19-13286673-G-T

Position:

• chr19-13286673-G-T

Variant summary

Our verdict is Uncertain significance. Variant got 2 ACMG points: 3P and 1B. PM2 PP2 BP4

The NM_001127222.2(CACNA1A):​c.3383C>A​(p.Pro1128Gln) variant causes a missense change. The variant was absent in control chromosomes in GnomAD project. In-silico tool predicts a benign outcome for this variant. Variant has been reported in ClinVar as Uncertain significance (★). Synonymous variant affecting the same amino acid position (i.e. P1128P) has been classified as Likely benign.

• Frequency: Genomes: not found (cov: 30)
• Consequence: CACNA1A NM_001127222.2 missense
• Clinical Significance: Uncertain significance criteria provided, single submitter U:1
• Conservation: PhyloP100: 4.87

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]

ACMG classification

Verdict is Uncertain_significance. Variant got 2 ACMG points.

• PM2: Very rare variant in population databases, with high coverage
• PP2: Missense variant in gene, where missense usually causes diseases (based on misZ statistic), CACNA1A. . Gene score misZ: 5.7845 (greater than the threshold 3.09). Trascript score misZ: 3.9354 (greater than threshold 3.09). The gene has 137 curated pathogenic missense variants (we use a threshold of 10). The gene has 132 curated benign missense variants. GenCC has associacion of the gene with benign paroxysmal torticollis of infancy, developmental and epileptic encephalopathy, 42, undetermined early-onset epileptic encephalopathy, episodic ataxia type 2, familial or sporadic hemiplegic migraine, spinocerebellar ataxia type 6, Lennox-Gastaut syndrome, migraine, familial hemiplegic, 1.
• BP4: Computational evidence support a benign effect (MetaRNN=0.33577937).

Transcripts

RefSeq

Gene	Transcript	HGVSc	HGVSp	Effect	#exon/exons	MANE	Protein	UniProt
CACNA1A	NM_001127222.2	c.3383C>A	p.Pro1128Gln	missense_variant	20/47	ENST00000360228.11	NP_001120694.1

Ensembl

Gene	Transcript	HGVSc	HGVSp	Effect	#exon/exons	TSL	MANE	Protein	Appris	UniProt
CACNA1A	ENST00000360228.11	c.3383C>A	p.Pro1128Gln	missense_variant	20/47	1	NM_001127222.2	ENSP00000353362.5
CACNA1A	ENST00000638029.1	c.3395C>A	p.Pro1132Gln	missense_variant	20/48	5		ENSP00000489829.1
CACNA1A	ENST00000573710.7	c.3389C>A	p.Pro1130Gln	missense_variant	20/47	5		ENSP00000460092.3
CACNA1A	ENST00000635727.1	c.3386C>A	p.Pro1129Gln	missense_variant	20/47	5		ENSP00000490001.1
CACNA1A	ENST00000637769.1	c.3386C>A	p.Pro1129Gln	missense_variant	20/47	1		ENSP00000489778.1
CACNA1A	ENST00000636012.1	c.3386C>A	p.Pro1129Gln	missense_variant	20/46	5		ENSP00000490223.1
CACNA1A	ENST00000637736.1	c.3245C>A	p.Pro1082Gln	missense_variant	19/46	5		ENSP00000489861.1
CACNA1A	ENST00000636389.1	c.3386C>A	p.Pro1129Gln	missense_variant	20/47	5		ENSP00000489992.1
CACNA1A	ENST00000637432.1	c.3395C>A	p.Pro1132Gln	missense_variant	20/48	5		ENSP00000490617.1
CACNA1A	ENST00000636549.1	c.3386C>A	p.Pro1129Gln	missense_variant	20/48	5		ENSP00000490578.1
CACNA1A	ENST00000637927.1	c.3389C>A	p.Pro1130Gln	missense_variant	20/47	5		ENSP00000489715.1
CACNA1A	ENST00000635895.1	c.3386C>A	p.Pro1129Gln	missense_variant	20/47	5		ENSP00000490323.1
CACNA1A	ENST00000638009.2	c.3386C>A	p.Pro1129Gln	missense_variant	20/47	1		ENSP00000489913.1
CACNA1A	ENST00000637276.1	c.3386C>A	p.Pro1129Gln	missense_variant	20/46	5		ENSP00000489777.1

Frequencies

GnomAD3 genomes Cov.: 30

GnomAD4 exome Cov.: 35

GnomAD4 genome Cov.: 30

Bravo AF: 0.00000378

ClinVar

Significance: Uncertain significance

Submissions summary: Uncertain:1

Revision: criteria provided, single submitter

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

Jun 05, 2020

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. Algorithms developed to predict the effect of sequence changes on RNA splicing suggest that this variant may create or strengthen a splice site, but this prediction has not been confirmed by published transcriptional studies. Algorithms developed to predict the effect of missense changes on protein structure and function are either unavailable or do not agree on the potential impact of this missense change (SIFT: "Deleterious"; PolyPhen-2: "Possibly Damaging"; Align-GVGD: "Class C0"). This variant has not been reported in the literature in individuals with CACNA1A-related conditions. This variant is not present in population databases (ExAC no frequency). This sequence change replaces proline with glutamine at codon 1129 of the CACNA1A protein (p.Pro1129Gln). The proline residue is moderately conserved and there is a moderate physicochemical difference between proline and glutamine. -

Computational scores

Source: dbNSFP v4.3

Name	Calibrated prediction	Score	Prediction
AlphaMissense	Benign	0.12
BayesDel_addAF	Uncertain	0.12	D
BayesDel_noAF	Uncertain	-0.060
CADD	Pathogenic	26
DANN	Uncertain	0.99
DEOGEN2	Benign	0.018	.;.;T;.;.;.;.;.;.;T;.;.;.;T;.
Eigen	Benign	0.10
Eigen_PC	Uncertain	0.23
FATHMM_MKL	Uncertain	0.93	D
LIST_S2	Uncertain	0.89	D;D;D;D;D;D;D;D;.;D;D;D;D;D;D
M_CAP	Pathogenic	0.58	D
MetaRNN	Benign	0.34	T;T;T;T;T;T;T;T;T;T;T;T;T;T;T
MetaSVM	Uncertain	0.060	D
MutationAssessor	Benign	0.34	.;.;.;.;N;.;.;.;.;.;.;.;N;.;.
PrimateAI	Uncertain	0.56	T
PROVEAN	Benign	-2.2	.;N;.;.;.;.;.;.;.;.;.;.;.;.;.
REVEL	Uncertain	0.41
Sift	Benign	0.061	.;T;.;.;.;.;.;.;.;.;.;.;.;.;.
Sift4G	Benign	0.70	T;T;.;.;.;.;.;.;.;.;.;.;.;.;.
Vest4		0.30
MutPred		0.19		.;.;Loss of glycosylation at P1129 (P = 0.0216);Loss of glycosylation at P1129 (P = 0.0216);Loss of glycosylation at P1129 (P = 0.0216);.;Loss of glycosylation at P1129 (P = 0.0216);.;.;Loss of glycosylation at P1129 (P = 0.0216);Loss of glycosylation at P1129 (P = 0.0216);.;Loss of glycosylation at P1129 (P = 0.0216);.;Loss of glycosylation at P1129 (P = 0.0216);
MVP		0.91
MPC		0.095
ClinPred		0.93	D
GERP RS		4.2
Varity_R		0.075
gMVP		0.54

Splicing

Name	Calibrated prediction	Score	Prediction
SpliceAI score (max)		0.0		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

Other links and lift over

dbSNP: rs754208553; hg19: chr19-13397487;