rs267608426

Positions:

• chrX-154032472-CTTCT-C

Variant summary

Our verdict is Pathogenic. Variant got 18 ACMG points: 18P and 0B. PVS1 PM2 PP5_Very_Strong

The ENST00000453960.7(MECP2):​c.144_147del​(p.Glu49ArgfsTer87) variant causes a frameshift change. The variant was absent in control chromosomes in GnomAD project. Variant has been reported in ClinVar as Pathogenic (★★).

• Frequency: Genomes: not found (cov: 24)
• Consequence: MECP2 ENST00000453960.7 frameshift
• Clinical Significance: Pathogenic criteria provided, multiple submitters, no conflicts P:5
• Conservation: PhyloP100: 4.61

Genes affected

MECP2 (HGNC:6990): (methyl-CpG binding protein 2) DNA methylation is the major modification of eukaryotic genomes and plays an essential role in mammalian development. Human proteins MECP2, MBD1, MBD2, MBD3, and MBD4 comprise a family of nuclear proteins related by the presence in each of a methyl-CpG binding domain (MBD). Each of these proteins, with the exception of MBD3, is capable of binding specifically to methylated DNA. MECP2, MBD1 and MBD2 can also repress transcription from methylated gene promoters. In contrast to other MBD family members, MECP2 is X-linked and subject to X inactivation. MECP2 is dispensible in stem cells, but is essential for embryonic development. MECP2 gene mutations are the cause of most cases of Rett syndrome, a progressive neurologic developmental disorder and one of the most common causes of cognitive disability in females. Alternative splicing results in multiple transcript variants encoding different isoforms. [provided by RefSeq, Oct 2015]

ACMG classification

Verdict is Pathogenic. Variant got 18 ACMG points.

• PVS1: Loss of function variant, product does not undergo nonsense mediated mRNA decay. Variant is located in the 3'-most 50 bp of the penultimate exon, not predicted to undergo nonsense mediated mRNA decay. There are 663 pathogenic variants in the truncated region.
• PM2: Very rare variant in population databases, with high coverage
• PP5: Variant X-154032472-CTTCT-C is Pathogenic according to our data. Variant chrX-154032472-CTTCT-C is described in ClinVar as [Pathogenic]. Clinvar id is 143328.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chrX-154032472-CTTCT-C is described in Lovd as [Pathogenic]. Variant chrX-154032472-CTTCT-C is described in Lovd as [Pathogenic].

Transcripts

RefSeq

Gene	Transcript	HGVSc	HGVSp	Effect	#exon/exons	MANE	Protein	UniProt
MECP2	NM_001110792.2	c.144_147del	p.Glu49ArgfsTer87	frameshift_variant	2/3	ENST00000453960.7	NP_001104262.1
MECP2	NM_004992.4	c.108_111del	p.Glu37ArgfsTer87	frameshift_variant	3/4	ENST00000303391.11	NP_004983.1

Ensembl

Gene	Transcript	HGVSc	HGVSp	Effect	#exon/exons	TSL	MANE	Protein	Appris	UniProt
MECP2	ENST00000303391.11	c.108_111del	p.Glu37ArgfsTer87	frameshift_variant	3/4	1	NM_004992.4	ENSP00000301948	P1
MECP2	ENST00000453960.7	c.144_147del	p.Glu49ArgfsTer87	frameshift_variant	2/3	1	NM_001110792.2	ENSP00000395535

Frequencies

GnomAD3 genomes Cov.: 24

We have no GnomAD4 exomes data on this position. Probably position not covered by the project.

GnomAD4 genome Cov.: 24

ClinVar

Significance: Pathogenic

Submissions summary: Pathogenic:5

Revision: criteria provided, multiple submitters, no conflicts

Submissions by phenotype

Rett syndrome Pathogenic:2

Pathogenic, criteria provided, single submitter	curation	Centre for Population Genomics, CPG	Oct 09, 2023	This variant has been collected from RettBASE and curated to current modified ACMG/AMP criteria. Based on the classification scheme defined by the ClinGen Rett/Angelman-like Expert Panel for Rett/AS-like Disorders Specifications to the ACMG/AMP Variant Interpretation Guidelines VCEP 2.0, this variant is classified as pathogenic. At least the following criteria are met: This variant is absent from gnomAD (PM2_Supporting). Predicted to result in loss of function, and LOF is a known mechanism of disease (PVS1). Has been observed in at least 2 individuals with phenotypes consistent with MECP2-related disease (PS4_Supporting, PMID: 30405208). -
Pathogenic, no assertion criteria provided	curation	RettBASE	Jul 28, 2004	- -

Severe neonatal-onset encephalopathy with microcephaly Pathogenic:1

Pathogenic, criteria provided, single submitter

clinical testing

Labcorp Genetics (formerly Invitae), Labcorp

Jul 07, 2023

For these reasons, this variant has been classified as Pathogenic. This variant disrupts a region of the MECP2 protein in which other variant(s) (p.Gln437Alafs*49) have been determined to be pathogenic (PMID: 11055898; Invitae). This suggests that this is a clinically significant region of the protein, and that variants that disrupt it are likely to be disease-causing. ClinVar contains an entry for this variant (Variation ID: 143328). This premature translational stop signal has been observed in individuals with Rett syndrome (PMID: 30405208, 31095231). This variant is not present in population databases (gnomAD no frequency). This sequence change creates a premature translational stop signal (p.Glu37Argfs*87) in the MECP2 gene. While this is not anticipated to result in nonsense mediated decay, it is expected to disrupt the last 450 amino acid(s) of the MECP2 protein. -

not provided Pathogenic:1

Pathogenic, criteria provided, single submitter

clinical testing

Revvity Omics, Revvity

Apr 03, 2020

- -

Rett syndrome;C0162635:Angelman syndrome;C0796222:X-linked intellectual disability-psychosis-macroorchidism syndrome Pathogenic:1

Pathogenic, criteria provided, single submitter

clinical testing

Labcorp Genetics (formerly Invitae), Labcorp

May 01, 2016

This sequence change deletes 4 nucleotides from exon 3 of the MECP2 mRNA (c.108_111delAGAA), causing a frameshift at codon 37. This creates a premature translational stop signal in the last exon of the MECP2 mRNA (p.Glu37Argfs*87). While this is not anticipated to result in nonsense mediated decay, it is expected to result in a truncated MECP2 protein. This variant is not present in population databases (ExAC no frequency) and has not been reported in the literature in individuals with a MECP2-related disease. The region of the protein disrupted by this variant includes the entire methyl-CpG DNA binding domain of MECP2 (PMID: 10508514). Many pathogenic truncations have been reported downstream of this variant (PMID: 16473305). For these reasons, this variant has been classified as Pathogenic. -

Computational scores

Source: dbNSFP v4.3

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

LitVar

Other links and lift over

dbSNP: rs267608426; hg19: chrX-153297923;