Our verdict is Pathogenic. The variant received 18 ACMG points: 18P and 0B. PM1PM2PM5PP3_StrongPP5_Very_Strong
The NM_000179.3(MSH6):c.2341C>T(p.Pro781Ser) variant causes a missense change involving the alteration of a conserved nucleotide. The variant was absent in control chromosomes in GnomAD project. 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. P781T) has been classified as Likely pathogenic.
MSH6 (HGNC:7329): (mutS homolog 6) This gene encodes a member of the DNA mismatch repair MutS family. In E. coli, the MutS protein helps in the recognition of mismatched nucleotides prior to their repair. A highly conserved region of approximately 150 aa, called the Walker-A adenine nucleotide binding motif, exists in MutS homologs. The encoded protein heterodimerizes with MSH2 to form a mismatch recognition complex that functions as a bidirectional molecular switch that exchanges ADP and ATP as DNA mismatches are bound and dissociated. Mutations in this gene may be associated with hereditary nonpolyposis colon cancer, colorectal cancer, and endometrial cancer. Transcripts variants encoding different isoforms have been described. [provided by RefSeq, Jul 2013]
FBXO11 (HGNC:13590): (F-box protein 11) This gene encodes a member of the F-box protein family which is characterized by an approximately 40 amino acid motif, the F-box. The F-box proteins constitute one of the four subunits of ubiquitin protein ligase complex called SCFs (SKP1-cullin-F-box), which function in phosphorylation-dependent ubiquitination. The F-box proteins are divided into 3 classes: Fbws containing WD-40 domains, Fbls containing leucine-rich repeats, and Fbxs containing either different protein-protein interaction modules or no recognizable motifs. The protein encoded by this gene belongs to the Fbxs class. It can function as an arginine methyltransferase that symmetrically dimethylates arginine residues, and it acts as an adaptor protein to mediate the neddylation of p53, which leads to the suppression of p53 function. This gene is known to be down-regulated in melanocytes from patients with vitiligo, a skin disorder that results in depigmentation. Polymorphisms in this gene are associated with chronic otitis media with effusion and recurrent otitis media (COME/ROM), a hearing loss disorder, and the knockout of the homologous mouse gene results in the deaf mouse mutant Jeff (Jf), a single gene model of otitis media. Alternatively spliced transcript variants encoding distinct isoforms have been identified for this gene. [provided by RefSeq, Jun 2010]
FBXO11 Gene-Disease associations (from GenCC):
intellectual developmental disorder with dysmorphic facies and behavioral abnormalities
Our verdict: Pathogenic. The variant received 18 ACMG points.
PM1
In a hotspot region, there are 3 aminoacids with missense pathogenic changes in the window of +-8 aminoacids around while only 1 benign, 52 uncertain in NM_000179.3
PM2
Very rare variant in population databases, with high coverage;
PM5
Other missense variant is known to change same aminoacid residue: Variant chr2-47800324-C-A is described in CliVar as Conflicting_classifications_of_pathogenicity. Clinvar id is 182635.
PP3
MetaRNN computational evidence supports a deleterious effect, 0.982
PP5
Variant 2-47800324-C-T is Pathogenic according to our data. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr2-47800324-C-T is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 1789871.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars.
For these reasons, this variant has been classified as Pathogenic. This variant disrupts the p.Pro781 amino acid residue in MSH6. Other variant(s) that disrupt this residue have been determined to be pathogenic (PMID: 30374176; Invitae). This suggests that this residue is clinically significant, and that variants that disrupt this residue are likely to be disease-causing. 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 expected to disrupt MSH6 protein function. ClinVar contains an entry for this variant (Variation ID: 1789871). This missense change has been observed in individuals with Lynch syndrome (PMID: 27273229; Invitae). This variant is not present in population databases (gnomAD no frequency). This sequence change replaces proline, which is neutral and non-polar, with serine, which is neutral and polar, at codon 781 of the MSH6 protein (p.Pro781Ser). -
The p.P781S variant (also known as c.2341C>T), located in coding exon 4 of the MSH6 gene, results from a C to T substitution at nucleotide position 2341. The proline at codon 781 is replaced by serine, an amino acid with similar properties. This alteration was identified in an individual diagnosed with MSI-H cecal cancer at age 50 that demonstrated loss of MSH6 protein expression by IHC (Buchanan DD et al. J. Gastroenterol. Hepatol., 2017 Feb;32:427-438). This variant has been identified in a proband(s) whose reportedly synchronous Lynch syndrome-associated tumors demonstrated microsatellite instability and loss of MSH6 expression by immunohistochemistry (Ambry internal data). This amino acid position is highly conserved in available vertebrate species. This variant is considered to be rare based on population cohorts in the Genome Aggregation Database (gnomAD). 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. -