NM_001276345.2:c.803A>T
Variant summary
Our verdict is Likely pathogenic. Variant got 7 ACMG points: 7P and 0B. PM1PM2PP3_ModeratePP5
The NM_001276345.2(TNNT2):c.803A>T(p.Lys268Ile) variant causes a missense change involving the alteration of a conserved nucleotide. The variant allele was found at a frequency of 0.00000657 in 152,150 control chromosomes in the GnomAD database, with no homozygous occurrence. In-silico tool predicts a pathogenic outcome for this variant. Variant has been reported in ClinVar as Conflicting classifications of pathogenicity (no stars).
Frequency
Consequence
NM_001276345.2 missense
Scores
Clinical Significance
Conservation
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ACMG classification
Verdict is Likely_pathogenic. Variant got 7 ACMG points.
Transcripts
RefSeq
Ensembl
Frequencies
GnomAD3 genomes AF: 0.00000657 AC: 1AN: 152150Hom.: 0 Cov.: 32
GnomAD4 exome Cov.: 31
GnomAD4 genome AF: 0.00000657 AC: 1AN: 152150Hom.: 0 Cov.: 32 AF XY: 0.0000135 AC XY: 1AN XY: 74336
ClinVar
Submissions by phenotype
Cardiomyopathy Pathogenic:2
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This missense variant replaces lysine with isoleucine at codon 258 of the TNNT2 protein. Computational prediction suggests that this variant may have a deleterious impact on protein structure and function (internally defined REVEL score threshold >= 0.7, PMID: 27666373). A functional study using human induced pluripotent stem cells has shown that this variant may impact TNNT2 protein function in manner consistent with hypertrophic cardiomyopathy (PMID: 33025817); the clinical relevance of this observation is not known. This variant has been reported in over 15 individuals affected with hypertrophic cardiomyopathy (PMID: 25611685, 26656175, 27483260, 27532257, 28640247, 29875424, 33495596, 33495597, 33673806; communication with an external laboratory; ClinVar SCV000060273.6, SCV000767829.7, SCV000209262.13). One of these individuals also carried a pathogenic variant in a different gene associated with cardiomyopathy (SCV000209262.13). This variant has not been identified in the general population by the Genome Aggregation Database (gnomAD). Based on the available evidence, this variant is classified as Likely Pathogenic. -
Hypertrophic cardiomyopathy Pathogenic:1Uncertain:1
The p.Lys258Ile variant in TNNT2 has been reported in 8 individuals with hypertrophic cardiomyopathy (HCM; Bottillo 2016 PMID: 26656175, Rubattu 2016 PMID: 27483260, Walsh 2017 PMID: 27532257, Hathaway 2021 PMID: 33673806, LMM Data, Invitae Personal Communication 2023). This variant has also been reported by other clinical laboratories in ClinVar (Variation ID 43670) and has been identified in 0.0015% (1/68010) of European chromosomes by gnomAD (http://gnomad.broadinstitute.org, v.3.1.2). In vitro functional studies provide some evidence that this variant may impact protein function (Pettinato 2020 PMID: 33025817); however, these types of assays may not accurately represent biological function. Computational prediction tools and conservation analyses suggest that this variant may impact the protein, though this information is not predictive enough to determine pathogenicity. In summary, the clinical significance of this variant is uncertain. ACMG/AMP Criteria applied: PS4_Moderate, PM2_Supporting, PP3. -
This missense variant replaces lysine with isoleucine at codon 258 of the TNNT2 protein. Computational prediction suggests that this variant may have a deleterious impact on protein structure and function (internally defined REVEL score threshold >= 0.7, PMID: 27666373). A functional study using human induced pluripotent stem cells has shown that this variant may impact TNNT2 protein function in manner consistent with hypertrophic cardiomyopathy (PMID: 33025817); the clinical relevance of this observation is not known. This variant has been reported in over 15 individuals affected with hypertrophic cardiomyopathy (PMID: 25611685, 26656175, 27483260, 27532257, 28640247, 29875424, 33495596, 33495597, 33673806; communication with an external laboratory; ClinVar SCV000060273.6, SCV000767829.7, SCV000209262.13). One of these individuals also carried a pathogenic variant in a different gene associated with cardiomyopathy (SCV000209262.13). This variant has not been identified in the general population by the Genome Aggregation Database (gnomAD). Based on the available evidence, this variant is classified as Likely Pathogenic. -
Primary familial hypertrophic cardiomyopathy Pathogenic:1
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Dilated cardiomyopathy 1D;C1861864:Hypertrophic cardiomyopathy 2;C2676271:Cardiomyopathy, familial restrictive, 3 Pathogenic:1
This sequence change replaces lysine, which is basic and polar, with isoleucine, which is neutral and non-polar, at codon 258 of the TNNT2 protein (p.Lys258Ile). This variant is not present in population databases (gnomAD no frequency). This missense change has been observed in individuals with hypertrophic cardiomyopathy (PMID: 26656175, 27483260, 27532257; internal data). This variant is also known as c.A775T, p.Lys252Ile, c.794C>T and p.Lys265Ile. ClinVar contains an entry for this variant (Variation ID: 43670). Invitae Evidence Modeling of protein sequence and biophysical properties (such as structural, functional, and spatial information, amino acid conservation, physicochemical variation, residue mobility, and thermodynamic stability) has been performed for this missense variant. However, the output from this modeling did not meet the statistical confidence thresholds required to predict the impact of this variant on TNNT2 protein function. For these reasons, this variant has been classified as Pathogenic. -
not specified Uncertain:1
Variant summary: TNNT2 c.773A>T (p.Lys258Ile) results in a non-conservative amino acid change in the encoded protein sequence. Five of five in-silico tools predict a damaging effect of the variant on protein function. The variant allele was found at a frequency of 6.6e-06 in 152150 control chromosomes in gnomAD database (v4.0.0). c.773A>T has been reported in the literature in individuals affected with Cardiomyopathy (e.g. Botillo_2016, Walsh_2016, Hathaway_2021, Ho_2018, Ko_2018) with limited clinical details. These data indicate that the variant may be associated with disease. To our knowledge, no experimental evidence demonstrating an impact on protein function has been reported.The following publications have been ascertained in the context of this evaluation (PMID: 26656175, 33673806, 30297972, 28640247, 27483260, 27532257). ClinVar contains an entry for this variant (Variation ID: 43670). Based on the evidence outlined above, the variant was classified as VUS-possibly pathogenic. -
not provided Uncertain:1
The K258I variant in the TNNT2 gene has been published as a variant of uncertain significance in an individual with early onset HCM and a family history of disease, however no clinical details or segregation data was provided (reported as c.794 A>T, K265I, using alternate nomenclature) (Rubattu et al., 2016). It was also reported in an individual diagnosed with HCM who harbored five additional cardiogenetic variants (reported as c.755 A>T, K252I, using alternate nomenclature) (Bottillo et al., 2016). Additionally, K258I was reported as a variant of uncertain significance in two individuals in a HCM cohort, although no clinical or segregation data was provided and it is unknown if there were other co-occurring variants (Walsh et al., 2017).This variant was not observed in large population cohorts (Lek et al., 2016; 1000 Genomes Consortium et al., 2015; Exome Variant Server), indicating it is not a common benign variant. The K258I variant is a non-conservative amino acid substitution, which is likely to impact secondary protein structure as these residues differ in polarity, charge, size and/or other properties and this substitution occurs at a position that is conserved across species. Finally, in silico analysis predicts this variant is probably damaging to the protein structure/function. However, this variant lacks observation in a significant number of affected individuals, segregation data, and functional evidence, which would further clarify its pathogenicity. Therefore, based on the currently available information, it is unclear whether the K258I variant in the TNNT2 gene is pathogenic or rare benign. -
Cardiovascular phenotype Uncertain:1
The c.773A>T (p.K258I) alteration is located in exon 14 (coding exon 13) of the TNNT2 gene. This alteration results from a A to T substitution at nucleotide position 773, causing the lysine (K) at amino acid position 258 to be replaced by an isoleucine (I). Based on insufficient or conflicting evidence, the clinical significance of this alteration remains unclear. -
Computational scores
Source:
Splicing
Find out detailed SpliceAI scores and Pangolin per-transcript scores at