Our verdict is Pathogenic. The variant received 18 ACMG points: 18P and 0B. PVS1PM2PP5_Very_Strong
The NM_000249.4(MLH1):c.1831_1832delAT(p.Ile611CysfsTer2) variant causes a frameshift change involving the alteration of a conserved nucleotide. The variant was absent in control chromosomes in GnomAD project. Variant has been reported in ClinVar as Pathogenic (★★★). Variant results in nonsense mediated mRNA decay.
MLH1 (HGNC:7127): (mutL homolog 1) The protein encoded by this gene can heterodimerize with mismatch repair endonuclease PMS2 to form MutL alpha, part of the DNA mismatch repair system. When MutL alpha is bound by MutS beta and some accessory proteins, the PMS2 subunit of MutL alpha introduces a single-strand break near DNA mismatches, providing an entry point for exonuclease degradation. The encoded protein is also involved in DNA damage signaling and can heterodimerize with DNA mismatch repair protein MLH3 to form MutL gamma, which is involved in meiosis. This gene was identified as a locus frequently mutated in hereditary nonpolyposis colon cancer (HNPCC). [provided by RefSeq, Aug 2017]
MLH1 Gene-Disease associations (from GenCC):
Lynch syndrome
Inheritance: AD Classification: DEFINITIVE, SUPPORTIVE Submitted by: G2P, ClinGen, Orphanet
Lynch syndrome 2
Inheritance: AD Classification: DEFINITIVE, STRONG Submitted by: Ambry Genetics, Genomics England PanelApp
Muir-Torre syndrome
Inheritance: AD Classification: DEFINITIVE, STRONG, MODERATE, SUPPORTIVE Submitted by: Genomics England PanelApp, Ambry Genetics, G2P, Orphanet
Our verdict: Pathogenic. The variant received 18 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 3-37047617-CAT-C is Pathogenic according to our data. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr3-37047617-CAT-C is described in CliVar as Pathogenic. Clinvar id is 89899.Status of the report is reviewed_by_expert_panel, 3 stars.
This sequence change creates a premature translational stop signal (p.Ile611Cysfs*2) in the MLH1 gene. It is expected to result in an absent or disrupted protein product. For these reasons, this variant has been classified as Pathogenic. Loss-of-function variants in MLH1 are known to be pathogenic (PMID: 15713769, 24362816). This variant has been observed in individual(s) with Lynch syndrome (PMID: 15253764). It has also been observed to segregate with disease in related individuals. ClinVar contains an entry for this variant (Variation ID: 89899). This variant is not present in population databases (ExAC no frequency). -
not providedUncertain:1
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Department of Pathology and Laboratory Medicine, Sinai Health System