NM_198253.3:c.2011C>T
Variant summary
Our verdict is Uncertain significance. Variant got 3 ACMG points: 3P and 0B. PM2PP5
The NM_198253.3(TERT):c.2011C>T(p.Arg671Trp) variant causes a missense change involving the alteration of a non-conserved nucleotide. The variant allele was found at a frequency of 0.00000515 in 1,552,250 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_198253.3 missense
Scores
Clinical Significance
Conservation
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ACMG classification
Verdict is Uncertain_significance. Variant got 3 ACMG points.
Transcripts
RefSeq
Gene | Transcript | HGVSc | HGVSp | Effect | Exon rank | MANE | Protein | UniProt |
---|---|---|---|---|---|---|---|---|
TERT | NM_198253.3 | c.2011C>T | p.Arg671Trp | missense_variant | Exon 5 of 16 | ENST00000310581.10 | NP_937983.2 | |
TERT | NM_001193376.3 | c.2011C>T | p.Arg671Trp | missense_variant | Exon 5 of 15 | NP_001180305.1 | ||
TERT | NR_149162.3 | n.2090C>T | non_coding_transcript_exon_variant | Exon 5 of 13 | ||||
TERT | NR_149163.3 | n.2090C>T | non_coding_transcript_exon_variant | Exon 5 of 13 |
Ensembl
Frequencies
GnomAD3 genomes AF: 0.00000657 AC: 1AN: 152190Hom.: 0 Cov.: 33
GnomAD4 exome AF: 0.00000500 AC: 7AN: 1400060Hom.: 0 Cov.: 33 AF XY: 0.00000434 AC XY: 3AN XY: 691046
GnomAD4 genome AF: 0.00000657 AC: 1AN: 152190Hom.: 0 Cov.: 33 AF XY: 0.00 AC XY: 0AN XY: 74328
ClinVar
Submissions by phenotype
not provided Pathogenic:2
Not observed at significant frequency in large population cohorts (gnomAD); In silico analysis supports that this missense variant has a deleterious effect on protein structure/function; This variant is associated with the following publications: (PMID: 33006015, 35078193, 20502709, 30995915, 34890115) -
PS3_Supporting, PS4_Moderate, PM2, PP2 -
Idiopathic Pulmonary Fibrosis;C3151443:Dyskeratosis congenita, autosomal dominant 2 Pathogenic:1
This sequence change replaces arginine, which is basic and polar, with tryptophan, which is neutral and slightly polar, at codon 671 of the TERT protein (p.Arg671Trp). The frequency data for this variant in the population databases is considered unreliable, as metrics indicate poor data quality at this position in the gnomAD database. This missense change has been observed in individuals with autosomal recessive Hoyeraal Hreidarsson syndrome and autosomal dominant pulmonary fibrosis (PMID: 20502709, 34890115, 35078193). ClinVar contains an entry for this variant (Variation ID: 410693). 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) indicates that this missense variant is expected to disrupt TERT protein function with a positive predictive value of 95%. Experimental studies have shown that this missense change affects TERT function (PMID: 20502709). In summary, the currently available evidence indicates that the variant is pathogenic, but additional data are needed to prove that conclusively. Therefore, this variant has been classified as Likely Pathogenic. -
Telomere syndrome Pathogenic:1
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Pulmonary fibrosis Pathogenic:1
Leukocyte telomere length (by qPCR) less than 10th percentile age-adjusted -
Autosomal recessive dyskeratosis congenita 4 Pathogenic:1
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Hoyeraal-Hreidarsson syndrome;C3151444:Autosomal recessive dyskeratosis congenita 4 Pathogenic:1
The Arg671Trp variant in TERT was previously reported in heterozygous state in two kindred with familial pulmonary fibrosis and shown to reduce in vitro telomerase activity (Diaz de Leon, 2010). Identified variant was neither reported in 1000 Genomes Project, GnomAD (including ExAC), CentoMD nor ESP databases and predicted to be deleterious by SIFT and possibly damaging by Polyphen-2 prediction tools; ClinVar classed as a variant of unknown significance (VUS). The p.Arg671Trp variant impedes the second amino acid of the motif 3b that is highly conserved among RTs, most likely affecting the template realignment during RNA/DNA duplex formation, thus the telomere repeat addition rate and processivity (Xie, 2010). Conservation of the arginine at this position among species suggests its necessity for proper telomerase function. Concordant with the cases published up-to-date, localization of this homozygous mutation in a highly conserved residue within TERT may explain the observed severe clinical phenotype (Marrone, 2007; Gramatges, 2013; Vogiatzi, 2013). Furthermore in our experience, p.Arg671Trp variant segregated with short telomere lengths and was associated with full-blown, overlapping HHS/DC phenotype in the proband; and heterogeneous adult-onset manifestations in heterozygous individuals. -
Dyskeratosis congenita Uncertain:1
The p.R671W variant (also known as c.2011C>T), located in coding exon 5 of the TERT gene, results from a C to T substitution at nucleotide position 2011. The arginine at codon 671 is replaced by tryptophan, an amino acid with dissimilar properties. This variant has been reported in individuals with interstitial pneumonia (Snetselaar R et al. PLoS One, 2017 Dec;12:e0189467) and pulmonary fibrosis (Diaz de Leon A et al. PLoS One, 2010 May;5:e10680; Newton CA et al. Eur Respir J, 2016 Dec;48:1710-1720; Maryoung L et al. J Clin Invest, 2017 Mar;127:982-986; Aria). This amino acid position is poorly conserved in available vertebrate species. In addition, this alteration is predicted to be deleterious by in silico analysis. This variant is considered to be rare based on population cohorts in the Genome Aggregation Database (gnomAD). Since supporting evidence is limited at this time, the clinical significance of this alteration remains unclear. -
Computational scores
Source:
Splicing
Find out detailed SpliceAI scores and Pangolin per-transcript scores at