Our verdict is Pathogenic. Variant got 12 ACMG points: 12P and 0B. PVS1PM2PP5_Moderate
The NM_000251.3(MSH2):c.646-4_655delATAGATAATTCAAA(p.Ile216fs) variant causes a frameshift, splice acceptor, splice region, intron 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.
MSH2 (HGNC:7325): (mutS homolog 2) This locus is frequently mutated in hereditary nonpolyposis colon cancer (HNPCC). When cloned, it was discovered to be a human homolog of the E. coli mismatch repair gene mutS, consistent with the characteristic alterations in microsatellite sequences (RER+ phenotype) found in HNPCC. Two transcript variants encoding different isoforms have been found for this gene. [provided by RefSeq, Apr 2012]
Verdict is Pathogenic. Variant got 12 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 2-47412403-TTTCAAAATAGATAA-T is Pathogenic according to our data. Variant chr2-47412403-TTTCAAAATAGATAA-T is described in ClinVar as [Pathogenic]. Clinvar id is 428516.Status of the report is criteria_provided_single_submitter, 1 stars.
The c.646-4_655del14 pathogenic mutation spans the last four nucleotides of intron 3 (ATAG) through the first 10 nucleotides of coding exon 4 (ATAATTCAAA) in the MSH2 gene. This pathogenic mutation results from a deletion of 14 nucleotides and disrupts the canonical splice acceptor site. To our knowledge, this specific alteration has not been reported in the literature to date. However, a deletion of 12 nucleotides which disrupts the same splice acceptor site (c.646-5_654del12), has been reported in a German family with suspected HNPCC (Mangold E et al. Int. J. Cancer 2005 Sep;116(5):692-702). In silico splice site analysis predicts that this alteration will weaken the native acceptor site and may result in the creation or strengthening of a novel splice acceptor site. Alterations that disrupt the canonical splice site are expected to cause aberrant splicing, resulting in an abnormal protein or a transcript that is subject to nonsense-mediated mRNA decay. As such, this alteration is classified as a disease-causing mutation. -