SCN9A

protein-coding

sodium voltage-gated channel alpha subunit 9, the group of Sodium voltage-gated channel alpha subunits

Gene summary

This gene encodes a voltage-gated sodium channel which plays a significant role in nociception signaling. Mutations in this gene have been associated with primary erythermalgia, channelopathy-associated insensitivity to pain, and paroxysmal extreme pain disorder. [provided by RefSeq, Aug 2009]

MANE transcript

NM_001365536.1

Inheritance

AD, AR, SD

ClinVar variants

P:195U:1708B:697

Top phenotype

Paroxysmal extreme pain disorder

gnomAD constraint

pLI —, LoF o/e 0.55

Max pathogenic AF

—

Genomic locus

chr2:166,195,185-166,376,001

External References & Databases

Transcript & Mutation Effects

hg38 • Region Span ~180.8 kb
Loading mutation effect viewer...

GenCC Phenotypes & Disease Associations

Curated gene-disease validity assertions and inheritance patterns

primary erythermalgiaDEFINITIVE

Inheritance Pattern: AD

Disease ID:MONDO:0007571

Submitter: G2P

epilepsyNO_KNOWN

Inheritance Pattern: AD

Disease ID:MONDO:0005027

Submitter: ClinGen

Variants in SCN9A have been observed in individuals with a variety of primarily neuropathy phenotypes, including autosomal dominant small fiber neuropathy and erythermalgia and autosomal recessive congenital insensitivity to pain. A relationship between SCN9A and autosomal dominant epilepsy (MONDO:0005027) has also been reported, which is the focus of this recuration. The SCN9A gene was initially curated by the ClinGen Epilepsy Gene Curation Expert Panel (GCEP) in relation to autosomal dominant epilepsy on 6/5/2018. At the time, this gene-disease relationship was classified as LIMITED based on case-level data. Since that time, a publication providing evidence to refute this gene-disease relationship has become available. In the initial curation, the primary evidence supporting a gene-disease relationship with epilepsy was provided from Singh et al. 2009 (PMID 19763161). This publication described a large family segregating the p.Asn641Tyr SCN9A variant in individuals with febrile or afebrile seizures, primarily limited to childhood. Additionally, this publication provided weak experimental evidence with a homozygous p.Asn641Tyr knock-in mouse model. A recent publication by Fasham et al. 2020 (PMID 33216760) provides evidence to refute the pathogenicity of the p.Asn641Tyr variant. In this publication, the p.Asn641Tyr variant was identified in an Amish proband with a de novo CHD4 variant, consistent with the proband phenotype; the SCN9A variant was shown to be inherited from the proband’s unaffected father. The p.Asn641Tyr variant was subsequently identified in another 7 Amish families where it was transmitted through an additional minimum 26 constitutive gene carriers and presumed to be transmitted to hundreds of additional offspring, only one of whom had any reported seizures. Additionally, the p.Asn641Tyr variant is present in 6 alleles in the gnomAD database. Additional variants in SCN9A have been reported in the literature in association with epilepsy and are summarized in this recuration, but the majority are unable to be scored due to lack of segregation with disease, high minor allele frequency in general population databases or an alternate molecular explanation for disease. Case level data provides a score of 0.4 points and there is no scored experimental evidence, resulting in a total score of 0.4 points. In summary, there is convincing evidence refuting the relationship between SCN9A and autosomal dominant epilepsy, which significantly outweighs the evidence supporting the relationship. This classification was approved by the ClinGen Epilepsy GCEP on 2/5/21 (SOP Version 8).

channelopathy-associated congenital insensitivity to pain, autosomal recessiveSTRONG

Inheritance Pattern: AR

Disease ID:MONDO:0009459

Submitter: Laboratory for Molecular Medicine

This gene-disease relationship has undergone rapid assessment. Classifications are based on preliminary review of gene-disease validity during analysis of genomic sequencing results.

epilepsyLIMITED

Inheritance Pattern: AD

Disease ID:MONDO:0005027

Submitter: Illumina

generalized epilepsy with febrile seizures plus, type 7STRONG

Inheritance Pattern: AD

Disease ID:MONDO:0013470

Submitter: Labcorp Genetics (formerly Invitae)

paroxysmal extreme pain disorderSTRONG

Inheritance Pattern: AD

Disease ID:MONDO:0008179

Submitter: Labcorp Genetics (formerly Invitae)

hereditary peripheral neuropathySTRONG

Inheritance Pattern: SD

Disease ID:MONDO:0020127

Submitter: PanelApp Australia

epilepsyNO_KNOWN

Inheritance Pattern: AD

Disease ID:MONDO:0005027

Submitter: PanelApp Australia

primary erythermalgiaSTRONG

Inheritance Pattern: AD

Disease ID:MONDO:0007571

Submitter: Genomics England PanelApp

channelopathy-associated congenital insensitivity to pain, autosomal recessiveLIMITED

Inheritance Pattern: SD

Disease ID:MONDO:0009459

Submitter: Ambry Genetics

generalized epilepsy with febrile seizures plus, type 7LIMITED

Inheritance Pattern: AD

Disease ID:MONDO:0013470

Submitter: Ambry Genetics

sodium channelopathy-related small fiber neuropathySUPPORTIVE

Inheritance Pattern: AD

Disease ID:MONDO:0017629

Submitter: Orphanet

channelopathy-associated congenital insensitivity to pain, autosomal recessiveSUPPORTIVE

Inheritance Pattern: AD

Disease ID:MONDO:0009459

Submitter: Orphanet

primary erythermalgiaSUPPORTIVE

Inheritance Pattern: AD

Disease ID:MONDO:0007571

Submitter: Orphanet

hereditary sensory and autonomic neuropathy type 2SUPPORTIVE

Inheritance Pattern: AR

Disease ID:MONDO:0019941

Submitter: Orphanet

paroxysmal extreme pain disorderSUPPORTIVE

Inheritance Pattern: AD

Disease ID:MONDO:0008179

Submitter: Orphanet

channelopathy-associated congenital insensitivity to pain, autosomal recessiveSTRONG

Inheritance Pattern: AR

Disease ID:MONDO:0009459

Submitter: Labcorp Genetics (formerly Invitae)

Clinical Genomic Database (CGD)

Paroxysmal extreme pain disorderAD/AR

Manifestation: Dermatologic; Neurologic

Intervention: Neurologic

Rationale: In Primary erythermalgia, medical treatment (with specific sodium channel blocking agents such as XEN402) has been reported as beneficial; Individuals with Paroxysmal extreme pain disorder have been reported as responding to medical therapy (eg, carbamazepine) in terms of clinical manifestations (attacks of pain) as well as psychomotor development in some

Comments: Many treatments have been attempted (with inconsistent success) in Erythermalgia, primary, and some have been described by patients as providing subjective relief from symptoms; Indifference to pain, congenital, can result in injuries, some of which may in theory be preventable with early diagnosis and preventive measures

Refs: 13636703; 4111621; 4112340; 1536168; 10724194; 14985375; 15958509; 16216943; 17167479; 17145499; 17679678; 17470132; 19304393; 19763161; 21441906; 21698661; 22035805; 23596073; 24817410Source: CGD (NHGRI)

ClinVar Associated Diseases & Phenotypes

Reported disease conditions connected to SCN9A variants in ClinVar

34 Conditions Cataloged
Neuropathy, hereditary sensory and autonomic, type 2ATotal: 2643
Generalized epilepsy with febrile seizures plus, type 7Total: 2638
not providedTotal: 485
Inborn genetic diseasesTotal: 462
not specifiedTotal: 232
Channelopathy-associated congenital insensitivity to pain, autosomal recessiveTotal: 183
Primary erythromelalgiaTotal: 173
Paroxysmal extreme pain disorderTotal: 159

ClinVar Variants & Pathogenicity by Type

Statistics based on transcript NM_001365536.1. Only rare variants are included.

We include only reliable ClinVar variants with their consequences to MANE Select, MANE Plus Clinical transcripts, or transcripts with TSL equal to 1. Click a count to filter the variants table below.

Slight differences between displayed counts and ClinVar may occur due to a different transcript/consequence chosen by our variant effect predictor, or because we classify Benign/Likely benign as Likely benign and Pathogenic/Likely pathogenic as Likely pathogenic.

EffectPLPVUSLBBSum
synonymous
1
clinvar
24
clinvar
585
clinvar
13
clinvar
623
missense
18
clinvar
17
clinvar
1653
clinvar
94
clinvar
5
clinvar
1787
nonsense
41
clinvar
17
clinvar
8
clinvar
66
start loss
0
frameshift
49
clinvar
16
clinvar
17
clinvar
82
splice donor/acceptor (+/-2bp)
6
clinvar
30
clinvar
6
clinvar
42
Total114811708679182600

Highest pathogenic variant AF is 0.00004091658

Loading ClinVar variants...

Transcript Catalog

Annotated transcript isoforms across RefSeq and Ensembl databases

Showing 4 of 32 transcripts
Transcript IDSourceProtein IDCoding ExonsMANE Status
NM_001365536.1RefSeqNP_001352465.126MANE Select
ENST00000642356.2EnsemblENSP00000495601.126MANE Select
NM_002977.4RefSeqNP_002968.226Standard
ENST00000303354.11EnsemblENSP00000304748.726Standard

Gene Ontology (GO) Annotations & Pathways

Biological processes, molecular functions, cellular components and pathways

Pathways ConsensusPathDB

  • Taste transduction - Homo sapiens (human)
  • Developmental Biology
  • Phase 0 - rapid depolarisation
  • Cardiac conduction
  • Muscle contraction

Biological Process

  • sodium ion transport
  • inflammatory response
  • response to toxic substance
  • post-embryonic development
  • neuronal action potential

Molecular Function

  • voltage-gated ion channel activity
  • voltage-gated sodium channel activity
  • sodium ion binding

Cellular Component

  • voltage-gated sodium channel complex
  • plasma membrane
  • integral component of plasma membrane
  • axon

gnomAD Constraint

Source: gnomAD

Gene type
protein_coding
Transcript type
protein_coding
Transcript
ENST00000409672
Coding exons
26
Length
180809
Individuals with no LoFs
125635
Homozygous LoFs
0
Heterozygous LoFs
113
Defined
125748
p
0.000449
Z-ScoreObservedExpectedObserved/ExpectedMutation RateTotal Possible
Missense1.069131.01e+30.9060.000052413101
Missense (PolyPhen)343453.440.756436036
Synonymous-1.083773511.070.00001833627
Loss of Function3.704378.30.5490.000004241050

Population LoF Frequency

PopulationCAFp-valueStatus
African0.000840.00080rare
Latino/Admixed American0.000660.00064rare
Ashkenazi Jewish0.0000990.000099rare
East Asian0.00150.0015notable
Finnish0.0000460.000046rare
European (Non-Finnish)0.000370.00036rare
South Asian0.000200.00020rare
Other0.000330.00016rare

dbNSFP Gene Annotations

Source: dbNSFP

Function
FUNCTION: Mediates the voltage-dependent sodium ion permeability of excitable membranes. Assuming opened or closed conformations in response to the voltage difference across the membrane, the protein forms a sodium-selective channel through which Na(+) ions may pass in accordance with their electrochemical gradient (PubMed:7720699, PubMed:17167479, PubMed:25240195, PubMed:26680203, PubMed:15385606, PubMed:16988069, PubMed:17145499, PubMed:19369487, PubMed:24311784). It is a tetrodotoxin-sensitive Na(+) channel isoform (PubMed:7720699). Plays a role in pain mechanisms, especially in the development of inflammatory pain (PubMed:17167479, PubMed:17145499, PubMed:19369487, PubMed:24311784). {ECO:0000269|PubMed:15178348, ECO:0000269|PubMed:15385606, ECO:0000269|PubMed:16988069, ECO:0000269|PubMed:17145499, ECO:0000269|PubMed:17167479, ECO:0000269|PubMed:19369487, ECO:0000269|PubMed:24311784, ECO:0000269|PubMed:25240195, ECO:0000269|PubMed:26680203, ECO:0000269|PubMed:7720699}.;
Disease
DISEASE: Primary erythermalgia (PERYTHM) [MIM:133020]: Autosomal dominant disease characterized by recurrent episodes of severe pain associated with redness and warmth in the feet or hands. {ECO:0000269|PubMed:14985375, ECO:0000269|PubMed:15385606, ECO:0000269|PubMed:15955112, ECO:0000269|PubMed:15958509, ECO:0000269|PubMed:16216943, ECO:0000269|PubMed:16392115, ECO:0000269|PubMed:16702558, ECO:0000269|PubMed:16988069, ECO:0000269|PubMed:18945915, ECO:0000269|PubMed:19369487, ECO:0000269|PubMed:24311784}. Note=The disease is caused by mutations affecting the gene represented in this entry.; DISEASE: Indifference to pain, congenital, autosomal recessive (CIP) [MIM:243000]: A disorder characterized by congenital inability to perceive any form of pain, in any part of the body. All other sensory modalities are preserved and the peripheral and central nervous systems are apparently intact. Patients perceive the sensations of touch, warm and cold temperature, proprioception, tickle and pressure, but not painful stimuli. There is no evidence of a motor or sensory neuropathy, either axonal or demyelinating. {ECO:0000269|PubMed:20635406}. Note=The disease is caused by mutations affecting the gene represented in this entry.; DISEASE: Paroxysmal extreme pain disorder (PEPD) [MIM:167400]: Autosomal dominant paroxysmal disorder of pain and autonomic dysfunction. The distinctive features are paroxysmal episodes of burning pain in the rectal, ocular, and mandibular areas accompanied by autonomic manifestations such as skin flushing. {ECO:0000269|PubMed:17145499, ECO:0000269|PubMed:18945915, ECO:0000269|PubMed:25285947}. Note=The disease is caused by mutations affecting the gene represented in this entry.; DISEASE: Generalized epilepsy with febrile seizures plus 7 (GEFS+7) [MIM:613863]: A rare autosomal dominant, familial condition with incomplete penetrance and large intrafamilial variability. Patients display febrile seizures persisting sometimes beyond the age of 6 years and/or a variety of afebrile seizure types. This disease combines febrile seizures, generalized seizures often precipitated by fever at age 6 years or more, and partial seizures, with a variable degree of severity. {ECO:0000269|PubMed:19763161}. Note=The disease is caused by mutations affecting the gene represented in this entry.; DISEASE: Febrile seizures, familial, 3B (FEB3B) [MIM:613863]: Seizures associated with febrile episodes in childhood without any evidence of intracranial infection or defined pathologic or traumatic cause. It is a common condition, affecting 2-5% of children aged 3 months to 5 years. The majority are simple febrile seizures (generally defined as generalized onset, single seizures with a duration of less than 30 minutes). Complex febrile seizures are characterized by focal onset, duration greater than 30 minutes, and/or more than one seizure in a 24 hour period. The likelihood of developing epilepsy following simple febrile seizures is low. Complex febrile seizures are associated with a moderately increased incidence of epilepsy. {ECO:0000269|PubMed:19763161}. Note=The disease is caused by mutations affecting the gene represented in this entry.;

Recessive Scores

pRec
0.199

Intolerance Scores

LoFtool
0.0121
RVIS EVS
0.33
RVIS percentile EVS
73.63

Essentials

Essential (CRISPR)
N
Essential (CRISPR2)
N
Essential (gene trap)
N
Indispensability pred.
N
Indispensability score
0.179

Gene Damage Prediction

AllRecessiveDominant
MendelianMediumMediumMedium
Primary ImmunodeficiencyMediumMediumHigh
CancerMediumMediumMedium
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