Our verdict is Pathogenic. Variant got 12 ACMG points: 12P and 0B. PVS1PM2PP5_Moderate
The NM_000548.5(TSC2):c.5115_5116dupCC(p.Arg1706ProfsTer121) variant causes a frameshift change involving the alteration of a non-conserved nucleotide. The variant was absent in control chromosomes in GnomAD project. Variant has been reported in ClinVar as Pathogenic (★). Synonymous variant affecting the same amino acid position (i.e. R1706R) has been classified as Benign. Variant results in nonsense mediated mRNA decay.
TSC2 (HGNC:12363): (TSC complex subunit 2) This gene is a tumor suppressor gene that encodes the growth inhibitory protein tuberin. Tuberin interacts with hamartin to form the TSC protein complex which functions in the control of cell growth. This TSC protein complex negatively regulates mammalian target of rapamycin complex 1 (mTORC1) signaling which is a major regulator of anabolic cell growth. Mutations in this gene have been associated with tuberous sclerosis and lymphangioleiomyomatosis. [provided by RefSeq, May 2022]
Verdict is Pathogenic. Variant got 12 ACMG points.
PVS1
Loss of function variant, product undergoes nonsense mediated mRNA decay. LoF is a known mechanism of disease.
PM2
Very rare variant in population databases, with high coverage;
PP5
Variant 16-2088093-A-ACC is Pathogenic according to our data. Variant chr16-2088093-A-ACC is described in ClinVar as [Pathogenic]. Clinvar id is 1745431.Status of the report is criteria_provided_single_submitter, 1 stars.
Review Status: criteria provided, single submitter
Collection Method: clinical testing
The c.5115_5116dupCC pathogenic mutation, located in coding exon 39 of the TSC2 gene, results from a duplication of CC at nucleotide position 5115, causing a translational frameshift with a predicted alternate stop codon (p.R1706Pfs*121). This frameshift occurs at the 3' terminus of TSC2, is not expected to trigger nonsense-mediated mRNA decay, and results in the elongation of the protein by 18 amino acids. This alteration was reported in a patient meeting clinical diagnostic criteria for tuberous sclerosis (Ambry Internal data), and other elongations of TSC2 that disrupt this region of the protein have been reported in the literature in patients with tuberous sclerosis (Jones AC et al. Hum. Mol. Genet. 1997 Nov;6(12):2155-61; Gilbert JR et al. Neurogenetics 1998 Aug;1(4):267-72; Jones AC et al. Am. J. Hum. Genet. 1999 May;64(5):1305-15; Au KS et al. Genet. Med. 2007 Feb;9(2):88-100). Based on the available evidence, this alteration is classified as a pathogenic mutation. -