chr3-37048973-C-T
Variant summary
Our verdict is Pathogenic. Variant got 12 ACMG points: 12P and 0B. PM5PP3_ModeratePP5_Very_Strong
The NM_000249.4(MLH1):c.2059C>T(p.Arg687Trp) variant causes a missense change. The variant allele was found at a frequency of 0.00000744 in 1,613,936 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 Pathogenic (★★★). Another variant affecting the same amino acid position, but resulting in a different missense (i.e. R687G) has been classified as Likely pathogenic.
Frequency
Consequence
NM_000249.4 missense
Scores
Clinical Significance
Conservation
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ACMG classification
Verdict is Pathogenic. Variant got 12 ACMG points.
Transcripts
RefSeq
Gene | Transcript | HGVSc | HGVSp | Effect | #exon/exons | MANE | Protein | UniProt |
---|---|---|---|---|---|---|---|---|
MLH1 | NM_000249.4 | c.2059C>T | p.Arg687Trp | missense_variant | 18/19 | ENST00000231790.8 | NP_000240.1 |
Ensembl
Gene | Transcript | HGVSc | HGVSp | Effect | #exon/exons | TSL | MANE | Protein | Appris | UniProt |
---|---|---|---|---|---|---|---|---|---|---|
MLH1 | ENST00000231790.8 | c.2059C>T | p.Arg687Trp | missense_variant | 18/19 | 1 | NM_000249.4 | ENSP00000231790.3 |
Frequencies
GnomAD3 genomes AF: 0.00000657 AC: 1AN: 152118Hom.: 0 Cov.: 32
GnomAD3 exomes AF: 0.0000199 AC: 5AN: 251196Hom.: 0 AF XY: 0.0000368 AC XY: 5AN XY: 135752
GnomAD4 exome AF: 0.00000752 AC: 11AN: 1461818Hom.: 0 Cov.: 31 AF XY: 0.0000110 AC XY: 8AN XY: 727214
GnomAD4 genome AF: 0.00000657 AC: 1AN: 152118Hom.: 0 Cov.: 32 AF XY: 0.0000135 AC XY: 1AN XY: 74332
ClinVar
Submissions by phenotype
not provided Pathogenic:7
Pathogenic, criteria provided, single submitter | clinical testing | GeneDx | Jul 19, 2024 | 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: 18383312, 22949379, 23760103, 16042583, 24362816, 16395668, 15845562, 27629256, 18709565, 31830689, 29922827, 17510385, 21120944, 22736432, 22949387, 25525159, 11139242, 17192056, 15289847, 24440087, 22180144, 14762794, 11748856, 11920458, 11920650, 12362047, 16451135, 17312306, 18566915, 22120844, 21404117, 19267393, 27300758, 27152634, 27831900, 28874130, 29288294, 27601186, 25430799, 22290698, 16288214, 30521064, 30720243, 30787465, 33087929, 26485756, 34873480, 12799449, 20533529, 22753075, 19697156, 31391288, 35430768) - |
Likely pathogenic, no assertion criteria provided | clinical testing | Clinical Genetics DNA and cytogenetics Diagnostics Lab, Erasmus MC, Erasmus Medical Center | - | - - |
Pathogenic, criteria provided, single submitter | clinical testing | Revvity Omics, Revvity | Aug 31, 2022 | - - |
Pathogenic, criteria provided, single submitter | clinical testing | Quest Diagnostics Nichols Institute San Juan Capistrano | May 13, 2024 | The MLH1 c.2059C>T (p.Arg687Trp) variant has been reported in the published literature in multiple individuals and families with Lynch syndrome, including as a founder mutation in the Swedish population (PMID: 29288294 (2018), 28874130 (2017), 27152634 (2016), 26485756 (2015), 21404117 (2011), 19697156 (2009), 17312306 (2007), 11920650 (2002), 11920458 (2002), 12362047 (2002), 11139242 (2001)). It has also been reported as homozygous in three siblings with constitutional mismatch repair deficiency (CMMRD) syndrome (PMID: 14762794 (2004)). Functional evidence for this variant is inconclusive since one experimental study showed that this variant reduced in-vitro MMR activity and MLH1 expression (PMID: 17510385(2007)) and another study showed that this variant was comparable to the wildtype MLH1 in its expression and MMR efficiency (PMID: 19697156 (2009)). The variant was shown to segregate with disease in multiple families (PMID: 19267393 (2009), 19697156 (2009), 14762794 (2004), 11920650 (2002)). The frequency of this variant in the general population, 0.000098 (3/30612 chromosomes (Genome Aggregation Database, http://gnomad.broadinstitute.org)), is uninformative in the assessment of its pathogenicity. Analysis of this variant using bioinformatics tools for the prediction of the effect of amino acid changes on protein structure and function yielded predictions that this variant is damaging. Based on the available information, this variant is classified as pathogenic. - |
Pathogenic, no assertion criteria provided | clinical testing | Joint Genome Diagnostic Labs from Nijmegen and Maastricht, Radboudumc and MUMC+ | - | - - |
Pathogenic, criteria provided, single submitter | clinical testing | Clinical Genetics Laboratory, Skane University Hospital Lund | Oct 24, 2022 | - - |
Pathogenic, criteria provided, single submitter | clinical testing | Clinical Genetics and Genomics, Karolinska University Hospital | Sep 12, 2014 | - - |
Colorectal cancer, hereditary nonpolyposis, type 2 Pathogenic:6
Pathogenic, criteria provided, single submitter | clinical testing | Baylor Genetics | Mar 15, 2023 | - - |
Pathogenic, criteria provided, single submitter | clinical testing | Counsyl | Dec 18, 2015 | - - |
Pathogenic, criteria provided, single submitter | clinical testing | Neuberg Centre For Genomic Medicine, NCGM | - | The c.2059C>T (p.Arg687Trp) missense variant has been reported in in individuals and families affected with Lynch syndrome, constitutional mismatch repair deficiency syndrome, as well as colorectal and gastrointestinal cancer (Jakubowska et al., 2001; Godino et al., 2001). In several families, this variant cosegregated with disease (Godino et al., 2001). An experimental study has shown that this variant affects mismatch repair activity in yeast-based functional assays, and MLH1 protein expression in vitro (Takahashi et al., 2007). This variant is reported with the allele frequency (0.001%) in the gnomAD and novel in 1000 genome database. It has been submitted to ClinVar as a Pathogenic variant. The amino acid Arg at position 687 is changed to a Trp changing protein sequence and it might alter its composition and physico-chemical properties. The amino acid change p.Arg687Trp in MLH1 is predicted as conserved by GERP++ and PhyloP across 100 vertebrates. For these reasons, this variant has been classified as Pathogenic. - |
Pathogenic, criteria provided, single submitter | clinical testing | Human Genetics Bochum, Ruhr University Bochum | Jun 18, 2022 | ACMG criteria used to clasify this variant: PM1, PM2, PP3, PP2, PP1 - |
Pathogenic, criteria provided, single submitter | clinical testing | Myriad Genetics, Inc. | Mar 15, 2023 | This variant is considered pathogenic. This variant has been reported in multiple individuals with clinical features of gene-specific disease [PMID: 11920650, 14762794]. - |
Pathogenic, criteria provided, single submitter | clinical testing | St. Jude Molecular Pathology, St. Jude Children's Research Hospital | Jul 26, 2023 | The MLH1 c.2059C>T (p.Arg687Trp) missense change has a maximum subpopulation frequency of 0.0098% in gnomAD v2.1.1 (https://gnomad.broadinstitute.org). The in silico tool REVEL predicts a deleterious effect on protein function, and a functional study in yeast demonstrated a reduction in MMR activity and MLH1 protein expression (PMID: 17510385). This variant has been reported as heterozygous in individuals with a personal and/or family history of Lynch syndrome (PMID: 11139242, 11748856, 11920458, 11920650, 12362047, 17312306, 18566915, 19697156, 27152634, 29288294). It has also been reported as homozygous in multiple unrelated individuals with constitutional mismatch repair deficiency (PMID: 14762794, 24440087). In summary, this variant meets criteria to be classified as pathogenic. - |
Lynch syndrome Pathogenic:3
Pathogenic, criteria provided, single submitter | clinical testing | Women's Health and Genetics/Laboratory Corporation of America, LabCorp | Apr 23, 2019 | Variant summary: MLH1 c.2059C>T (p.Arg687Trp) results in a non-conservative amino acid change located in the DNA mismatch repair protein Mlh1, C-terminal (IPR032189) of 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 2e-05 in 251916 control chromosomes (gnomAD). It has also has been reported in the literature in multiple individuals and families affected with Lynch syndrome, constitutional mismatch repair deficiency syndrome, colorectal and gastrointestinal cancers from different populations (e.g. Arnold_2009, Caldes_2002; Lagerstedt Robinson_2007; Furukawa_2002, Bakry_2014, Gallinger_2004). The variant co-segregated with the disease in multiple families (e.g. Arnold_2009, Caldes_2002, Christensen_2009) but not in all (Lagerstedt Robinson_2007). In addition, International Society for Gastrointestianl Heriditary Tumors (InSiGHT) and others have performed systematic investigation and classified this variant as pathogenic (Tricarico_2017). These data indicate that the variant is very likely to be associated with disease. One experimental study demonstrated that this variant affects function in yeast functional assays and reduce in vitro MMR activity and MLH1 expression (Takahashi_2007). In contrast Christensen et al (Christensen_2009) has shown that this variant behaved like WT-MLH1 in its expression, MMR efficiency and subcellular localization. Six submitters have provided clinical significance assessments for this variant to ClinVar after 2014 without evidence for independent evaluation. They classified the variant as pathogenic (4x) /likely pathogenic (2x). Based on the evidence outlined above, the variant was classified as pathogenic. - |
Pathogenic, reviewed by expert panel | research | International Society for Gastrointestinal Hereditary Tumours (InSiGHT) | Sep 05, 2013 | Multifactorial likelihood analysis posterior probability >0.99 - |
Pathogenic, criteria provided, single submitter | clinical testing | Laboratory for Molecular Medicine, Mass General Brigham Personalized Medicine | Oct 14, 2019 | The p.Arg687Trp variant in MLH1 has been previously reported in at least 16 individuals with Lynch syndrome (von Salome 2018, Jakubowska 2001, Furukawa 2002, Caldes 2002) and 3 homozygous siblings affected with constitutive mismatch repair deficiency (Durno 2012). It is considered a founder mutation for Lynch syndrome in Sweden (von Salome 2018). It has also been identified in 3/30612 of South Asian chromosomes by gnomAD (http://gnomad.broadinstitute.org). This variant was classified as Pathogenic by several clinical labs in ClinVar and on September 5, 2013 by the ClinGen-approved InSiGHT expert panel (Variation ID 90014). 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 vitro functional studies provide some evidence that this variant mildly impacts protein function (Takahashi 2007, Christensen 2009, Kansikas 2011); however, these types of assays may not accurately represent biological function. In summary, this variant meets criteria to be classified as pathogenic for autosomal dominant Lynch syndrome. ACMG/AMP criteria applied: PS4, PP1_Strong, PM3, PM2_Supporting, PP4. - |
Hereditary cancer-predisposing syndrome Pathogenic:2
Pathogenic, criteria provided, single submitter | clinical testing | Ambry Genetics | Aug 21, 2024 | The p.R687W pathogenic mutation (also known as c.2059C>T), located in coding exon 18 of the MLH1 gene, results from a C to T substitution at nucleotide position 2059. The arginine at codon 687 is replaced by tryptophan, an amino acid with dissimilar properties. This mutation has been reported in the heterozygous state in multiple families with Lynch syndrome (Jakubowska A et al. Hum Mutat, 2001;17:52-60; Godino J et al. Hum. Mutat., 2001 Dec;18:549;Furukawa T et al. Cancer, 2002 Feb;94:911-20; Caldes T et al. Int J Cancer, 2002 Apr;98:774-9; Kurzawski G et al. J Med Genet, 2002 Oct;39:E65; Lagerstedt Robinson K et al. J Natl Cancer Inst, 2007 Feb;99:291-9; Nilbert M et al. Fam Cancer, 2009 Jun;8:75-83; (Hardt K et al. Fam Cancer, 2011 Jun;10:273-84; Zumstein V et al. Swiss Med Wkly, 2016 May;146:w14315; von Salomé J et al. Fam Cancer, 2017 Dec). One study reported segregation with disease in a large kindred (LOD score 1.5), including multiple individuals diagnosed with colon and/or endometrial cancer (Christensen LL et al. Fam Cancer, 2009 Aug;8:489-500). This mutation has also been observed in the homozygous state in multiple individuals from unrelated families with constitutional mismatch repair deficiency (CMMRD) syndrome (Gallinger S et al. Gastroenterology, 2004 Feb;126:576-85; Bakry D et al. Eur. J. Cancer, 2014 Mar;50:987-96). In one functional study, this mutation demonstrated lack of a dominant mutator effect (DME) and reduced MLH1 protein expression in yeast assays (Takahashi M et al. Cancer Res, 2007 May;67:4595-604). This amino acid position is highly conserved in available vertebrate species. In addition, this alteration is predicted to be deleterious by in silico analysis. Based on the supporting evidence, this variant is interpreted as a disease-causing mutation. - |
Pathogenic, criteria provided, single submitter | clinical testing | Color Diagnostics, LLC DBA Color Health | May 17, 2021 | This missense variant replaces arginine with tryptophan at codon 687 of the MLH1 protein. Computational prediction is inconclusive regarding the impact of this variant on protein structure and function (internally defined REVEL score threshold 0.5 < inconclusive < 0.7, PMID: 27666373). Functional studies have shown that this variant resulted in functional DNA repair in vitro and normal protein stability (PMID: 17510385, 19697156). This variant has been reported in individuals affected with Lynch syndrome (PMID: 11748856, 11920458, 18566915, 19267393, 19697156, 21404117, 25430799, 27629256, 28874130, 29288294), CMMRD (24440087), colorectal cancer (PMID: 26485756, 27152634), or ovarian cancer (PMID: 19697156). This variant has been identified in 5/251196 chromosomes in the general population by the Genome Aggregation Database (gnomAD). Based on the available evidence, this variant is classified as Pathogenic. - |
Carcinoma of colon Pathogenic:1
Likely pathogenic, no assertion criteria provided | clinical testing | Department of Pathology and Laboratory Medicine, Sinai Health System | - | The MLH1 p.Arg687Trp variant was identified in 15 of 7816 proband chromosomes (frequency: 0.002) from individuals or families with Lynch syndrome and constitutional biallelic mismatch repair deficiency syndrome, and was not identified in 3420 control chromosomes from healthy individuals (Lagerstedt-Robinson 2016, von Salome 2017, Zumstein 2016, Bakry 2014, Caldes 2002, Gallinger 2004). The variant was also identified in the following databases: dbSNP (ID: rs63751275) as "With Pathogenic, Uncertain significance allele", ClinVar (4x likely pathogenic, 3x pathogenic including review by expert panel InSiGHT), Clinvitae, Cosmic (1x, confirmed somatic, in carcinoma of the large intestine), UMD-LSDB (6x, unclassified variant), Mismatch Repair Genes Variant Database, and the Insight Hereditary Tumors Database (58x, pathogenic). The variant was not identified in GeneInsight-COGR, MutDB, or the Zhejiang Colon Cancer Database. The variant was identified in control databases in 5 of 245948 chromosomes at a frequency of 0.00002 (Genome Aggregation Database Feb 27, 2017). Breakdown of the observations by population include African in 1 of 15302 chromosomes (freq: 0.00007), European in 1 of 111454 chromosomes (freq: 0.000009), and South Asian in 3 of 30778 chromosomes (freq: 0.0001). The variant was not observed in the Other, Latino, Ashkenazi Jewish, East Asian, or Finnish populations. Functional studies show conflicting results; a study by Christensen 2009 found protein expression, repair efficiency, and subcellular localization of the variant protein similar to wildtype MLH1. However, a study by Takahashi 2007 demonstrated a pathogenic phenotype in three functional assays in yeast, as well as reduced protein expression and mismatch repair activity. No effect in splicing was found in a cDNA splicing assay (Borras 2012). This variant has been found in a homozygous state in children diagnosed with constitutional biallelic mismatch repair deficiency syndrome (Gallinger 2004, Bakry 2014). In several families, this variant co-segregated with disease (Caldes 2002, Christensen 2009, Zumstein 2016). Although the p.Arg687 residue is not conserved in mammals and other organisms, computational analyses (PolyPhen-2, SIFT, AlignGVGD, BLOSUM, MutationTaster) suggest that the p.Arg687Trp variant may impact the protein. The variant occurs outside of the splicing consensus sequence and in silico or computational prediction software programs (SpliceSiteFinder, MaxEntScan, NNSPLICE, GeneSplicer, HumanSpliceFinder) do not predict a difference in splicing. In summary, based on the above information the clinical significance of this variant cannot be determined with certainty at this time although we would lean towards a more pathogenic role for this variant. This variant is classified as likely pathogenic. - |
Muir-Torré syndrome;C1333991:Colorectal cancer, hereditary nonpolyposis, type 2;C5399763:Mismatch repair cancer syndrome 1 Pathogenic:1
Likely pathogenic, criteria provided, single submitter | clinical testing | Fulgent Genetics, Fulgent Genetics | Oct 31, 2018 | - - |
MLH1-related disorder Pathogenic:1
Pathogenic, no assertion criteria provided | clinical testing | PreventionGenetics, part of Exact Sciences | Jan 16, 2024 | The MLH1 c.2059C>T variant is predicted to result in the amino acid substitution p.Arg687Trp. This variant is considered to be a founder variant in the Swedish population and has been reported in individuals with hereditary non-polyposis colorectal cancer (Jakubowska et al. 2001. PubMed ID: 11139242), mismatch repair deficiency syndromes (Bakry et al. 2014. PubMed ID: 24440087), and Lynch syndrome (von Salomé et al. 2018. PubMed ID: 29288294). Functional studies have been discrepant regarding the impact of this variant on MLH1 function with reports ranging from wild type activity (Christensen et al. 2009. PubMed ID: 19697156) to reduced expression and MMR activity (Takahashi et al. 2007. PubMed ID: 17510385). This variant is reported in 0.0098% of alleles in individuals of South Asian descent in gnomAD and has been interpreted as pathogenic by an expert review panel in ClinVar (https://www.ncbi.nlm.nih.gov/clinvar/variation/90014). This variant is interpreted as pathogenic. - |
Hereditary nonpolyposis colorectal neoplasms Pathogenic:1
Pathogenic, criteria provided, single submitter | clinical testing | Labcorp Genetics (formerly Invitae), Labcorp | Jan 24, 2024 | This sequence change replaces arginine, which is basic and polar, with tryptophan, which is neutral and slightly polar, at codon 687 of the MLH1 protein (p.Arg687Trp). This variant is present in population databases (rs63751275, gnomAD 0.01%). This missense change has been observed in individuals with Lynch syndrome, constitutional mismatch repair deficiency syndrome, as well as colorectal and gastrointestinal cancer (PMID: 11139242, 11748856, 11920650, 14762794, 19697156, 21404117, 24440087, 26485756). It has also been observed to segregate with disease in related individuals. ClinVar contains an entry for this variant (Variation ID: 90014). Based on a multifactorial likelihood algorithm using genetic, in silico, and/or statistical data, this variant has been determined to have a high probability of being pathogenic (PMID: 22949379, 22949387, 24362816). Experimental studies are conflicting or provide insufficient evidence to determine the effect of this variant on MLH1 function (PMID: 16395668, 17510385). For these reasons, this variant has been classified as Pathogenic. - |
Lynch syndrome 1 Uncertain:1
Uncertain significance, no assertion criteria provided | clinical testing | Ding PR Lab, Sun Yat-sen University Cancer Center | - | - - |
Computational scores
Source:
Splicing
Find out detailed SpliceAI scores and Pangolin per-transcript scores at