Our verdict is Uncertain significance. Variant got 2 ACMG points: 2P and 0B. PM2
The NM_000368.5(TSC1):c.3368_3369delAA(p.Lys1123ArgfsTer35) 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 Uncertain significance (★).
TSC1 (HGNC:12362): (TSC complex subunit 1) This gene is a tumor suppressor gene that encodes the growth inhibitory protein hamartin. The encoded protein interacts with and stabilizes the GTPase activating protein tuberin. This hamartin-tuberin complex negatively regulates mammalian target of rapamycin complex 1 (mTORC1) signaling which is a major regulator of anabolic cell growth. This protein also functions as a co-chaperone for Hsp90 that inhibits its ATPase activity. This protein functions as a facilitator of Hsp90-mediated folding of kinase and non-kinase clients, including TSC2 and thereby preventing their ubiquitination and proteasomal degradation. Mutations in this gene have been associated with tuberous sclerosis and lymphangioleiomyomatosis. [provided by RefSeq, May 2022]
Review Status: criteria provided, single submitter
Collection Method: clinical testing
This sequence change deletes two nucleotides in exon 23 of the TSC1 mRNA (c.3368_3369delAA),  causing a frameshift at codon 1123. This creates a premature translational stop signal in the last exon of the TSC1 mRNA (p.Lys1123Argfs*35). While this is not anticipated to result in nonsense mediated decay, it is expected to result in a truncated TSC1 protein. This variant is not present in population databases (ExAC no frequency) and has not been reported in the literature in individuals with a TSC1-related disease. In summary, this is a novel nonsense change, There is insufficient evidence at this time to conclude whether a truncation in the last exon of the TSC1 gene has a deleterious effect on TSC1 protein function. Therefore, it has been classified as a Variant of Uncertain Significance. -