19-11113329-C-T
Variant summary
Our verdict is Likely pathogenic. Variant got 6 ACMG points: 6P and 0B. PM2PP1PP4PS4_Moderate
This summary comes from the ClinGen Evidence Repository: NM_000527.5(LDLR):c.1238C>T (p.Thr413Met) variant is classified as Likely pathogenic for Familial Hypercholesterolemia by applying evidence codes (PM2, PS4_Moderate, PP1 and PP4) as defined by the ClinGen Familial Hypercholesterolemia Expert Panel LDLR-specific variant curation guidelines (https://doi.org/10.1101/2021.03.17.21252755). The supporting evidence is as follows: PM2 - PopMax MAF = 0.00006533 (0.007%) in South Asian (gnomAD v2.1.1). PS4_moderate - Variant meets PM2. Variant identified in 6 index cases.PP1 - Variant segregates with phenotype in 2 members of family (2 meiosis) from GeneDx laboratory.PP4 - Variant meets PM2. Variant identified in 6 index cases (2 cases from Center of molecular biology and gene therapy with Simon-Broome criteria; 1 case from GeneDx laboratory with Simon Broome criteria, 1 case from Color laboratory with DLCN criteria, 2 cases from Cardiovascular Genetics Laboratory (PathWest Laboratory Medicine WA) with DLCN criteria). LINK:https://erepo.genome.network/evrepo/ui/classification/CA023439/MONDO:0007750/013
Frequency
Consequence
NM_000527.5 missense
Scores
Clinical Significance
Conservation
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ACMG classification
Verdict is Likely_pathogenic. Variant got 6 ACMG points.
Transcripts
RefSeq
Gene | Transcript | HGVSc | HGVSp | Effect | Exon rank | MANE | Protein | UniProt |
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LDLR | NM_000527.5 | c.1238C>T | p.Thr413Met | missense_variant | Exon 9 of 18 | ENST00000558518.6 | NP_000518.1 |
Ensembl
Frequencies
GnomAD3 genomes AF: 0.00000658 AC: 1AN: 152072Hom.: 0 Cov.: 29
GnomAD3 exomes AF: 0.0000279 AC: 7AN: 251176Hom.: 0 AF XY: 0.0000442 AC XY: 6AN XY: 135870
GnomAD4 exome AF: 0.0000472 AC: 69AN: 1461564Hom.: 1 Cov.: 33 AF XY: 0.0000413 AC XY: 30AN XY: 727094
GnomAD4 genome AF: 0.00000658 AC: 1AN: 152072Hom.: 0 Cov.: 29 AF XY: 0.00 AC XY: 0AN XY: 74284
ClinVar
Submissions by phenotype
Hypercholesterolemia, familial, 1 Pathogenic:10Uncertain:2
Criteria applied: PS4_MOD,PM2_SUP,PP1,PP3,PP4 -
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This c.1238C>T (p.Thr413Met) variant in the LDLR gene has been reported in multiple individuals with familial hypercholesterolemia (PMID: 11857755, 17539906, 19843101, 11668627, 15015036, 25682026) or myocardial infarction (PMID: 25487149). The p.Thr413Met variant occurs within the low-density lipoprotein receptor repeat class B domain of the LDLR protein (https://www.ncbi.nlm.nih.gov/Structure/cdd/wrpsb.cgi?seqinput=NP_001182729.1 ). The c.1238C>T variant is rare in the general population and threonine at position 413 of the LDLR protein is highly evolutionarily conserved. The c.1238C>T (p.Thr413Met) variant in the LDLR gene is classified as likely pathogenic. -
NM_000527.5(LDLR):c.1238C>T (p.Thr413Met) variant is classified as Likely pathogenic for Familial Hypercholesterolemia by applying evidence codes (PM2, PS4_Moderate, PP1 and PP4) as defined by the ClinGen Familial Hypercholesterolemia Expert Panel LDLR-specific variant curation guidelines (https://doi.org/10.1101/2021.03.17.21252755). The supporting evidence is as follows: PM2 - PopMax MAF = 0.00006533 (0.007%) in South Asian (gnomAD v2.1.1). PS4_moderate - Variant meets PM2. Variant identified in 6 index cases. PP1 - Variant segregates with phenotype in 2 members of family (2 meiosis) from GeneDx laboratory. PP4 - Variant meets PM2. Variant identified in 6 index cases (2 cases from Center of molecular biology and gene therapy with Simon-Broome criteria; 1 case from GeneDx laboratory with Simon Broome criteria, 1 case from Color laboratory with DLCN criteria, 2 cases from Cardiovascular Genetics Laboratory (PathWest Laboratory Medicine WA) with DLCN criteria). -
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PM2_Supporting+PS4_Moderate+PM3+PP4+PS3_Supporting -
This missense variant replaces threonine with methionine at codon 413 in the LDLR type B repeat 1 of the EGF precursor homology domain of the LDLR protein. This variant is also known as p.Thr392Met in the mature protein. Computational prediction is inconclusive regarding the impact of this variant on protein structure and function (internally defined REVEL score threshold 0.5 < inconclusive < 0.7, PMID: 27666373). Functional studies have indicated no significant change in LDLR protein expression and function due to this variant (PMID: 32015373, 34029164). This variant has been reported in over twenty heterozygous individuals affected with familial hypercholesterolemia (PMID: 11668627, 11857755, 15015036, 15199436, 15576851, 17539906, 19843101, 22883975, 25682026, 31993549; ClinVar SCV001960926.1) and in an individual affected with myocardial infarction (PMID: 25487149). This variant has been observed in an individual with severe familial hypercholesterolemia who also carried a pathogenic truncation variant in the same gene (PMID: 34029164). This variant has been reported to segregate with disease in two members of a family (ClinVar SCV001960926.1). This variant has been identified in 7/251176 chromosomes in the general population by the Genome Aggregation Database (gnomAD). Based on the available evidence, this variant is classified as Likely Pathogenic. -
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MAF =<0.3%, likely pathogenic based on the integrative in-silico score, previously reported as P/LP in the literature -
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subject mutated among 2600 FH index cases screened = 1 / Software predictions: Conflicting -
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not provided Pathogenic:5
The LDLR c.1238C>T; p.Thr413Met variant (rs368562025) is reported in the literature in multiple individuals affected with familial hypercholesterolemia and myocardial infarction (Do 2015, Dong 2022, eMERGE Consortium 2019, Sturm 2021, Sustar 2022). This variant is also reported as likely pathogenic by an expert panel in ClinVar (Variation ID: 161276). This variant is found in the general population with an overall allele frequency of 0.003% (7/251176 alleles) in the Genome Aggregation Database. Computational analyses are uncertain whether this variant is neutral or deleterious (REVEL: 0.692). Based on available information, this variant is considered to be likely pathogenic. References: Do R, et al. Exome sequencing identifies rare LDLR and APOA5 alleles conferring risk for myocardial infarction. Nature. 2015 Feb 5;518(7537):102-6. PMID: 25487149. Dong W et al. Whole-exome sequencing reveals damaging gene variants associated with hypoalphalipoproteinemia. J Lipid Res. 2022 Jun;63(6):100209. PMID: 35460704. eMERGE Consortium et al. Harmonizing Clinical Sequencing and Interpretation for the eMERGE III Network. Am J Hum Genet. 2019 Sep 5;105(3):588-605. PMID: 31447099. Sturm AC et al. Limited-Variant Screening vs Comprehensive Genetic Testing for Familial Hypercholesterolemia Diagnosis. JAMA Cardiol. 2021 Aug 1;6(8):902-909. PMID: 34037665. Sustar U et al. Universal screening for familial hypercholesterolemia in 2 populations. Genet Med. 2022 Oct;24(10):2103-2111. PMID: 35913489. -
PP1, PP4, PM2, PS3_supporting, PS4_moderate -
Not observed at significant frequency in large population cohorts (gnomAD); In silico analysis supports that this missense variant has a deleterious effect on protein structure/function; This variant is associated with the following publications: (PMID: 24055113, 25487149, 11668627, 11857755, 25637381, 15015036, 15576851, 15199436, 17539906, 28145427, 32015373, 32719484, 32522009, 30586733, 31447099, 34037665, 25682026, 27783906, 22883975, 35913489, 33854068, 34906840, Gratton2023[CaseReport], 37409534, 35460704, 37443404, 38740897, 38258479, 38506081) -
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The LDLR c.1238C>T (p.Thr413Met) variant has been reported in the published literature in several affected individuals with familial hypercholesterolemia (PMIDs: 11857755 (2002), 15199436 (2004), 17539906 (2007), 22883975 (2012), 25682026 (2015), 32522009 (2020), 33854068 (2021), 34029164 (2021), 34037665 (2021), 34906840 (2022), and 35460704 (2022)), coronary artery disease (PMID: 27050191 (2016)), or myocardial infarction (PMID: 25487149 (2015)). A functional study found that LDL-LDLR binding activity and LDL uptake were similar to wild type LDLR, as well as no effect on protein expression in transfected cells (PMID: 32015373 (2020)). The frequency of this variant in the general population, 0.000071 (3/42136 chromosomes (Genome Aggregation Database, http://gnomad.broadinstitute.org)), is uninformative in the assessment of its pathogenicity. Analysis of this variant using bioinformatics tools for the prediction of the effect of amino acid changes on protein structure and function yielded predictions that this variant is damaging. Based on the available information, this variant is classified as likely pathogenic. -
Familial hypercholesterolemia Pathogenic:4
This sequence change replaces threonine, which is neutral and polar, with methionine, which is neutral and non-polar, at codon 413 of the LDLR protein (p.Thr413Met). This variant is present in population databases (rs368562025, gnomAD 0.01%), including at least one homozygous and/or hemizygous individual. This missense change has been observed in individual(s) with familial hypercholesterolemia (PMID: 11857755, 20236128, 25682026; internal data). In at least one individual the data is consistent with being in trans (on the opposite chromosome) from a pathogenic variant. Invitae Evidence Modeling of clinical and family history, age, sex, and reported ancestry of multiple individuals with this LDLR variant has been performed. This variant is expected to be pathogenic with a positive predictive value of at least 99%. This is a validated machine learning model that incorporates the clinical features of 363,995 individuals referred to our laboratory for LDLR testing. ClinVar contains an entry for this variant (Variation ID: 161276). Invitae Evidence Modeling of protein sequence and biophysical properties (such as structural, functional, and spatial information, amino acid conservation, physicochemical variation, residue mobility, and thermodynamic stability) indicates that this missense variant is expected to disrupt LDLR protein function with a positive predictive value of 95%. For these reasons, this variant has been classified as Pathogenic. -
Variant summary: LDLR c.1238C>T (p.Thr413Met) results in a non-conservative amino acid change located in the EGF spacer domain (Dong_2022) of the encoded protein sequence. Five of five in-silico tools predict a damaging effect of the variant on protein function. The variant allele was found at a frequency of 2.8e-05 in 253468 control chromosomes (gnomAD and publication data). c.1238C>T has been reported in the literature in individuals affected with Familial Hypercholesterolemia, Myocardial infarction or Coronary artery disease (Bunn_2022, Leren_2004, Taylor_2007, Hooper_2012, Do_2014, Khera_2016, Wald_2016, Saadatagah_2021, Sturm_2021). These data indicate that the variant is likely to be associated with disease. At least one functional study showed LDLR activity (LDL binding and uptake) of this variant determined by flow cytometry and indicated LDL uptake as 85% WT and LDL binding as 80% WT, but no effect on protein expression level in transfected cellls (Galicia-Garcia_2020). Twelve ClinVar submitters (evaluation after 2014) cite this variant as uncertain significance (n=3), likely pathogenic (n=8) and pathogenic (n=1), including one expert panel (ClinGen Familial Hypercholesterolemia Variant Curation Expert Panel) classified it as likely pathogenic. Based on the evidence outlined above, the variant was classified as likely pathogenic. -
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This missense variant (also known as p.Thr392Met in the mature protein) replaces threonine with methionine at codon 413 in the LDLR type B repeat 1 of the EGF precursor homology domain of the LDLR protein. Computational prediction is inconclusive regarding the impact of this variant on protein structure and function (internally defined REVEL score threshold 0.5 < inconclusive < 0.7, PMID: 27666373). Functional studies have indicated no significant change in LDLR protein expression and function due to this variant (PMID: 32015373, 34029164). This variant has been reported in over twenty heterozygous individuals affected with familial hypercholesterolemia (PMID: 11668627, 11857755, 15015036, 15199436, 15576851, 17539906, 19843101, 22883975, 25682026, 31993549, 34037665; ClinVar SCV001960926.1). It has also been reported in an individual affected with myocardial infarction (PMID: 25487149) and in an individual affected with low circulating HDL-C (PMID: 35460704). This variant has also been observed in compound heterozygous state with a known pathogenic LDLR variant in an individual affected with severe homozygous familial hypercholesterolemia, a phenotype expected of having two deleterious LDLR variants (PMID: 34029164). This variant has been reported to segregate with disease in two members of a family (ClinVar SCV001960926.1). This variant has been identified in 7/251176 chromosomes in the general population by the Genome Aggregation Database (gnomAD). Based on the available evidence, this variant is classified as Likely Pathogenic. -
Cardiovascular phenotype Pathogenic:1
The p.T413M variant (also known as c.1238C>T), located in coding exon 9 of the LDLR gene, results from a C to T substitution at nucleotide position 1238. The threonine at codon 413 is replaced by methionine, an amino acid with similar properties. This variant (also described as p.T392M) has been detected in individuals with familial hypercholesterolemia (FH) (Bunn CF et al. Hum. Mutat., 2002 Mar;19:311; Leren TP et al. Semin Vasc Med, 2004 Feb;4:75-85; Taylor A et al. Clin. Genet., 2007 Jun;71:561-8; Safarova MS et al. Eur. J. Hum. Genet., 2017 04;25:410-415). This alteration has also been reported in additional subjects with FH and as a compound heterozygote in a child with features of FH (personal communication). This amino acid position is well conserved in available vertebrate species. In addition, this alteration is predicted to be deleterious by in silico analysis. Based on the majority of available evidence to date, this variant is likely to be pathogenic. -
Hypercholesterolemia Uncertain:1
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Computational scores
Source:
Splicing
Find out detailed SpliceAI scores and Pangolin per-transcript scores at