19-11113590-G-T

Variant names:

Variant summary

Our verdict is Pathogenic. Variant got 18 ACMG points: 18P and 0B. PM1PM2PM5PP3_StrongPP5_Very_Strong

The NM_000527.5(LDLR):c.1414G>T(p.Asp472Tyr) variant causes a missense change involving the alteration of a non-conserved nucleotide. The variant allele was found at a frequency of 0.000026 in 1,613,872 control chromosomes in the GnomAD database, including 1 homozygotes. In-silico tool predicts a pathogenic outcome for this variant. Variant has been reported in ClinVar as Likely pathogenic (★★). Another variant affecting the same amino acid position, but resulting in a different missense (i.e. D472N) has been classified as Uncertain significance.

Frequency

Genomes: 𝑓 0.000020 ( 0 hom., cov: 32)

Exomes 𝑓: 0.000027 ( 1 hom. )

Consequence

LDLR
NM_000527.5 missense

Scores

Clinical Significance

Pathogenic/Likely pathogenic criteria provided, multiple submitters, no conflicts P:17B:1O:1

Conservation

PhyloP100: 2.58

Variant links:

Genes affected

LDLR (HGNC:6547): (low density lipoprotein receptor) The low density lipoprotein receptor (LDLR) gene family consists of cell surface proteins involved in receptor-mediated endocytosis of specific ligands. The encoded protein is normally bound at the cell membrane, where it binds low density lipoprotein/cholesterol and is taken into the cell. Lysosomes release the cholesterol, which is made available for repression of microsomal enzyme 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, the rate-limiting step in cholesterol synthesis. At the same time, a reciprocal stimulation of cholesterol ester synthesis takes place. Mutations in this gene cause the autosomal dominant disorder, familial hypercholesterolemia. Alternate splicing results in multiple transcript variants.[provided by RefSeq, May 2022]

LDLR links:

MIR6886 (HGNC:50121): (microRNA 6886) microRNAs (miRNAs) are short (20-24 nt) non-coding RNAs that are involved in post-transcriptional regulation of gene expression in multicellular organisms by affecting both the stability and translation of mRNAs. miRNAs are transcribed by RNA polymerase II as part of capped and polyadenylated primary transcripts (pri-miRNAs) that can be either protein-coding or non-coding. The primary transcript is cleaved by the Drosha ribonuclease III enzyme to produce an approximately 70-nt stem-loop precursor miRNA (pre-miRNA), which is further cleaved by the cytoplasmic Dicer ribonuclease to generate the mature miRNA and antisense miRNA star (miRNA*) products. The mature miRNA is incorporated into a RNA-induced silencing complex (RISC), which recognizes target mRNAs through imperfect base pairing with the miRNA and most commonly results in translational inhibition or destabilization of the target mRNA. The RefSeq represents the predicted microRNA stem-loop. [provided by RefSeq, Sep 2009]

MIR6886 links:

Genome browser will be placed here

ACMG classification

Classification made for transcript

Verdict is Pathogenic. Variant got 18 ACMG points.

PM1

In a hotspot region, there are 11 aminoacids with missense pathogenic changes in the window of +-8 aminoacids around while only 5 benign, 9 uncertain in NM_000527.5

PM2

Very rare variant in population databases, with high coverage;

PM5

Other missense variant is known to change same aminoacid residue: Variant chr19-11113590-G-A is described in Lovd as [Likely_pathogenic].

PP3

MetaRNN computational evidence supports a deleterious effect, 0.978

PP5

Variant 19-11113590-G-T is Pathogenic according to our data. Variant chr19-11113590-G-T is described in ClinVar as [Likely_pathogenic]. Clinvar id is 183116.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr19-11113590-G-T is described in Lovd as [Likely_pathogenic].

Transcripts

RefSeq

Gene	Transcript	HGVSc	HGVSp	Effect	Exon rank	MANE	Protein	UniProt
LDLR	NM_000527.5 link	c.1414G>T	p.Asp472Tyr	missense_variant	Exon 10 of 18	ENST00000558518.6	NP_000518.1	P01130-1A0A024R7D5

Ensembl

Gene	Transcript	HGVSc	HGVSp	Effect	Exon rank	TSL	MANE	Protein	Appris	UniProt
LDLR	ENST00000558518.6 link	c.1414G>T	p.Asp472Tyr	missense_variant	Exon 10 of 18	1	NM_000527.5	ENSP00000454071.1		P01130-1

Frequencies

GnomAD3 genomes

AF:

0.0000197

AC:

AN:

152132

Hom.:

Cov.:

show subpopulations

Gnomad AFR

AF:

0.0000241

Gnomad AMI

AF:

0.00

Gnomad AMR

AF:

0.00

Gnomad ASJ

AF:

0.00

Gnomad EAS

AF:

0.00

Gnomad SAS

AF:

0.000207

Gnomad FIN

AF:

0.00

Gnomad MID

AF:

0.00

Gnomad NFE

AF:

0.0000147

Gnomad OTH

AF:

0.00

GnomAD3 exomes

AF:

0.0000557

AC:

AN:

251206

Hom.:

AF XY:

0.0000957

AC XY:

AN XY:

135804

show subpopulations

Gnomad AFR exome

AF:

0.00

Gnomad AMR exome

AF:

0.00

Gnomad ASJ exome

AF:

0.00

Gnomad EAS exome

AF:

0.00

Gnomad SAS exome

AF:

0.000163

Gnomad FIN exome

AF:

0.00

Gnomad NFE exome

AF:

0.0000793

Gnomad OTH exome

AF:

0.00

GnomAD4 exome

AF:

0.0000267

AC:

AN:

1461740

Hom.:

Cov.:

AF XY:

0.0000358

AC XY:

AN XY:

727182

show subpopulations

Gnomad4 AFR exome

AF:

0.0000299

Gnomad4 AMR exome

AF:

0.00

Gnomad4 ASJ exome

AF:

0.00

Gnomad4 EAS exome

AF:

0.00

Gnomad4 SAS exome

AF:

0.000104

Gnomad4 FIN exome

AF:

0.00

Gnomad4 NFE exome

AF:

0.0000252

Gnomad4 OTH exome

AF:

0.0000166

GnomAD4 genome

AF:

0.0000197

AC:

AN:

152132

Hom.:

Cov.:

AF XY:

0.0000269

AC XY:

AN XY:

74318

show subpopulations

Gnomad4 AFR

AF:

0.0000241

Gnomad4 AMR

AF:

0.00

Gnomad4 ASJ

AF:

0.00

Gnomad4 EAS

AF:

0.00

Gnomad4 SAS

AF:

0.000207

Gnomad4 FIN

AF:

0.00

Gnomad4 NFE

AF:

0.0000147

Gnomad4 OTH

AF:

0.00

Bravo

AF:

0.00000756

ExAC

AF:

0.0000824

AC:

EpiCase

AF:

0.000109

EpiControl

AF:

0.000178

ClinVar

Significance: Pathogenic/Likely pathogenic

Submissions summary: Pathogenic:17Benign:1Other:1

Revision: criteria provided, multiple submitters, no conflicts

LINK: link

Submissions by phenotype

Hypercholesterolemia, familial, 1

Pathogenic:7Benign:1

Mar 25, 2016

LDLR-LOVD, British Heart Foundation

Significance: Likely pathogenic

Review Status: criteria provided, single submitter

Collection Method: literature only

- -

Sep 18, 2024

All of Us Research Program, National Institutes of Health

Significance: Likely pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

This missense variant replaces aspartic acid with tyrosine at codon 472 of the LDLR protein. This variant is also known as p.Asp451Tyr in the mature protein. This variant alters a conserved aspartic acid residue in the LDLR type B repeat 2 of the LDLR protein (aa 439-485), where pathogenic missense variants are found enriched (ClinVar-LDLR). Computational prediction tools indicate that this variant's impact on protein structure and function is inconclusive. A functional study has demonstrated that the mutant protein is partially defective in LDLR activity due to impaired protein expression or instability (PMID: 25647241). This variant has been reported in over ten individuals affected with familial hypercholesterolemia (PMID: 17196209, 17196209, 21310417, 22698793, 23375686, 27542166, 28008010, 27542166, 28008010, 35101175, 37129685; Fife 2021 https://doi.org/10.1101/2021.08.12.21261563; Alieva 2022, dissertation, University of Milan) and is reported to be associated with mild symptoms. This variant has also been shown to segregate with disease in two families (PMID: 17196209, 27542166). This variant has been identified in 15/282578 chromosomes in the general population by the Genome Aggregation Database (gnomAD). Based on the available evidence, this variant is classified as Likely Pathogenic. -

Nov 05, 2016

Molecular Genetics Laboratory, Centre for Cardiovascular Surgery and Transplantation

Significance: Likely pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

- -

May 24, 2021

Laboratory of molecular diagnosis of dyslipidemias, Università egli studi di Napoli Federico II

Significance: Likely pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

- -

Dec 16, 2016

Centre de Génétique Moléculaire et Chromosomique, Unité de génétique de l'Obésité et des Dyslipidémies, APHP, GH Hôpitaux Universitaires Pitié-Salpêtrière / Charles-Foix

Significance: Likely benign

Review Status: flagged submission

Collection Method: clinical testing

subject mutated among 2600 FH index cases screened = 1 / Software predictions: Conflicting -

Nov 03, 2022

Revvity Omics, Revvity

Significance: Likely pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

- -

Mar 30, 2021

Center for Genomics, Ann and Robert H. Lurie Children's Hospital of Chicago

Significance: Likely pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

LDLR NM_000527.4 exon 10 p.Asp472Tyr (c.1414G>T): This variant has been reported in the literature in the heterozygous state in several individuals with elevated LDL-C levels and/or a history of myocardial infaction, segregating with disease in multiple affected family members (Campagna 2008 PMID:17196209, Tichy 2012 PMID:22698793, Bertolini 2013 PMID:23375686, Do 2015 PMID:25487149, Thormaehlen 2015 PMID:25647241, Vohnout 2016 PMID:27542166). This variant is also present in 0.01% (5/30612) of South Asian alleles in the Genome Aggregation Database, including one homozygote (https://gnomad.broadinstitute.org/variant/19-11224266-G-T). Please note, disease causing variants may be present in control databases at low frequencies, reflective of the general population, carrier status, and/or variable expressivity. This variant is present in ClinVar, with several labs classifying this variant as pathogenic or likely pathogenic (Variation ID:183116). Evolutionary conservation suggests that this variant may not impact the protein, but computational predictive tools do suggest an impact. In addition, an in vitro functional study predicts that this variant will impact the protein (Thormaehlen 2015 PMID:25647241). However, this study may not accurately represent in vivo biological function. Of note, splice prediction tools suggest that this variant may affect splicing. However, further studies are needed to understand its impact. In summary, data on this variant is highly suspicious for disease, but requires further evidence for pathogenicity. Therefore, this variant is classified as likely pathogenic. -

Laboratorium voor Moleculaire Diagnostiek Experimentele Vasculaire Geneeskunde, Academisch Medisch Centrum

Significance: Pathogenic

Review Status: no assertion criteria provided

Collection Method: research

- -

not provided

Pathogenic:4Other:1

Aug 01, 2024

CeGaT Center for Human Genetics Tuebingen

Significance: Pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

LDLR: PP1:Strong, PM2, PM5, PS4:Moderate, PS3:Supporting -

Dept. of Genetics and Pharmacogenomics, Merck Research Labs

Significance: not provided

Review Status: no classification provided

Collection Method: in vitro

- -

Dec 07, 2022

Mayo Clinic Laboratories, Mayo Clinic

Significance: Likely pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

PP1, PM2_supporting, PM3, PS3_supporting, PS4 -

Jun 22, 2016

GeneDx

Significance: Pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

The D472Y c.1414 GAC>TAC variant in the LDLR gene has been published previously as a disease-causing variant in association with hypercholesterolemia (Campagna et al., 2008; Bertolini et al., 2013). Based on the ACMG recommendations, D472Y is interpreted as a known pathogenic sequence change. -

May 04, 2018

Quest Diagnostics Nichols Institute San Juan Capistrano

Significance: Likely pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

- -

Familial hypercholesterolemia

Pathogenic:3

Oct 29, 2024

Color Diagnostics, LLC DBA Color Health

Significance: Likely pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

This missense variant replaces aspartic acid with tyrosine at codon 472 of the LDLR protein. This variant is also known as p.Asp451Tyr in the mature protein. This variant alters a conserved aspartic acid residue in the LDLR type B repeat 2 of the LDLR protein (aa 439-485), where pathogenic missense variants are found enriched (ClinVar-LDLR). Computational prediction tool is inconclusive regarding the impact of this variant on protein structure and function. A functional study has demonstrated that the mutant protein is partially defective in LDLR activity due to impaired protein expression or instability (PMID: 25647241). This variant has been reported in over ten individuals affected with familial hypercholesterolemia (PMID: 17196209, 17196209, 21310417, 22698793, 23375686, 27542166, 28008010, 27542166, 28008010, 35101175, 37129685; Fife 2021 https://doi.org/10.1101/2021.08.12.21261563; Alieva 2022, dissertation, University of Milan) and is reported to be associated with mild symptoms. This variant has also been shown to segregate with disease in two families (PMID: 17196209, 27542166). This variant has been identified in 15/282578 chromosomes in the general population by the Genome Aggregation Database (gnomAD). Based on the available evidence, this variant is classified as Likely Pathogenic. -

Dec 12, 2023

Women's Health and Genetics/Laboratory Corporation of America, LabCorp

Significance: Likely pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

Variant summary: LDLR c.1414G>T (p.Asp472Tyr) results in a non-conservative amino acid change located in the class B repeat domain (IPR000033) 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 5.6e-05 in 251206 control chromosomes in the gnomAD database, including 1 homozygote. This frequency is not significantly higher than expected for a pathogenic variant in LDLR causing Familial Hypercholesterolemia (5.6e-05 vs 0.0013), allowing no conclusion about variant significance. c.1414G>T has been reported in the literature in multiple individuals affected with Familial Hypercholesterolemia (e.g., Bertolini_2013, Futema_2021, Hou_2020, Tichy_2012, Abul-Husn_2016, DiTaranto_2021) where it is also shown to segregate with the disease in at least two families (e.g., Vohnoout_2016, Campagna_2008). These data indicate that the variant is likely to be associated with disease. At least one publication reports that the variant affects LDLR protein function, suggesting that the variant disrupts either LDLR biosynthesis or turnover (e.g., Thormaehlen_2015). The following publications have been ascertained in the context of this evaluation (PMID: 28008010, 23375686, 17196209, 34297352, 25487149, 21310417, 32820175, 33508743, 31980526, 30312929, 23833242, 25647241, 22698793, 27542166). Multiple submitters have reported clinical-significance assessments for this variant to ClinVar after 2014, with 11 submitters classifying the variant as likely pathogenic/pathogenic and one submitter classifying it as likely benign. Additionally, there are other missense variants reported in the Human Gene Mutation Database (HGMD) affecting the same and/or nearby codons (example: p.S470C, p.D472N, p.I473N) associated with Hypercholesterolaemia suggesting this region may be clinically significant. Based on the evidence outlined above, the variant was classified as likely pathogenic. -

Dec 02, 2024

Labcorp Genetics (formerly Invitae), Labcorp

Significance: Pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

This sequence change replaces aspartic acid, which is acidic and polar, with tyrosine, which is neutral and polar, at codon 472 of the LDLR protein (p.Asp472Tyr). This variant is present in population databases (rs730882102, gnomAD 0.02%), including at least one homozygous and/or hemizygous individual. This missense change has been observed in individual(s) with hypercholesterolemia (PMID: 17196209, 21310417, 22698793, 23375686, 27542166, 27824480, 28008010, 28161202). It has also been observed to segregate with disease in related individuals. 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. This variant is also known as p.D451Y. ClinVar contains an entry for this variant (Variation ID: 183116). 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%. Experimental studies have shown that this missense change affects LDLR function (PMID: 25647241). For these reasons, this variant has been classified as Pathogenic. -

Homozygous familial hypercholesterolemia

Pathogenic:1

Apr 07, 2021

Laboratory for Molecular Medicine, Mass General Brigham Personalized Medicine

Significance: Likely pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

The p.Asp472Tyr variant in LDLR (also described as p.Asp451Tyr in the literature) has been reported in >15 individuals with familial hypercholesterolemia (FH) and 12 individuals who had a myocardial infarction, and segregated with disease in 3 affected relatives from 2 families (Abul-Husn 2016 PMID: 28008010, Vohnout 2016 PMID: 27542166, Thormaehlen 2015 PMID: 25647241, Tichy 2012 PMID: 22698793, Bertolini 2013 PMID: 23375686, Do 2015 PMID: 25487149, Campagna 2008 PMID: 17196209, ClinVar submission IDs: SCV000503344.1, SCV000540817.1). This variant has also been reported by other clinical laboratories in ClinVar (Variation ID 183116) and has been identified in 0.02% (5/30612) of South Asian chromosomes by the Genome Aggregation Database (gnomAD, http://gnomad.broadinstitute.org/). This frequency is low enough to be consistent with the frequency of FH in the general population. Computational prediction tools and conservation analysis do not provide strong support for or against an impact to the protein, and in vitro functional assays were unclear in their overall impact (Thormaehlen 2015 PMID: 25647241). In summary, although additional studies are required to fully establish its clinical significance, this variant meets criteria to be classified as likely pathogenic for autosomal dominant familial hypercholesterolemia. ACMG/AMP Criteria applied: PS4, PM2_Supporting, PP1. -

LDLR-related disorder

Pathogenic:1

Apr 23, 2024

PreventionGenetics, part of Exact Sciences

Significance: Likely pathogenic

Review Status: no assertion criteria provided

Collection Method: clinical testing

The LDLR c.1414G>T variant is predicted to result in the amino acid substitution p.Asp472Tyr. This variant is also known as p.Asp451Tyr in the literature and has been reported in more than 10 individuals with familial hypercholesterolemia and myocardial infarction (Campagna et al. 2008. PubMed ID: 17196209; Tichý et al. 2012. PubMed ID: 22698793; Do et al. 2015. PubMed ID: 25487149; Vohnout et al. 2016. PubMed ID: 27542166; Hou et al. 2020. PubMed ID: 31980526). Functional studies suggested that p.Asp472Tyr substitution could impact normal protein function (Thormaehlen et al. 2015. PubMed ID: 25647241). This variant is reported in 0.016% of alleles in individuals of South Asian descent in gnomAD and has been interpreted as pathogenic and likely pathogenic by the vast majority of submitters in ClinVar (https://preview.ncbi.nlm.nih.gov/clinvar/variation/183116/). Of note, a different variant impacting the same amino acid (p.Asp472Asn) has been reported to be associated with familial hypercholesterolemia (Marmontel et al. 2018. PubMed ID: 29572815). Based on this evidence, we interpret the c.1414G>T (p.Asp472Tyr) as likely pathogenic. -

Cardiovascular phenotype

Pathogenic:1

Feb 17, 2025

Ambry Genetics

Significance: Likely pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

The p.D472Y variant (also known as c.1414G>T), located in coding exon 10 of the LDLR gene, results from a G to T substitution at nucleotide position 1414. The aspartic acid at codon 472 is replaced by tyrosine, an amino acid with highly dissimilar properties. This variant was identified in one or more individuals with features consistent with familial hypercholesterolemia and segregated with disease in at least one family (Campagna F et al. Atherosclerosis, 2008 Jan;196:356-64; Tichý L et al. Atherosclerosis, 2012 Aug;223:401-8; Bertolini S et al. Atherosclerosis, 2013 Apr;227:342-8; Vohnout B et al. Wien. Klin. Wochenschr., 2016 Dec;128:916-921; Gabová D et al. Physiol Res, 2017 Mar;66:75-84; Ibarretxe D et al. Atherosclerosis, 2018 11;278:210-216). In an assay testing LDLR function, this variant showed a functionally abnormal result (Thormaehlen AS et al. PLoS Genet., 2015 Feb;11:e1004855). 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. -

Computational scores

Source: dbNSFP v4.3

Name

Calibrated prediction

Score

Prediction

AlphaMissense

Benign

0.30

BayesDel_addAF

Pathogenic

0.29

BayesDel_noAF

Pathogenic

0.44

CADD

Benign

DANN

Uncertain

0.99

DEOGEN2

Pathogenic

0.90

D;.;.;.;.;.

Eigen

Benign

0.084

Eigen_PC

Benign

-0.14

FATHMM_MKL

Uncertain

0.84

LIST_S2

Uncertain

0.91

D;D;D;D;D;D

M_CAP

Pathogenic

0.68

MetaRNN

Pathogenic

0.98

D;D;D;D;D;D

MetaSVM

Uncertain

0.67

MutationAssessor

Pathogenic

3.3

M;.;.;.;.;M

PrimateAI

Benign

0.40

PROVEAN

Uncertain

-4.0

D;D;D;D;D;D

REVEL

Pathogenic

0.65

Sift

Uncertain

0.010

D;D;D;D;D;D

Sift4G

Uncertain

0.015

D;D;D;D;D;D

Polyphen

0.78

P;.;.;.;.;.

Vest4

0.62

MutPred

0.88

Gain of catalytic residue at P476 (P = 0.0707);Gain of catalytic residue at P476 (P = 0.0707);.;.;.;Gain of catalytic residue at P476 (P = 0.0707);

MVP

1.0

MPC

0.82

ClinPred

0.62

GERP RS

2.5

RBP_binding_hub_radar

0.0

RBP_regulation_power_radar

1.7

Varity_R

0.35

gMVP

0.96

Splicing

Name

Calibrated prediction

Score

Prediction

SpliceAI score (max)

0.060

Details are displayed if max score is > 0.2

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

Publications

LitVar

Below is the list of publications found by LitVar. It may be empty.

Variant summary

Frequency

Consequence

Scores

Clinical Significance

Conservation

ACMG classification

Transcripts

RefSeq

Ensembl

Frequencies

ClinVar

Submissions by phenotype

Computational scores

Splicing

Publications

LitVar

Other links and lift over