1-215674103-T-G

Variant names:

• chr1-215674103-T-G
• rs727504551
• NM_206933.4:c.13808A>C

Variant summary

Our verdict is Likely pathogenic. The variant received 6 ACMG points: 6P and 0B. PM3_Strong PP4 PM2_Supporting

This summary comes from the ClinGen Evidence Repository: The c.13808A>C (p.His4603Pro) variant in USH2A is a missense variant predicted to cause a substitution of histidine by a proline at amino acid 4603. The highest population minor allele frequency in gnomAD v4.1.0 is 0.00000084 (4/1179986 alleles) in the european non-finnish population, which is lower than the ClinGen Hearing Loss VCEP threshold (<0.00007) for PM2_Supporting, meeting this criterion (PM2_Supporting). The computational predictor REVEL gives a score of 0.34, which is neither above nor below the thresholds predicting a damaging or benign impact on USH2A function. This variant has been detected in 1 proband with retinal disease and hearing loss (which was diagnosed at the age of 49 years old) in trans with a pathogenic variant by family testing (PMID:28157192). Besides, this variant has been detected in 4 individuals with USH2A associated conditions which is highly specific for disease (PP4). All individuals were heterozygous for the variant and a pathogenic or likely pathogenic variant with phase unknown (c.2299del, p.(Glu767Serfs*21); c.5118G>A, p.(Trp1706*); c.2276G>T, p.(Cys759Phe) and c.5573-834A>G; PM3 3 points, Blueprint Genetics internal evidence SCV001239096.1) (PM3_Strong). In summary, this variant meets the criteria to be classified as likely pathogenic for autosomal recessive USH2A condition (isolated RP) based on the ACMG/AMP criteria applied, as specified by the ClinGen Hearing Loss VCEP: PM2_P, PM3_Strong and PP4. (ClinGen Hearing Loss VCEP specifications version 2, 20.11.2024). LINK:https://erepo.genome.network/evrepo/ui/classification/CA183350/MONDO:0019501/005

• Frequency:
  • Genomes: not found (cov: 32)
  • Exomes 𝑓: 0.0000027 (0 hom.)
• Consequence: USH2A NM_206933.4 missense
• Clinical Significance: Likely pathogenic reviewed by expert panel P:3 U:2
• Conservation: PhyloP100: 2.08
• Publications: 1 publications found

Genes affected

USH2A (HGNC:12601): (usherin) This gene encodes a protein that contains laminin EGF motifs, a pentaxin domain, and many fibronectin type III motifs. The protein is found in the basement membrane, and may be important in development and homeostasis of the inner ear and retina. Mutations within this gene have been associated with Usher syndrome type IIa and retinitis pigmentosa. Multiple transcript variants encoding different isoforms have been found for this gene. [provided by RefSeq, Dec 2008]

USH2A Gene-Disease associations (from GenCC):

• Usher syndrome type 2

  Inheritance: AR Classification: DEFINITIVE, SUPPORTIVE Submitted by: ClinGen, Orphanet
• Usher syndrome type 2A

  Inheritance: AR Classification: DEFINITIVE, STRONG Submitted by: G2P, PanelApp Australia, Labcorp Genetics (formerly Invitae)
• retinitis pigmentosa 39

  Inheritance: AR Classification: STRONG Submitted by: Labcorp Genetics (formerly Invitae)
• retinitis pigmentosa

  Inheritance: AD Classification: SUPPORTIVE Submitted by: Orphanet

ACMG classification

Our verdict: Likely_pathogenic. The variant received 6 ACMG points.

• PM2: For more information check the summary or visit ClinGen Evidence Repository.
• PM3: For more information check the summary or visit ClinGen Evidence Repository.
• PP4: For more information check the summary or visit ClinGen Evidence Repository.

Variant Effect in Transcripts

ACMG analysis was done for transcript: NM_206933.4. You can select a different transcript below to see updated ACMG assignments.

RefSeq Transcripts

Selected	Gene	Transcript	Tags	HGVSc	HGVSp	Effect	Exon Rank	Protein	UniProt
	USH2A	NM_206933.4	MANE Select	c.13808A>C	p.His4603Pro	missense	Exon 63 of 72	NP_996816.3

Ensembl Transcripts

Selected	Gene	Transcript	Tags	HGVSc	HGVSp	Effect	Exon Rank	Protein	UniProt
	USH2A	ENST00000307340.8	TSL:1 MANE Select	c.13808A>C	p.His4603Pro	missense	Exon 63 of 72	ENSP00000305941.3
	USH2A	ENST00000674083.1		c.13808A>C	p.His4603Pro	missense	Exon 63 of 73	ENSP00000501296.1

Frequencies

GnomAD3 genomes Cov.: 32

GnomAD4 exome AF: 0.00000274 AC: 4 AN: 1461772 Hom.: 0 Cov.: 30 AF XY: 0.00000275 AC XY: 2 AN XY: 727192

African (AFR) AF: 0.00 AC: 0 AN: 33476

American (AMR) AF: 0.00 AC: 0 AN: 44720

Ashkenazi Jewish (ASJ) AF: 0.00 AC: 0 AN: 26132

East Asian (EAS) AF: 0.00 AC: 0 AN: 39694

South Asian (SAS) AF: 0.00 AC: 0 AN: 86212

European-Finnish (FIN) AF: 0.00 AC: 0 AN: 53416

Middle Eastern (MID) AF: 0.00 AC: 0 AN: 5768

European-Non Finnish (NFE) AF: 0.00000360 AC: 4 AN: 1111968

Other (OTH) AF: 0.00 AC: 0 AN: 60386

GnomAD4 genome Cov.: 32

ClinVar

Significance: Likely pathogenic

Submissions summary: Pathogenic:3 Uncertain:2

Revision: reviewed by expert panel

Submissions by phenotype

Usher syndrome Pathogenic:1

Nov 20, 2024

ClinGen Hearing Loss Variant Curation Expert Panel

Significance: Likely pathogenic

Review Status: reviewed by expert panel

Collection Method: curation

The c.13808A>C (p.His4603Pro) variant in USH2A is a missense variant predicted to cause a substitution of histidine by a proline at amino acid 4603. The highest population minor allele frequency in gnomAD v4.1.0 is 0.00000084 (4/1179986 alleles) in the european non-finnish population, which is lower than the ClinGen Hearing Loss VCEP threshold (<0.00007) for PM2_Supporting, meeting this criterion (PM2_Supporting). The computational predictor REVEL gives a score of 0.34, which is neither above nor below the thresholds predicting a damaging or benign impact on USH2A function. This variant has been detected in 1 proband with retinal disease and hearing loss (which was diagnosed at the age of 49 years old) in trans with a pathogenic variant by family testing (PMID: 28157192). Besides, this variant has been detected in 4 individuals with USH2A associated conditions which is highly specific for disease (PP4). All individuals were heterozygous for the variant and a pathogenic or likely pathogenic variant with phase unknown (c.2299del, p.(Glu767Serfs*21); c.5118G>A, p.(Trp1706*); c.2276G>T, p.(Cys759Phe) and c.5573-834A>G; PM3 3 points, Blueprint Genetics internal evidence SCV001239096.1) (PM3_Strong). In summary, this variant meets the criteria to be classified as likely pathogenic for autosomal recessive USH2A condition (isolated RP) based on the ACMG/AMP criteria applied, as specified by the ClinGen Hearing Loss VCEP: PM2_P, PM3_Strong and PP4. (ClinGen Hearing Loss VCEP specifications version 2, 20.11.2024).

not provided Pathogenic:1

Feb 06, 2024

Labcorp Genetics (formerly Invitae), Labcorp

Significance: Likely pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

This sequence change replaces histidine, which is basic and polar, with proline, which is neutral and non-polar, at codon 4603 of the USH2A protein (p.His4603Pro). This variant is not present in population databases (gnomAD no frequency). This missense change has been observed in individual(s) with clinical features of retinitis pigmentosa (PMID: 28157192; Invitae). In at least one individual the data is consistent with being in trans (on the opposite chromosome) from a pathogenic variant. ClinVar contains an entry for this variant (Variation ID: 178937). Advanced modeling of protein sequence and biophysical properties (such as structural, functional, and spatial information, amino acid conservation, physicochemical variation, residue mobility, and thermodynamic stability) performed at Invitae indicates that this missense variant is not expected to disrupt USH2A protein function with a negative predictive value of 95%. In summary, the currently available evidence indicates that the variant is pathogenic, but additional data are needed to prove that conclusively. Therefore, this variant has been classified as Likely Pathogenic.

Retinal dystrophy Pathogenic:1

May 23, 2019

Blueprint Genetics

Significance: Likely pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

not specified Uncertain:1

Jul 23, 2013

Laboratory for Molecular Medicine, Mass General Brigham Personalized Medicine

Significance: Uncertain significance

Review Status: criteria provided, single submitter

Collection Method: clinical testing

The His4603Pro variant in USH2A has not been reported in individuals with hearin g loss or in large population studies. Computational analyses (biochemical amin o acid properties, conservation, AlignGVGD, PolyPhen2, and SIFT) do not provide strong support for or against an impact to the protein. In summary, additional d ata is needed to determine the clinical significance of this variant.

Usher syndrome type 2A;C3151138:Retinitis pigmentosa 39 Uncertain:1

Dec 21, 2017

Counsyl

Significance: Uncertain significance

Review Status: no assertion criteria provided

Collection Method: clinical testing

This submission and the accompanying classification are no longer maintained by the submitter. For more information on current observations and classification, please contact variantquestions@myriad.com.

Computational scores

Source: dbNSFP v4.9

Name	Calibrated prediction	Score	Prediction
AlphaMissense	Uncertain	0.35
BayesDel_addAF	Benign	-0.017	T
BayesDel_noAF	Benign	-0.26
CADD	Benign	18
DANN	Benign	0.93
DEOGEN2	Benign	0.23	T
Eigen	Benign	0.18
Eigen_PC	Benign	0.13
FATHMM_MKL	Uncertain	0.94	D
LIST_S2	Benign	0.55	T
M_CAP	Pathogenic	0.30	D
MetaRNN	Pathogenic	0.76	D
MetaSVM	Benign	-0.73	T
MutationAssessor	Uncertain	2.4	M
PhyloP100		2.1
PrimateAI	Benign	0.29	T
PROVEAN	Uncertain	-3.3	D
REVEL	Uncertain	0.34
Sift	Benign	0.15	T
Sift4G	Uncertain	0.016	D
Polyphen		0.94	P
Vest4		0.53
MutPred		0.61		Gain of glycosylation at H4603 (P = 0.0903)
MVP		0.94
MPC		0.21
ClinPred		0.78	D
GERP RS		2.7
Varity_R		0.86
gMVP		0.69
Mutation Taster		=11/89	disease causing (ClinVar)

Splicing

Name	Calibrated prediction	Score	Prediction
SpliceAI score (max)		0.050		Details are displayed if max score is > 0.2

Find out detailed SpliceAI scores and Pangolin per-transcript scores at spliceailookup.broadinstitute.org

Other links and lift over

dbSNP: rs727504551; hg19: chr1-215847445;