NM_000053.4:c.19_20delCA
Variant summary
Our verdict is Pathogenic. Variant got 10 ACMG points: 10P and 0B. PVS1PM2
The NM_000053.4(ATP7B):c.19_20delCA(p.Gln7AspfsTer14) variant causes a frameshift change involving the alteration of a non-conserved nucleotide. The variant allele was found at a frequency of 0.000112 in 1,614,242 control chromosomes in the GnomAD database, with no homozygous occurrence. Variant has been reported in ClinVar as Conflicting classifications of pathogenicity (no stars).
Frequency
Consequence
NM_000053.4 frameshift
Scores
Clinical Significance
Conservation
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ACMG classification
Verdict is Pathogenic. Variant got 10 ACMG points.
Transcripts
RefSeq
Gene | Transcript | HGVSc | HGVSp | Effect | Exon rank | MANE | Protein | UniProt |
---|---|---|---|---|---|---|---|---|
ATP7B | NM_000053.4 | c.19_20delCA | p.Gln7AspfsTer14 | frameshift_variant | Exon 1 of 21 | ENST00000242839.10 | NP_000044.2 |
Ensembl
Frequencies
GnomAD3 genomes AF: 0.000151 AC: 23AN: 152262Hom.: 0 Cov.: 34
GnomAD3 exomes AF: 0.000152 AC: 38AN: 249432Hom.: 0 AF XY: 0.000177 AC XY: 24AN XY: 135350
GnomAD4 exome AF: 0.000108 AC: 158AN: 1461862Hom.: 0 AF XY: 0.000124 AC XY: 90AN XY: 727222
GnomAD4 genome AF: 0.000151 AC: 23AN: 152380Hom.: 0 Cov.: 34 AF XY: 0.000134 AC XY: 10AN XY: 74512
ClinVar
Submissions by phenotype
Wilson disease Pathogenic:4Uncertain:5
This sequence change creates a premature translational stop signal (p.Gln7Aspfs*14) in the ATP7B gene. It is expected to result in an absent or disrupted protein product. Loss-of-function variants in ATP7B are known to be pathogenic (PMID: 10441329, 16283883). This variant is present in population databases (rs749363958, gnomAD 0.05%). This premature translational stop signal has been observed in individual(s) with Wilson disease (PMID: 15967699). ClinVar contains an entry for this variant (Variation ID: 419611). For these reasons, this variant has been classified as Pathogenic. -
PM2_Supporting+PVS1+PM3+PP4 -
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The frameshift c.19_20del(p.Gln7AspfsTer14) variant in ATP7B gene has been reported previously to be correlating with Wilson disease (Vrabelova et al. 2005), and has also been reported in both homozygous and compound heterozygous state in individuals asymptomatic for Wilson disease (Loudianos et al. 2016; Stalke et al. 2019). The p.Gln7AspfsTer14 variant is reported with an allele frequency of 0.02% in the gnomAD exomes database and is novel (not in any individuals) in 1000 Genomes database. This variant has been reported to the ClinVar database as Pathogenic / Likely Pathogenic / Uncertain Siginificance. This variant causes a frameshift starting with codon Glutamine 7, changes this amino acid to Aspartic Acid residue, and creates a premature Stop codon at position 14 of the new reading frame, denoted p.Gln7AspfsTer14. Loss of function variants have been previously reported to be disease causing. However, experimental evidence suggests that this variant's mRNA and protein is expressed in amounts comparable to the wild-type and the copper export capacity is also comparable to the wild-type, indicating that this variant is able to bypass non-sense mediated decay by translation reinitiation (Stalke et al. 2019). For these reasons, this variant is classified as a Variant of Uncertain Significance (VUS). -
This variant deletes 2 nucleotides in exon 1 of the ATP7B gene, creating a frameshift and premature translation stop signal. While this variant is expected to result in nonsense-mediated mRNA decay, clinical findings and functional study results indicate that the effect of this variant appears to be mitigated, presumably by an alternate translation initiation. This variant has been reported as homozygous in a 5-year-old girl who exhibited no symptoms of Wilson disease, no abnormalities in liver biopsy, and ATP7B mRNA expression levels in the liver comparable to healthy controls (PMID: 30723317). When a minigene construct carrying this variant was overexpressed in HEK293T cells, it resulted in ATP7B mRNA and protein expression comparable to wild-type in size and amount, as well as normal copper export capacity (PMID: 30723317). This variant has also been reported in an asymptomatic adult in compound heterozygous state with a known pathogenic variant in the same gene (PMID: 26752957). These observations indicate that the predicted loss of ATP7B function due to this variant can be bypassed, presumably by alternate translation initiation using a downstream methionine. This variant has been reported in additional individuals affected with Wilson disease with unspecified second mutation (PMID: 15967699, 34620762). This variant has been identified in 39/280828 chromosomes in the general population by the Genome Aggregation Database (gnomAD). The available evidence is insufficient to determine the role of this variant in disease conclusively. Therefore, this variant is classified as a Variant of Uncertain Significance. -
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not provided Pathogenic:1Uncertain:2
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Reported homozygous in a female pediatric patient with no symptoms of Wilson disease or abnormalities on liver biopsy (PMID: 30723317); Expression of mRNA in liver cells of a patient homozygous for the variant was in the range of healthy controls and in-vitro expression assays found mRNA and protein levels comparable to wild type, suggesting that the variant may bypass nonsense-mediated mRNA decay (NMD) allowing normal copper export (PMID: 30723317); This variant is associated with the following publications: (PMID: 18371106, 29649982, 31169307, 23486543, 30291343, 31980526, 26752957, 15967699, 30723317, 36437915, 34620762, 30476936) -
not specified Uncertain:1
Variant summary: ATP7B c.19_20delCA (p.Gln7AspfsX14) results in a premature termination codon, predicted to cause a truncation of the encoded protein or absence of the protein due to nonsense mediated decay, which are commonly known mechanisms for disease. Truncations downstream of this position have been classified as pathogenic by our laboratory. However, in vitro functional studies (Stalke_2019) found the variant mRNA and protein are expressed in size and amount comparable to wild-type while copper export capacity was also comparable to wild-type; these results indicate that c.19_20del in ATP7B is able to bypass NMD by translation reinitiation. The variant allele was found at a frequency of 0.00015 in 249432 control chromosomes. This frequency is not significantly higher than estimated for a pathogenic variant in ATP7B causing Wilson Disease (0.00015 vs 0.0054), allowing no conclusion about variant significance. c.19_20delCA has been reported in the literature in individuals affected with Wilson Disease, however with limited information (i.e. second allele not reported/specified) in one case (Vrabelova_2005) and in two individuals diagnosed with the hepatic form of Wilson Disease who were compound heterozygous together with a pathogenic variant (p.H1069Q), but who had ATP7B peptide levels (assayed from dried blood spots) that were mostly within or near the normal range (Collins_2021). In addition, multiple compound heterozygous or homozygous individuals were found to be asymptomatic for ATP7B-related conditions (Loudianos_2016, Stalke_2019, Nicastro_2021), were found to be asymptomatic for ATP7B-related conditions. Thus, these reports do not provide unequivocal conclusions about association of the variant with Wilson Disease. The following publications have been ascertained in the context of this evaluation (PMID: 18371106, 15967699, 26752957, 23486543, 29649982, 30723317, 33640437, 37205945). ClinVar contains an entry for this variant (Variation ID: 419611). Based on the evidence outlined above, the variant was classified as uncertain significance. -
ATP7B-related disorder Uncertain:1
The ATP7B c.19_20delCA variant is predicted to result in a frameshift and premature protein termination (p.Gln7Aspfs*14). This variant has been reported in an individual with Wilson disease (Vrabelova et al. 2005. PubMed ID: 15967699). Of note, this variant was also detected in the compound heterozygous state in an asymptomatic adult patient (Loudianos et al. 2016. PubMed ID: 26752957) and in the homozygous state in an asymptomatic adolescent patient (Stalke et al. 2019. PubMed ID: 30723317). Additional function studies showed that this variant bypasses nonsense-mediated mRNA decay and protein function is similar to wild-type (Stalke et al. 2019. PubMed ID: 30723317). This variant is reported in 0.048% of alleles in individuals of Ashkenazi Jewish descent in gnomAD (http://gnomad.broadinstitute.org/variant/13-52585453-CTG-C). At this time, the clinical significance of this variant is uncertain due to the absence of conclusive functional and genetic evidence. -
Computational scores
Source:
Splicing
Find out detailed SpliceAI scores and Pangolin per-transcript scores at