Saturation-seq integrates single-cell saturation genome editing and RNA-seq to quantify NFE2L2 (NRF2) variant effects

Interpreting the functional consequences of variants remains one of the central unsolved problems in genomics and clinical genetics. Compounding this, most existing approaches rely on reductive, one-dimensional proxies such as cell growth to score variant effects, which can be a poor substitute for the rich, multidimensional phenotyping that is ultimately needed to understand how variants alter biology. This is especially true for variants known to act through gain-of-function/neomorphic mechanisms. We developed Saturation-seq, a high-throughput platform that combines saturation genome editing with single-cell DNA and RNA profiling to systematically map variant effects. Using CRISPR-based editing in a barcoded haploid cell line, we install hundreds of variants directly into endogenous genomic loci, testing them in multiplex and preserving the native coding and regulatory context. Single-cell amplicon and transcriptome sequencing enables direct linkage of each genomic edit to its transcriptional impact. We apply Saturation-seq to comprehensively characterize 230 variants in the recurrently mutated N-terminal region of NFE2L2 (NRF2), a master regulator of oxidative stress and an oncogene mutated in lung cancer. We define variant function with ‘disruption scores’ computed from misregulation of known NRF2 targets in single-cell transcriptomes; scores separate pathogenic/benign truthset variants with >90% accuracy and enabled interpretation of TCGA and TRACERx patient tumor data, as well as a rare NFE2L2 germline variant linked to a developmental syndrome. Thus, we establish a broadly applicable high-resolution single-cell variant-to-function platform with a rich phenotypic readout.