High-throughput sequencing data have been produced at unprecedented rates for diverse genomes. There is a strong need for novel informatics and analytical strategies, including methods for sequencing reads alignment, variant identification, genotype calling and association tests, in order to take advantage of the massive amounts of sequencing data. There have been dozens of short read alignment software available now with different functionalities (
1), as well as several single nucleotide variants (SNV) and copy number variant (CNV) calling algorithms (
2). However, there is a paucity of methods that can simultaneously handle a large number of called variants (typically >3

million variants for a given human genome) and annotate their functional impacts, despite the fact that this is an important task in many sequencing applications. Even when sequencing only exonic regions for Mendelian diseases such as Freeman–Sheldon syndrome, each subject still carries a total of ~20

000 variants, but only two variants
in trans are the true disease causal mutations (
3). Therefore, identifying a small subset of functionally important variants from large amounts of sequencing data is important to pinpoint potential disease causal genes and causal mutations.
Several reasons motivate us to develop a functional annotation pipeline for genetic variants. First, although companies that manufacture sequencing machines or provide sequencing services typically offer software for functional annotation, these software are usually sequencing platform-specific, and cannot be extended to handle users’ specific needs (such as using different genome builds or gene annotations). Second, although several databases have been developed for the functional annotation of SNPs or CNVs (
4–6), most of them are limited to known variants, typically those reported in dbSNP or CNV databases. We note that some exceptions exist (
7), for example, the F-SNP tool (
8) and Seattle Seq tool (
http://gvs.gs.washington.edu/SeattleSeqAnnotation/) can be used for annotation of novel SNPs. Third, several previously developed mutation prediction algorithms, such as SIFT (
9) and PolyPhen (
10), require building multiple alignments on sequence databases, can only handle non-synonymous mutations, and are difficult to scale up to many model organism genomes. Nevertheless, for human genomes, SIFT/PolyPhen scores for all possible non-synonymous mutations can be computed, so they can be utilized for fast annotation of novel SNVs. Fourth, although it is feasible to build a database with pre-calculated annotation for all 9

billion possible SNVs in the human genome, such databases cannot be easily updated when new annotation information is available, and they cannot handle insertions or deletions. Finally, the development of many current databases and web servers are geared toward the human genome, and cannot be utilized when sequences from non-human genomes need to be annotated. Therefore, there is a strong community need for efficient, configurable, extensible and cross-platform compatible tools to utilize update-to-date information to annotate genetic variants from diverse genomes. The software that we present here, ANNOVAR (Annotate Variation), was developed to fill these unmet needs.
Besides annotating functional effects of variants with respect to genes, ANNOVAR has several other functionalities, including the ability to perform genomic region-based annotations, as well as the ability to compare variants to existing variation databases. Region-based annotations refer to the annotations of variants based on specific genomic elements other than genes, for example, conserved genomic regions, predicted transcription factor binding sites, predicted microRNA target sites and predicted stable RNA secondary structures. These annotations are especially important for whole-genome sequencing data, as the vast majority of variants will be outside of protein coding regions and their functional effects cannot be assessed by gene-based annotations. ANNOVAR can utilize annotation databases from the UCSC Genome Browser as flat text files; however, essentially any annotation database can be handled as long as they conform to Generic Feature Format version 3 (GFF3) standards (
http://www.sequenceontology.org/gff3.shtml) for sequence-level feature annotations. Additionally, ANNOVAR can evaluate and filter out subsets of variants that are not reported in public databases such as dbSNP and the 1000 Genomes Project. Typically, rare variants causing Mendelian diseases are less likely to be present in these databases, or are unlikely to be present with high allele frequencies. This rationale has been used to enrich for subsets of variants in previous exome sequencing projects that identified causal mutations for Freeman–Sheldon syndrome (
11) and Miller syndrome (
3). ANNOVAR offers similar functionality but can extend the comparisons to other public databases such as the 1000 Genomes Project, which offers allele frequency information. Similarly, ANNOVAR can also filter variants against a user-compiled data set, such as all SIFT scores for all possible non-synonymous mutations in the human genome.
We will provide long-term support to the academic community for software usage issues. Additionally, we will continuously update the software to accommodate and take advantage of different sources of functional annotation, for example, annotations based on exome sequencing from the 1000 Genomes Project in the future. We believe that ANNOVAR will be useful to prioritize genetic variants from diverse genomes, and expedite scientific discoveries from the massive amounts of sequencing data produced from high-throughput sequencing platforms.