rs1285584068

Variant summary

Our verdict is Pathogenic. The variant received 14 ACMG points: 14P and 0B. PM1PM2PP3_ModeratePP5_Very_Strong

The NM_000435.3(NOTCH3):​c.3091C>T​(p.Arg1031Cys) variant causes a missense change involving the alteration of a non-conserved nucleotide. The variant allele was found at a frequency of 0.0000014 in 1,423,552 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 Likely pathogenic (★★).

Frequency

Genomes: not found (cov: 32)
Exomes 𝑓: 0.0000014 ( 0 hom. )

Consequence

NOTCH3
NM_000435.3 missense

Scores

3
8
8

Clinical Significance

Pathogenic/Likely pathogenic criteria provided, multiple submitters, no conflicts P:9

Conservation

PhyloP100: 2.10
Variant links:
Genes affected
NOTCH3 (HGNC:7883): (notch receptor 3) This gene encodes the third discovered human homologue of the Drosophilia melanogaster type I membrane protein notch. In Drosophilia, notch interaction with its cell-bound ligands (delta, serrate) establishes an intercellular signalling pathway that plays a key role in neural development. Homologues of the notch-ligands have also been identified in human, but precise interactions between these ligands and the human notch homologues remains to be determined. Mutations in NOTCH3 have been identified as the underlying cause of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). [provided by RefSeq, Jul 2008]

Genome browser will be placed here

ACMG classification

Classification was made for transcript

Our verdict: Pathogenic. The variant received 14 ACMG points.

PM1
In a disulfide_bond (size 9) in uniprot entity NOTC3_HUMAN there are 4 pathogenic changes around while only 0 benign (100%) in NM_000435.3
PM2
Very rare variant in population databases, with high coverage;
PP3
MetaRNN computational evidence supports a deleterious effect, 0.924
PP5
Variant 19-15180732-G-A is Pathogenic according to our data. Variant chr19-15180732-G-A is described in ClinVar as [Likely_pathogenic]. Clinvar id is 447827.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr19-15180732-G-A is described in Lovd as [Pathogenic].

Transcripts

RefSeq

Gene Transcript HGVSc HGVSp Effect Exon rank MANE Protein UniProt
NOTCH3NM_000435.3 linkc.3091C>T p.Arg1031Cys missense_variant Exon 19 of 33 ENST00000263388.7 NP_000426.2 Q9UM47
NOTCH3XM_005259924.5 linkc.2935C>T p.Arg979Cys missense_variant Exon 18 of 32 XP_005259981.1

Ensembl

Gene Transcript HGVSc HGVSp Effect Exon rank TSL MANE Protein Appris UniProt
NOTCH3ENST00000263388.7 linkc.3091C>T p.Arg1031Cys missense_variant Exon 19 of 33 1 NM_000435.3 ENSP00000263388.1 Q9UM47
NOTCH3ENST00000601011.1 linkc.2932C>T p.Arg978Cys missense_variant Exon 18 of 23 5 ENSP00000473138.1 M0R3C9

Frequencies

GnomAD3 genomes
Cov.:
32
GnomAD4 exome
AF:
0.00000140
AC:
2
AN:
1423552
Hom.:
0
Cov.:
34
AF XY:
0.00
AC XY:
0
AN XY:
704652
show subpopulations
African (AFR)
AF:
0.00
AC:
0
AN:
32868
American (AMR)
AF:
0.00
AC:
0
AN:
38240
Ashkenazi Jewish (ASJ)
AF:
0.00
AC:
0
AN:
25352
East Asian (EAS)
AF:
0.00
AC:
0
AN:
37896
South Asian (SAS)
AF:
0.00
AC:
0
AN:
81252
European-Finnish (FIN)
AF:
0.00
AC:
0
AN:
49798
Middle Eastern (MID)
AF:
0.00
AC:
0
AN:
5716
European-Non Finnish (NFE)
AF:
0.00000183
AC:
2
AN:
1093310
Other (OTH)
AF:
0.00
AC:
0
AN:
59120
Allele Balance Distribution
Red line indicates average allele balance
Average allele balance: 0.475
Heterozygous variant carriers
0
1
1
2
2
3
0.00
0.20
0.40
0.60
0.80
0.95
Allele balance

Age Distribution

Exome Het
Variant carriers
0
2
4
6
8
10
<30
30-35
35-40
40-45
45-50
50-55
55-60
60-65
65-70
70-75
75-80
>80
Age
GnomAD4 genome
Cov.:
32
Alfa
AF:
0.00
Hom.:
0

ClinVar

Significance: Pathogenic/Likely pathogenic
Submissions summary: Pathogenic:9
Revision: criteria provided, multiple submitters, no conflicts
LINK: link

Submissions by phenotype

not provided Pathogenic:5
Aug 27, 2024
Mayo Clinic Laboratories, Mayo Clinic
Significance:Pathogenic
Review Status:criteria provided, single submitter
Collection Method:clinical testing

PP2, PP4, PM1, PM2_moderate, PS3, PS4 -

Dec 14, 2020
Athena Diagnostics
Significance:Pathogenic
Review Status:criteria provided, single submitter
Collection Method:clinical testing

This variant has not been reported in large, multi-ethnic general populations (http://gnomad.broadinstitute.org). This variant has been identified in at least one individual with clinical features associated with this gene. Assessment of experimental evidence suggests this variant results in abnormal protein function. Study showed this variant rescued stroke susceptibility phenotype in young notch 3 knock-out mice, but failed to rescue older mice suggesting it might be an age-dependent hypomorphic variant (PMID: 21555590). This variant alters a critical location within the protein, and is expected to severely affect function and cause disease. Greater than 90% of NOTCH3 pathogenic mutations associated with CADASIL involve the gain or loss of a cysteine residue within the epidermal growth factor (EGF)-like repeat domain (PMID: 32457593, 20301673). -

Mar 20, 2024
Labcorp Genetics (formerly Invitae), Labcorp
Significance:Pathogenic
Review Status:criteria provided, single submitter
Collection Method:clinical testing

This sequence change replaces arginine, which is basic and polar, with cysteine, which is neutral and slightly polar, at codon 1031 of the NOTCH3 protein (p.Arg1031Cys). This variant is not present in population databases (gnomAD no frequency). This missense change has been observed in individuals with cerebral arteriopathy with subcortical infarcts and leukoencephalopathy 1 (CADASIL) (PMID: 9388399, 11244680, 12136071, 19174371). It has also been observed to segregate with disease in related individuals. ClinVar contains an entry for this variant (Variation ID: 447827). Advanced modeling of protein sequence and biophysical properties (such as structural, functional, and spatial information, amino acid conservation, physicochemical variation, residue mobility, and thermodynamic stability) performed at Invitae indicates that this missense variant is expected to disrupt NOTCH3 protein function with a positive predictive value of 80%. Experimental studies have shown that this missense change affects NOTCH3 function (PMID: 21555590). For these reasons, this variant has been classified as Pathogenic. -

Feb 16, 2025
Laboratory of Genetics, Children's Clinical University Hospital Latvia
Significance:Pathogenic
Review Status:criteria provided, single submitter
Collection Method:clinical testing

- -

Sep 06, 2024
GeneDx
Significance:Likely pathogenic
Review Status:criteria provided, single submitter
Collection Method:clinical testing

Published functional studies demonstrate that this variant failed to rescue stroke susceptibility phenotype in older notch3 knock-out mice, consistent with later onset disease (PMID: 21555590); Not observed at significant frequency in large population cohorts (gnomAD); In silico analysis indicates that this missense variant does not alter protein structure/function; This variant is associated with the following publications: (PMID: 9388399, 21555590, 19859875, 35401403, 36261288, 36380532) -

Cerebral arteriopathy, autosomal dominant, with subcortical infarcts and leukoencephalopathy, type 1 Pathogenic:3
Mar 04, 2025
Institute of Human Genetics, University of Leipzig Medical Center
Significance:Likely pathogenic
Review Status:criteria provided, single submitter
Collection Method:clinical testing

Criteria applied: PS3_MOD,PS4_MOD,PM1,PM2_SUP -

Aug 17, 2021
MGZ Medical Genetics Center
Significance:Pathogenic
Review Status:criteria provided, single submitter
Collection Method:clinical testing

- -

Jun 13, 2025
Institute of Medical Genetics and Applied Genomics, University Hospital Tübingen
Significance:Pathogenic
Review Status:criteria provided, single submitter
Collection Method:clinical testing

- -

NOTCH3-related disorder Pathogenic:1
Mar 27, 2024
PreventionGenetics, part of Exact Sciences
Significance:Pathogenic
Review Status:no assertion criteria provided
Collection Method:clinical testing

The NOTCH3 c.3091C>T variant is predicted to result in the amino acid substitution p.Arg1031Cys. This variant has been reported in individuals with CADASIL (Joutel et al. 1997. PubMed ID: 9388399; Wang et al. 2022. PubMed ID: 35401403; Uemura et al. 2022. PubMed ID: 36261288). This variant has not been reported in a large population database, indicating this variant is rare. Most CADASIL causing variants in the NOTCH3 gene result in the gain or loss of one or more cysteine residues in the extracellular domain of the protein, as seen in this patient. This patient’s variant alters a cysteine residue and is located in the extracellular EGF-like domain 26. Pathogenic variants in EGF-like domains 1-6 appear to be fully penetrant and are usually associated with the classical CADASIL phenotype. However, there is variability in disease severity. Pathogenic variants in EGF-like domains 7-34 have a much higher population frequency, and can predispose to a milder small-vessel disease, possibly even displaying incomplete or at least very late onset complete penetrance (OMIM #125310; Rutten et al. 2016. PubMed ID: 27844030; Rutten et al. 2019. PubMed ID: 30032161). This variant is interpreted as pathogenic. -

Computational scores

Source: dbNSFP v4.3

Name
Calibrated prediction
Score
Prediction
AlphaMissense
Benign
0.29
BayesDel_addAF
Pathogenic
0.20
D
BayesDel_noAF
Uncertain
0.050
CADD
Uncertain
24
DANN
Uncertain
1.0
DEOGEN2
Uncertain
0.76
D;T
Eigen
Benign
0.011
Eigen_PC
Benign
-0.18
FATHMM_MKL
Uncertain
0.79
D
LIST_S2
Uncertain
0.95
D;T
M_CAP
Pathogenic
0.40
D
MetaRNN
Pathogenic
0.92
D;D
MetaSVM
Uncertain
0.63
D
MutationAssessor
Uncertain
2.1
M;.
PhyloP100
2.1
PrimateAI
Benign
0.36
T
PROVEAN
Benign
-1.5
N;.
REVEL
Uncertain
0.63
Sift
Benign
0.21
T;.
Sift4G
Benign
0.11
T;T
Polyphen
0.92
P;.
Vest4
0.80
MutPred
0.88
Gain of glycosylation at P1026 (P = 0.1166);.;
MVP
1.0
MPC
1.3
ClinPred
0.77
D
GERP RS
3.1
Varity_R
0.42
gMVP
0.84
Mutation Taster
=14/86
disease causing (ClinVar)

Splicing

Name
Calibrated prediction
Score
Prediction
SpliceAI score (max)
0.0
Details are displayed if max score is > 0.2

Find out detailed SpliceAI scores and Pangolin per-transcript scores at spliceailookup.broadinstitute.org

Publications

Other links and lift over

dbSNP: rs1285584068; hg19: chr19-15291543; COSMIC: COSV54628005; COSMIC: COSV54628005; API