (COG) database provided by the NCBI Conserved Domain Database (Marchler-Bauer et al., 2017 (link)).

DFAST output files include INSDC submission files as well as standard GFF3, GenBank and FASTA files. For GenBank submission, two input files for the tbl2asn program are generated, a feature table (.tbl) and a sequence file (.fsa). For DDBJ submission, DFAST generates submission files required for DDBJ Mass Submission System (MSS) (Mashima et al., 2017 (link)). In particular, if additional metadata such as contact and reference information are supplied, it can generate fully qualified files that are ready for submission to MSS.
While the workflow described above is fully customizable in the stand-alone version, only limited features are currently available in the web version, e.g. orthologous assignment is not available. As a merit of the web version, users can curate the assigned protein names by using an on-line annotation editor with an easy access to the NCBI BLAST web service. We also offer optional databases for specific organism groups (Escherichia coli, lactic acid bacteria, bifidobacteria and cyanobacteria). They are downloadable from our web site and can be used in the stand-alone version. We are updating reference databases to cover more diverse organisms.
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Publication 2017
Amino Acid Sequence Bifidobacterium Biopharmaceuticals Catabolism Clustered Regularly Interspaced Short Palindromic Repeats Codon, Terminator Cyanobacteria Escherichia coli Frameshift Mutation Genes Genome Hypersensitivity Lactobacillales Prokaryotic Cells Protein Annotation Proteins Pseudogenes pyrrolysine RNA Selenocysteine Toxic Epidermal Necrolysis Triglyceride Storage Disease with Ichthyosis
Reads produced by MinION technology25 (link) are known to be noisy and contain frequent indel errors, a problem that also translates to assemblies derived from such long reads. In consequence, genes cannot be detected reliably on such DNA sequences. DIAMOND addresses this issue by providing frameshift alignments in translated search (blastx) mode. The protein sequences corresponding to all three reading frames of a strand are aligned simultaneously against the target sequence, allowing shifts in the reading frame at any position in the alignment, while incurring a user-defined score penalty (set using -F on the command line). The raw MinION reads and contigs up to the length of full bacterial chromosomes are supported as input in translated search mode, enabling gene discovery and annotation in the absence of known gene boundaries.
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Publication 2021
Amino Acid Sequence Candidate Gene Identification Chromosomes, Bacterial Diamond Frameshift Mutation Gene Annotation Genes INDEL Mutation Reading Frames
To identify genes that may be relevant to breast cancer, we looked for those that harboured multiple recurrent or inactivating mutations, as these are mutation patterns typical of oncogenes and tumour suppressors. Recurrent mutations were defined as missense SNVs and in-frame substitutions that affected the same codon of the annotation transcript, whereas inactivating mutations included nonsense SNVs, frameshift substitutions and variants that affected splice sites. The proportions of recurrent (ONC) and inactivating (TSG) mutations for each gene (out of the total number of mutations) were computed, and a threshold of 0.2 was used (20/20 rule). Genes with an ONC score >0.2 and with a TSG score >0.05 were classified as tumour suppressors. A minimum of five recurrent or inactivating mutations was required for a gene to be selected as putative drivers. The method was adapted from the study by Vogelstein et al.16 (link)
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Publication 2016
Codon Frameshift Mutation Genes Loss of Function Mutation Malignant Neoplasm of Breast Mutation Mutation, Nonsense Oncogenes Reading Frames Tumor Suppressor Genes
RATT is programmed in ‘bash’ and ‘PERL’ and its design is illustrated in Figure 1 and Supplementary Figure S1. First, two sequences are compared using ‘nucmer’ from the MUMmer package (17 (link)) to define sequence regions that share synteny. Those regions are filtered using configurable parameters depending on the type of annotation mapping that is being attempted. Preset parameters are provided for transfers between assembly versions, strains or species (see Supplementary Table S1). To be included, the minimum nucleotide sequence identity between synteny blocks must be 40%. Synteny information is stored as a base range in the query and its associated base range in the reference. However, this information alone is inadequate to map the annotation because insertions or deletions (indels) change the relative distance between mapped synteny blocks. The coordinates are therefore sequentially adjusted across a synteny block by calling indels using ‘show-snp’ from the MUMmer package. Accurately calling indels within repetitive regions presents a particular challenge. Therefore, RATT recalibrates the adjusted coordinates using single nucleotide polymorphisms (SNPs, also called using ‘show-snp’) as unambiguous anchor points within synteny blocks. In transfers between very closely related sequences (e.g. successive assembly versions), SNPs may occur with insufficient frequency to perform this coordinate adjustment. In such cases, RATT modifies the query by inserting a faux SNP every 300 bp to aid in the recalibrating step. The final sequence and transferred annotations remain unaffected.

Workflow of RATT.

Once the coordinates within synteny blocks have been defined, RATT proceeds to the annotation-mapping step, whereby each feature within a reference EMBL file is associated with new coordinates on the query (Supplementary Figure S1B). A feature is not mapped (and is put in the non-transferred bin file), if it bridges a synteny break and if its coordinate boundaries match different chromosomes, different DNA strands, or if the new mapped distance of its coordinates has increased by more than 20 kb. If a short sequence from the beginning, middle or the end of a feature can be placed within a synteny region, mapping is attempted (see Supplementary Figure S1B). In addition, if the exons of a single gene model map to different gene regions, the model is split and identified in the output file. The bin is an EMBL-format file that can be loaded onto the reference sequence for analysis (see Figure 2, brown colour track). Further outputs include statistics about transferred features or the amount of synteny conserved between the reference and query, as well as Artemis-readable files showing SNPs, indels and regions that lack synteny between the compared sequences, see the example on the sourceforge site.

Transfer of annotation from the M. tuberculosis strain H37Rv onto the strain F11 sequence, over a deletion. The genomes of H37Rv (upper) and F11 (lower) are shown using the Artemis Comparison Tool (ACT). The source H37Rv annotation (light blue) is directly mapped onto F11 by RATT (green) except for those features corresponding to a region that is unique to the source strain that cannot be transferred and are written to a separate output file (brown).

Although two sequences may be related, differences can occur, such as a change in the start or stop codons of a protein-coding sequence. Therefore, we implemented a correction algorithm in RATT (see Supplementary Figure S1C). Figure 3 shows examples of the correction step. First, the start codon is checked. If it is not present, the upstream sequence is searched for a new start codon (Figure 3A). If a stop codon is found, the first start codon downstream is used. In the absence of any start codon, an error is recorded in the results file. If the sequence between exons has no stop codon and a length divisible by three bases but the splice acceptor or donor sequences are wrong, then the intron is eliminated. Likewise, frameshifts previously introduced into the reference to maintain conceptual translations (for instance, in apparent pseudogenes) will also be removed from coding sequences in the query. RATT will also detect, and attempt to fix, incorrect splice sites. As splice sites are difficult to annotate correctly, RATT only tries to correct a gene model that has one wrong splice site. If one incorrect splice site is detected, the closest alternative splice donor or acceptor is found that, when used, generates no frame shifts. Next, RATT searches for genes or exons with internal stop codons, further than 150 bp from the 3′-end. If the introduction of a frameshift would generate a model without internal stop codons, the model is corrected (Figure 3C). Stop codons are corrected last: if a model has less than five internal stops in its last exon, the model is shortened to the first stop codon (Figure 3B). If the model has no stop codon it is extended downstream until a stop codon is found.

RATT corrections of transferred annotations. Annotation from H37Rv were transferred onto the F11 sequence (pale blue), corrected (green) and then compared with the existing strain F11 annotation in EMBL (yellow). (A and B) The correction of start and stop codons, respectively. In a more complex mapping situation (C), where all three reading frames are shown for clarity, RATT maps a large single coding sequence (CDS) from H37Rv to a locus within F11 that includes several in-frame stop codons. By inserting a frameshift (i.e. to indicate a pseudogene) the conceptual translation is preserved. This contrasts with two overlapping genes predicted as part of the F11 genome project.

Different criteria can be specified depending on the translation that an organism uses (e.g. such bacterial TTG and GTG start codons) or whether unsual splice sites are used. RATT is programmed in PERL and was tested in UNIX/LINUX environments. The output can be loaded into Artemis/Act. The list and explanation of all the output files can be found at the sourceforge site.
Publication 2011
Bacteria Base Sequence Chromosomes Codon, Initiator Codon, Terminator Contrast Media Deletion Mutation Exons Frameshift Mutation Gene Deletion Genes Genes, Overlapping Genome INDEL Mutation Insertion Mutation Introns Light Microtubule-Associated Proteins Mycobacterium tuberculosis H37Rv Open Reading Frames Pseudogenes Reading Frames Repetitive Region Single Nucleotide Polymorphism Strains Synteny Tissue Donors
The first part of the IntOGen-mutations pipeline assesses the potential functional impact of somatic mutations detected across the cohort of tumor samples. The Ensembl variant effect predictor10 (link) (VEP, v.70) script and precomputed cache files, downloaded from the Ensembl FTP site (ftp://ftp.ensembl.org/pub/), are used to determine the consequences of somatic mutations in annotated functional elements. The pipeline obtains SIFT11 (link) and PolyPhen2 (ref. 12 (link)) functional impact from VEP. Precomputed MutationAssessor13 (link) functional impacts are obtained from the MutationAssessor Web server (http://www.mutationassessor.org/) during the installation of the pipeline and are queried locally during execution. The transformation of functional impact scores to account for the baseline tolerance of genes to germline mutation (transFIC), described elsewhere14 (link), has been reimplemented in Python as a module of the IntOGen-mutations pipeline.
The pipeline implements an expression filter to disregard genes that are not expressed across the tumor samples in the cohort. This list of expressed genes is an optional input to the pipeline, which excludes all genes outside the list from the foreground of both OncodriveFM and OncodriveCLUST (see below) while keeping their mutations in the background. In the current release of the IntOGen-mutations Web discovery tool, we have employed as a filter the list of genes expressed across any of the 12 pan-cancer data sets (ref. syn1734155).
The OncodriveFM and OncodriveCLUST approaches, also described elsewhere7 (link),9 (link), have been reimplemented as IntOGen-mutations pipeline modules and are available as independent programs from two Git-controlled repositories at https://bitbucket.org/bbglab/. Briefly, OncodriveFM receives as input the list of synonymous, nonsynonymous and frameshift-indel mutations and their corresponding SIFT, PolyPhen2 and MutationAssessor scores. Then it assesses whether any gene shows a trend toward the accumulation of mutations with high functional impact as compared to the background distribution of these functional impact scores in all mutations detected across the cohort of tumor samples (FM bias). For each functional impact score included in the pipeline, the method produces an empirical P value that evaluates this FM bias. These three P values are subsequently combined using Fisher's approach to produce one integrated P value for each gene. To account for possible nondependence between the three P values included in the combination, the IntOGen-mutations Web discovery tool considers as significant those with a false discovery rate (FDR) below 0.05.
OncodriveFM also computes an FM bias for pathways. Three z scores are computed in this case to assess the trend of pathways to accumulate mutations with high functional impact. The z scores are combined using Stouffer's approach, and the combined z score is transformed into an integrated P value.
OncodriveCLUST, on the other hand, receives as input two separate lists of mutations: potentially protein-affecting mutations (nonsynonymous, stop and splice site) and silent mutations (synonymous), with their corresponding locations across the proteins' sequences. It then assesses the significance of the trend of potentially protein-affecting mutations to be clustered with respect to a background represented by the homologous trend for silent mutations.
Genes mutated in less than 1% of the samples in projects whose median of mutations per sample was below 100 were not analyzed by OncodriveFM. In projects with higher median of mutations per samples, this threshold was set to 5 samples with mutations. For OncodriveCLUST, the thresholds were 3 and 5 mutated samples, respectively. These and many other parameters of the pipeline are configurable by the user, as explained in its documentation.
In addition to third-party (and in-house) software and data, IntOGen-mutations pipeline installation requires some Python libraries. The most important of these are the numpy and scipy scientific computing libraries and the statsmodels Python statistical library.
The pipeline also relies on other external data files. During pipeline installation, all of the needed external and third-party data files are downloaded and correctly placed, and external libraries are downloaded and compiled, thereby creating a Python environment where the pipeline executes.
The analysis of the 4,623 tumor samples currently included in the IntOGen-mutations Web discovery tool takes approximately 5 h on an eight-core, 12 GB RAM computer.
Publication 2013
Amino Acid Sequence cDNA Library Diploid Cell Frameshift Mutation Gene Expression Genes Germ-Line Mutation Immune Tolerance INDEL Mutation Malignant Neoplasms Mutation Mutation Accumulation Neoplasms Proteins Python Silent Mutation

Most recents protocols related to «Frameshift Mutation»

Full exon sequencing (WES 1000 g) was performed by Agilent's liquid chip capture system. Genomic DNA extracted from peripheral blood for each sample was fragmented to an average size of 180–280 bp and subjected to DNA library creation using established Illumina paired-end protocols. The Agilent SureSelect Human All ExonV6 Kit (Agilent Technologies, Santa Clara, CA, USA) was used for exome capture according to the manufacturer’s instructions. The Illumina Novaseq 6000 platform (Illumina Inc., San Diego, CA, USA) was utilized for genomic DNA sequencing in Genechem Bioinformatics Technology Co., Ltd (Beijing, China) to generate 150-bp paired-end reads with a minimum coverage of 10 × for ~ 99% of the genome (mean coverage of 100 ×). After sequencing, base call files conversion and demultiplexing were performed with bcl2fastq software (Illumina). The resulting fastq data were submitted to in-house quality control software for removing low quality reads, and then were aligned to the reference human genome (hs37d5) using the Burrows-Wheeler Aligner (bwa), and duplicate reads were marked using Sambamba tools. ANNOVAR software was used to annotate the variants.
Filtering of rare variants was performed as follows: (1) variants with a MAF less than 0.01 in 1000 genomic data (1000g_all), esp6500siv2_all, gnomAD data (gnomAD_ALL and gnomAD_EAS) and in house Genechem-Zhonghua exome database from Genechem; (2) Only SNVs occurring in exons or splice sites (splicing junction 10 bp) are further analyzed since we are interested in amino acid changes. (3) Then synonymous SNVs which are not relevant to the amino acid alternation predicted by dbscSNV are discarded; The small fragment non-frameshift (< 10 bp) indel in the repeat region defined by RepeatMasker are discarded. (4) Variations are screened according to scores of SIFT, Polyphen, MutationTaster and CADD software. The potentially deleterious variations are reserved if the score of more than half of these four software support harmfulness of variations. Sites (> 2 bp) did not affect alternative splicing were removed.
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Publication 2023
Amino Acids BLOOD DNA Chips DNA Library Exome Exons Frameshift Mutation Genome Genome, Human Homo sapiens INDEL Mutation Strains
Knockout (KO) of GlcNAc-1-phosphate transferase subunits alpha and beta (Gnptab) gene was carried out in selected CHO clones that stably express the lysosomal enzymes of interest. Cells were seeded at a density of 0.5 × 106 cells/mL in T25 flasks 24 h prior to transfection, and ∼2 × 106 cells and 1 μg each of plasmid DNA of Cas9-GFP and gRNA were used for electroporation. 48 h after electroporation, cells with GFP expression were enriched by FACS. After culturing for 1 week, cells were single cell sorted by FACS into 96-wells. KO clones with desired mutations were identified using a rapid and efficient screening method, Indel Detection by Amplicon Analysis (IDAA), as previously described (Yang et al., 2015a (link)). Final clones were verified by Sanger sequencing. On average 2–5 clones with frameshift mutations were selected from each targeting event. The full list of CRISPR gRNA design and PCR primers used is listed elsewhere (Tian et al., 2019 (link)).
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Publication 2023
Cells Clone Cells Clustered Regularly Interspaced Short Palindromic Repeats Electroporation Enzymes Frameshift Mutation Gene Knockout Techniques Glycoprotein Hormones, alpha Subunit INDEL Mutation Lysosomes Mutation N-acetylglucosamine-1-phosphate Oligonucleotide Primers Plasmids Transfection Transferase
In both two cohorts, we targeted the variants in the coding region of the DNM1L gene (NM_001278466). The variants with a missing rate of >5% and deviations from Hardy–Weinberg equilibrium in controls (p < 0.05) were removed using PLINK v1.90. We annotated the gene regions (hg19 RefSeq), amino acid changes, and allele frequency of each variant in the Genomic Aggregation Database (gnomAD) and Exon Aggregation Consortium (ExAC) by ANNOVAR. Next, the functional impact of each nonsynonymous variant was predicted by ReVe (threshold, 0.7).
We categorized the variants according to the minor allele frequency (MAF) as common variants (MAF > 0.01) and rare variants (MAF < 0.01). Furthermore, we re-extracted the rare variants with MAF below 0.001 and performed gene analysis of rare variants with MAF below 0.01 and 0.001, respectively. According to predicted functions, all the rare nonsynonymous variants were classified into three variant groups: missense, potentially damaging missense (Dmis, ReVe score > 0.7), and loss of function variants (LoF stop gain/loss, frameshift, and splice site), and the sum of Dmis and LoF. After adjusting the abovementioned covariates in two cohorts, sequence kernel association test-optimal (SKAT-O) was applied to each cohort to assess the combined effect of rare variants and each variants group. Fisher's exact test was also done for common variants to validate the significant relationship between the common variants of DNM1L and PD. Moreover, logistic regression analysis based on an allele model was also performed by PLINK v1.90, and a p-value of < 0.05 was considered suggestive significant.
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Publication 2023
Alleles Amino Acids Desipramine DNM1L protein, human Exons Frameshift Mutation Genes Genetic Diversity Genome
Genome-wide CRISPR–Cas9 knockout (GeCKO) v2.0 library plasmids were kindly provided by Feng Zhang [14 (link)]. The GeCKOv2.0 library A consists of 65,383 single guide RNAs (sgRNAs) that target 19,050 genes and 1864 miRNAs, causing frameshift indel mutations that lead to loss-of-function alleles. MCF7 cells were transduced with lentivirus carrying the GeCKOv2.0 library at an MOI of 0.2–0.4 for 24 h to achieve 100 × coverage of each sgRNA construct and then selected with puromycin (3 μg/mL) for 7 days. Puromycin-resistant cells were expanded for another 10 days to allow gene editing. Transwell invasion assays were performed as described, and invasive and noninvasive cells were harvested. Genomic DNA was isolated from the cells using a Blood & Cell Culture Midi kit (Qiagen). The sequences targeted by sgRNAs were amplified by the two-step PCR method, and the primer sequences for lentiCRISPR sgRNAs are listed in Additional file 1: Table S1 [14 (link), 15 (link)]. The PCR products were purified by agarose gel electrophoresis, quantified using a Qubit 3.0 Fluorometer (Invitrogen) and an ABI7900 real-time fluorescence quantitative PCR instrument (Applied Biosystems) and sequenced on a HiSeq 2500 instrument (Illumina) in single-end mode. The MAGeCK algorithm was used to analyze the FASTQ files and identify metastasis-related genes.
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Publication 2023
Biological Assay BLOOD Blood Cells Blood Culture Cell Culture Techniques Cells Clustered Regularly Interspaced Short Palindromic Repeats DNA Library Electrophoresis, Agar Gel Fluorescence Frameshift Mutation Geckos Genes Genome INDEL Mutation Lentivirus Loss of Heterozygosity MCF-7 Cells MicroRNAs Neoplasm Metastasis Oligonucleotide Primers Plasmids Puromycin Real-Time Polymerase Chain Reaction RNA, Single Guide
Single nucleotide variation (SNV) data (n = 7130) were collected across 18 cancer types from Genomic Data Commons. We estimated the mutation frequency of each circadian rhythm gene in each tumor using the maftools (https://bioconductor.org/packages/release/bioc/html/maftools.html) and oncoplot waterfall plot [38 (link)]. We show genes with an overall mutation proportion of over 10%. SNV mutation frequency (percentage) of each gene's coding region was calculated using the formula: Number of Mutated Samples/Number of Cancer Samples. The SNVs were divided into missense mutations, nonsense mutations, multiple hits, frameshift insertions, frameshift deletions, splice sites, in-frame amplifications and in-frame deletions.
For copy number variation (CNV) data, we downloaded gene level copy number score data (GISTIC—focal score by gene) from UCSC Xena, which is the sequence interval focused on the gene and assessed whether the gene was amplified or deleted. Values between − 0.3 and 0.3 were scored as 0 for no changes, larger than 0.3 as 1 for amplifications, and less than 0.3 as − 1 for deletions. Heatmap plot of mutation frequency was generated by using ComplexHeatmap R package.
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Publication 2023
Circadian Rhythms Frameshift Mutation Gene Deletion Genes Genome Insertion Mutation Malignant Neoplasms Missense Mutation Mutation Mutation, Nonsense Neoplasms Nucleotides Reading Frames

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More about "Frameshift Mutation"

Frameshift Mutation is a type of genetic alteration that involves the insertion or deletion of a number of nucleotides that is not evenly divisible by three, causing a shift in the reading frame of the genetic code.
This can lead to the production of a completely different protein sequence, often with adverse effects on cellular function.
Frameshift mutations are associated with a variety of genetic disorders and are an important consideration in the study of disease genetics and the development of targeted therapies.
The analysis of frameshift mutations is a crucial aspect of genetic research, and researchers often rely on various tools and techniques to ensure accurate and reproducible results.
The PubCompare.ai platform provides a comprehensive, AI-driven approach to optimizing research protocols for the analysis of frameshift mutations, helping researchers locate the most up-to-date and reliable protocols from literature, preprints, and patents.
One key technique used in frameshift mutation analysis is DNA sequencing, which can be performed using various platforms such as the Illumina HiSeq 2000, HiSeq 2500, MiSeq, and NovaSeq 6000 systems.
These platforms utilize advanced sequencing technologies, such as the BigDye Terminator v3.1 Cycle Sequencing Kit, to generate high-quality sequence data.
Additionally, cell culture techniques, such as the use of Lipofectamine 2000 or Lipofectamine 3000 for transfection, and the inclusion of Penicillin/streptomycin and FBS (Fetal Bovine Serum) in cell culture media, can be important for maintaining cell health and viability during experimental procedures.
By leveraging the comprehensive resources and AI-powered comparisons provided by the PubCompare.ai platform, researchers can ensure the reproducibility and accuracy of their frameshift mutation analyses, ultimately advancing our understanding of the underlying mechanisms and clinical implications of these genetic alterations.