19-13283266-CGTT-C

Position:

• chr19-13283266-CGTT-C

Variant summary

Our verdict is Likely pathogenic. Variant got 6 ACMG points: 6P and 0B. PM1 PM2 PM4_Supporting PP3

The NM_001127222.2(CACNA1A):​c.3820_3822delAAC​(p.Asn1274del) variant causes a conservative inframe deletion, splice region change involving the alteration of a conserved nucleotide. The variant was absent in control chromosomes in GnomAD project. 1/1 splice prediction tools predicting alterations to normal splicing. Variant has been reported in ClinVar as Uncertain significance (★★).

• Frequency: Genomes: not found (cov: 32)
• Consequence: CACNA1A NM_001127222.2 conservative_inframe_deletion, splice_region
• Clinical Significance: Uncertain significance criteria provided, multiple submitters, no conflicts U:2
• Conservation: PhyloP100: 7.85

Genes affected

CACNA1A (HGNC:1388): (calcium voltage-gated channel subunit alpha1 A) Voltage-dependent calcium channels mediate the entry of calcium ions into excitable cells, and are also involved in a variety of calcium-dependent processes, including muscle contraction, hormone or neurotransmitter release, and gene expression. Calcium channels are multisubunit complexes composed of alpha-1, beta, alpha-2/delta, and gamma subunits. The channel activity is directed by the pore-forming alpha-1 subunit, whereas, the others act as auxiliary subunits regulating this activity. The distinctive properties of the calcium channel types are related primarily to the expression of a variety of alpha-1 isoforms, alpha-1A, B, C, D, E, and S. This gene encodes the alpha-1A subunit, which is predominantly expressed in neuronal tissue. Mutations in this gene are associated with 2 neurologic disorders, familial hemiplegic migraine and episodic ataxia 2. This gene also exhibits polymorphic variation due to (CAG)n-repeats. Multiple transcript variants encoding different isoforms have been found for this gene. In one set of transcript variants, the (CAG)n-repeats occur in the 3' UTR, and are not associated with any disease. But in another set of variants, an insertion extends the coding region to include the (CAG)n-repeats which encode a polyglutamine tract. Expansion of the (CAG)n-repeats from the normal 4-18 to 21-33 in the coding region is associated with spinocerebellar ataxia 6. [provided by RefSeq, Jul 2016]

CACNA1A (HGNC:):

ACMG classification

Verdict is Likely_pathogenic. Variant got 6 ACMG points.

• PM1: In a repeat III (size 283) in uniprot entity CAC1A_HUMAN there are 14 pathogenic changes around while only 1 benign (93%) in NM_001127222.2
• PM2: Very rare variant in population databases, with high coverage
• PM4: Nonframeshift variant in NON repetitive region in NM_001127222.2. Strenght limited to Supporting due to length of the change: 1aa.
• PP3: Multiple lines of computational evidence support a deleterious effect 2: max_spliceai, phyloP100way_vertebrate [when was below the threshold]

Transcripts

RefSeq

Gene	Transcript	HGVSc	HGVSp	Effect	#exon/exons	MANE	Protein	UniProt
CACNA1A	NM_001127222.2	c.3820_3822delAAC	p.Asn1274del	conservative_inframe_deletion, splice_region_variant	22/47	ENST00000360228.11	NP_001120694.1

Ensembl

Gene	Transcript	HGVSc	HGVSp	Effect	#exon/exons	TSL	MANE	Protein	Appris	UniProt
CACNA1A	ENST00000360228.11	c.3820_3822delAAC	p.Asn1274del	conservative_inframe_deletion, splice_region_variant	22/47	1	NM_001127222.2	ENSP00000353362.5
CACNA1A	ENST00000638029.1	c.3832_3834delAAC	p.Asn1278del	conservative_inframe_deletion, splice_region_variant	22/48	5		ENSP00000489829.1
CACNA1A	ENST00000573710.7	c.3826_3828delAAC	p.Asn1276del	conservative_inframe_deletion, splice_region_variant	22/47	5		ENSP00000460092.3
CACNA1A	ENST00000635727.1	c.3823_3825delAAC	p.Asn1275del	conservative_inframe_deletion, splice_region_variant	22/47	5		ENSP00000490001.1
CACNA1A	ENST00000637769.1	c.3823_3825delAAC	p.Asn1275del	conservative_inframe_deletion, splice_region_variant	22/47	1		ENSP00000489778.1
CACNA1A	ENST00000636012.1	c.3823_3825delAAC	p.Asn1275del	conservative_inframe_deletion, splice_region_variant	22/46	5		ENSP00000490223.1
CACNA1A	ENST00000637736.1	c.3682_3684delAAC	p.Asn1228del	conservative_inframe_deletion, splice_region_variant	21/46	5		ENSP00000489861.1
CACNA1A	ENST00000636389.1	c.3823_3825delAAC	p.Asn1275del	conservative_inframe_deletion, splice_region_variant	22/47	5		ENSP00000489992.1
CACNA1A	ENST00000637432.1	c.3832_3834delAAC	p.Asn1278del	conservative_inframe_deletion, splice_region_variant	22/48	5		ENSP00000490617.1
CACNA1A	ENST00000636549.1	c.3823_3825delAAC	p.Asn1275del	conservative_inframe_deletion, splice_region_variant	22/48	5		ENSP00000490578.1
CACNA1A	ENST00000637927.1	c.3826_3828delAAC	p.Asn1276del	conservative_inframe_deletion, splice_region_variant	22/47	5		ENSP00000489715.1
CACNA1A	ENST00000635895.1	c.3823_3825delAAC	p.Asn1275del	conservative_inframe_deletion, splice_region_variant	22/47	5		ENSP00000490323.1
CACNA1A	ENST00000638009.2	c.3823_3825delAAC	p.Asn1275del	conservative_inframe_deletion, splice_region_variant	22/47	1		ENSP00000489913.1
CACNA1A	ENST00000637276.1	c.3823_3825delAAC	p.Asn1275del	conservative_inframe_deletion, splice_region_variant	22/46	5		ENSP00000489777.1

Frequencies

GnomAD3 genomes Cov.: 32

We have no GnomAD4 exomes data on this position. Probably position not covered by the project.

GnomAD4 genome Cov.: 32

ClinVar

Significance: Uncertain significance

Submissions summary: Uncertain:2

Revision: criteria provided, multiple submitters, no conflicts

Submissions by phenotype

Episodic ataxia type 2;C4310716:Developmental and epileptic encephalopathy, 42 Uncertain:1

Uncertain significance, criteria provided, single submitter

clinical testing

Labcorp Genetics (formerly Invitae), Labcorp

Apr 07, 2018

Algorithms developed to predict the effect of sequence changes on RNA splicing suggest that this variant may disrupt the consensus splice site, but this prediction has not been confirmed by published transcriptional studies. In summary, the available evidence is currently insufficient to determine the role of this variant in disease. Therefore, it has been classified as a Variant of Uncertain Significance. Experimental studies and prediction algorithms are not available for this variant, and the functional significance of the deleted amino acid is currently unknown. This variant, c.3823_3825delAAC, results in the deletion of 1 amino acid of the CACNA1A protein (p.Asn1275del), but otherwise preserves the integrity of the reading frame. This variant is not present in population databases (ExAC no frequency). This variant has not been reported in the literature in individuals with CACNA1A-related disease. ClinVar contains an entry for this variant (Variation ID: 426946). -

not provided Uncertain:1

Uncertain significance, criteria provided, single submitter

clinical testing

GeneDx

Mar 23, 2017

A variant of uncertain significance has been identified in the CACNA1A gene. The c.3823_3825delAAC variant has not been published as a pathogenic variant, nor has it been reported as a benign variant to our knowledge. The c.3823_3825delAAC variant is not observed in large population cohorts (Lek et al., 2016; 1000 Genomes Consortium et al., 2015; Exome Variant Server). The c.3823_3825delAAC variant results in an in-frame deletion of one amino acid, denoted p.Asn1275del. This deletion occurs at a position that is conserved in mammals. However, the c.3823_3825delAAC variant is not predicted to cause loss of normal protein function through protein truncation or nonsense-mediated mRNA decay. Therefore, based on the currently available information, it is unclear whether this variant is a pathogenic variant or a rare benign variant. -

Computational scores

Source: dbNSFP v4.3

Splicing

Name	Calibrated prediction	Score	Prediction
SpliceAI score (max)		1.0		Details are displayed if max score is > 0.2
DS_DG_spliceai		0.99		Position offset: 4
DS_DL_spliceai		1.0		Position offset: 1

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

Publications

LitVar

Other links and lift over

dbSNP: rs1085307864; hg19: chr19-13394080;