rs28936375

Variant names:

Variant summary

Our verdict is Pathogenic. The variant received 12 ACMG points: 13P and 1B. PM1PM5PP3PP5_Very_StrongBP4

The NM_000098.3(CPT2):c.149C>A(p.Pro50His) variant causes a missense change. The variant allele was found at a frequency of 0.000331 in 1,538,178 control chromosomes in the GnomAD database, with no homozygous occurrence. In-silico tool predicts a benign 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. P50S) has been classified as Likely pathogenic.

Frequency

Genomes: 𝑓 0.00020 ( 0 hom., cov: 32)

Exomes 𝑓: 0.00034 ( 0 hom. )

Consequence

CPT2
NM_000098.3 missense

Scores

Clinical Significance

Pathogenic criteria provided, multiple submitters, no conflicts P:17O:1

Conservation

PhyloP100: 4.63

Publications

32 publications found

Variant links:

Genes affected

CPT2 (HGNC:2330): (carnitine palmitoyltransferase 2) The protein encoded by this gene is a nuclear protein which is transported to the mitochondrial inner membrane. Together with carnitine palmitoyltransferase I, the encoded protein oxidizes long-chain fatty acids in the mitochondria. Defects in this gene are associated with mitochondrial long-chain fatty-acid (LCFA) oxidation disorders. [provided by RefSeq, Jul 2008]

CPT2 Gene-Disease associations (from GenCC):

carnitine palmitoyltransferase II deficiency
Inheritance: AR Classification: DEFINITIVE Submitted by: ClinGen, Myriad Women’s Health
carnitine palmitoyl transferase II deficiency, myopathic form
Inheritance: AR Classification: STRONG, SUPPORTIVE Submitted by: Orphanet, PanelApp Australia
carnitine palmitoyl transferase II deficiency, neonatal form
Inheritance: AR Classification: STRONG, SUPPORTIVE Submitted by: Orphanet, Labcorp Genetics (formerly Invitae), PanelApp Australia
carnitine palmitoyl transferase II deficiency, severe infantile form
Inheritance: AR Classification: STRONG, SUPPORTIVE Submitted by: PanelApp Australia, Orphanet
encephalopathy, acute, infection-induced, susceptibility to, 4
Inheritance: Unknown Classification: LIMITED Submitted by: Labcorp Genetics (formerly Invitae)

CPT2 links:

Genome browser will be placed here

ACMG classification

Classification was made for transcript

Our verdict: Pathogenic. The variant received 12 ACMG points.

PM1

In a topological_domain Mitochondrial matrix (size 152) in uniprot entity CPT2_HUMAN there are 15 pathogenic changes around while only 4 benign (79%) in NM_000098.3

PM5

Other missense variant is known to change same aminoacid residue: Variant chr1-53197091-C-T is described in ClinVar as Likely_pathogenic. ClinVar VariationId is 2078263.Status of the report is criteria_provided_single_submitter, 1 stars.

PP3

Multiple lines of computational evidence support a deleterious effect 9: AlphaMissense, BayesDel_addAF, BayesDel_noAF, Cadd, Eigen, MutationAssessor, PROVEAN, REVEL, REVEL [when max_spliceai, FATHMM_MKL, MetaRNN, MutationTaster was below the threshold]

PP5

Variant 1-53197092-C-A is Pathogenic according to our data. Variant chr1-53197092-C-A is described in ClinVar as Pathogenic. ClinVar VariationId is 8954.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars.

BP4

Computational evidence support a benign effect (MetaRNN=0.016327322). . Strength limited to SUPPORTING due to the PP5.

Transcripts

RefSeq

Gene	Transcript	HGVSc	HGVSp	Effect	Exon rank	MANE	Protein	UniProt
CPT2	NM_000098.3 link	c.149C>A	p.Pro50His	missense_variant	Exon 1 of 5	ENST00000371486.4	NP_000089.1
CPT2	NM_001330589.2 link	c.149C>A	p.Pro50His	missense_variant	Exon 1 of 5		NP_001317518.1

Ensembl

Gene	Transcript	HGVSc	HGVSp	Effect	Exon rank	TSL	MANE	Protein	Appris	UniProt
CPT2	ENST00000371486.4 link	c.149C>A	p.Pro50His	missense_variant	Exon 1 of 5	1	NM_000098.3	ENSP00000360541.3

Frequencies

GnomAD3 genomes

AF:

0.000204

AC:

AN:

152062

Hom.:

Cov.:

show subpopulations

Gnomad AFR

AF:

0.0000483

Gnomad AMI

AF:

0.00

Gnomad AMR

AF:

0.00

Gnomad ASJ

AF:

0.00

Gnomad EAS

AF:

0.00

Gnomad SAS

AF:

0.00

Gnomad FIN

AF:

0.00141

Gnomad MID

AF:

0.00

Gnomad NFE

AF:

0.000191

Gnomad OTH

AF:

0.000479

GnomAD2 exomes

AF:

0.000173

AC:

AN:

132920

AF XY:

0.000207

show subpopulations

Gnomad AFR exome

AF:

0.00

Gnomad AMR exome

AF:

0.00

Gnomad ASJ exome

AF:

0.00

Gnomad EAS exome

AF:

0.00

Gnomad FIN exome

AF:

0.00185

Gnomad NFE exome

AF:

0.000182

Gnomad OTH exome

AF:

0.000246

GnomAD4 exome

AF:

0.000345

AC:

478

AN:

1386116

Hom.:

Cov.:

AF XY:

0.000319

AC XY:

218

AN XY:

684186

show subpopulations

African (AFR)

AF:

0.0000317

AC:

AN:

31564

American (AMR)

AF:

0.0000280

AC:

AN:

35738

Ashkenazi Jewish (ASJ)

AF:

0.00

AC:

AN:

25136

East Asian (EAS)

AF:

0.00

AC:

AN:

35720

South Asian (SAS)

AF:

0.00

AC:

AN:

79234

European-Finnish (FIN)

AF:

0.00216

AC:

AN:

36658

Middle Eastern (MID)

AF:

0.00

AC:

AN:

5690

European-Non Finnish (NFE)

AF:

0.000352

AC:

380

AN:

1078496

Other (OTH)

AF:

0.000294

AC:

AN:

57880

Allele Balance Distribution

Red line indicates average allele balance

Average allele balance: 0.488

Heterozygous variant carriers

114

142

0.00

0.20

0.40

0.60

0.80

0.95

Allele balance

Age Distribution

Exome Het

Variant carriers

100

<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

AF:

0.000204

AC:

AN:

152062

Hom.:

Cov.:

AF XY:

0.000215

AC XY:

AN XY:

74278

show subpopulations

African (AFR)

AF:

0.0000483

AC:

AN:

41388

American (AMR)

AF:

0.00

AC:

AN:

15282

Ashkenazi Jewish (ASJ)

AF:

0.00

AC:

AN:

3470

East Asian (EAS)

AF:

0.00

AC:

AN:

5176

South Asian (SAS)

AF:

0.00

AC:

AN:

4828

European-Finnish (FIN)

AF:

0.00141

AC:

AN:

10614

Middle Eastern (MID)

AF:

0.00

AC:

AN:

314

European-Non Finnish (NFE)

AF:

0.000191

AC:

AN:

67990

Other (OTH)

AF:

0.000479

AC:

AN:

2088

Allele Balance Distribution

Red line indicates average allele balance

Average allele balance: 0.502

Heterozygous variant carriers

0.00

0.20

0.40

0.60

0.80

0.95

Allele balance

Age Distribution

Genome Het

Variant carriers

<30

30-35

35-40

40-45

45-50

50-55

55-60

60-65

65-70

70-75

75-80

>80

Age

Alfa

AF:

0.000572

Hom.:

Bravo

AF:

0.000128

TwinsUK

AF:

0.00

AC:

ALSPAC

AF:

0.000259

AC:

ExAC

AF:

0.000146

AC:

ClinVar

Significance: Pathogenic

Submissions summary: Pathogenic:17Other:1

Revision: criteria provided, multiple submitters, no conflicts

LINK: link

Submissions by phenotype

Carnitine palmitoyltransferase II deficiency

Pathogenic:4Other:1

Oct 17, 2023

Laboratory for Molecular Medicine, Mass General Brigham Personalized Medicine

Significance:Pathogenic

Review Status:criteria provided, single submitter

Collection Method:clinical testing

The p.Pro50His variant in CPT2 has been reported in the homozygous state in least 2 individuals and in the compound heterozygous state in at least 5 individuals with CPTII deficiency, at least 2 of whom were found to have low CPT II activity and segregated with disease in 1 affected relative. Most of these individuals had the myopathic form with juvenile to adult onset, however one individual who had a loss of function variant on the other copy of the CPT2 gene had infantile onset (Verderio 1995 PMID: 7711730, Taggart 1999 PMID: 10090476, Vladutiu 2002 PMID: 12410208, Wieser 2003 PMID: 12707442, Orngreen 2005 PMID: 15622536, Isackson 2006 PMID: 16996287, Corti 2008 PMID: 17936304). This variant has also been reported by other clinical laboratories in ClinVar (Variation ID 8954) and has been identified in 0.1% (15/10614) of European chromosomes by gnomAD (http://gnomad.broadinstitute.org, v.3.1.2). In vitro functional studies provide some evidence that this variant significantly affects the CPT II catalytic activity (Verderio 1995 PMID: 7711730) and computational prediction tools and conservation analyses are consistent with pathogenicity. In summary, this variant meets criteria to be classified as pathogenic for autosomal recessive CPTII deficiency though it should we noted that this variant typically causes the milder myopathic form; however, when found with a loss of function variant, it can cause more severe disease. ACMG/AMP Criteria applied: PM3_VeryStrong, PP3, PS3_Supporting, PP4. -

GeneReviews

Significance:not provided

Review Status:no classification provided

Collection Method:literature only

- -

Sep 16, 2020

Natera, Inc.

Significance:Pathogenic

Review Status:no assertion criteria provided

Collection Method:clinical testing

- -

Dec 31, 2024

Labcorp Genetics (formerly Invitae), Labcorp

Significance:Pathogenic

Review Status:criteria provided, single submitter

Collection Method:clinical testing

This sequence change replaces proline, which is neutral and non-polar, with histidine, which is basic and polar, at codon 50 of the CPT2 protein (p.Pro50His). This variant is present in population databases (rs28936375, gnomAD 0.2%). This missense change has been observed in individual(s) with CPT2 deficiency (PMID: 7711730, 10090476, 12410208, 12707442, 16996287, 17936304). In at least one individual the data is consistent with being in trans (on the opposite chromosome) from a pathogenic variant. ClinVar contains an entry for this variant (Variation ID: 8954). Invitae Evidence Modeling of protein sequence and biophysical properties (such as structural, functional, and spatial information, amino acid conservation, physicochemical variation, residue mobility, and thermodynamic stability) indicates that this missense variant is expected to disrupt CPT2 protein function with a positive predictive value of 95%. Experimental studies have shown that this missense change affects CPT2 function (PMID: 7711730). For these reasons, this variant has been classified as Pathogenic. -

Jul 13, 2017

Women's Health and Genetics/Laboratory Corporation of America, LabCorp

Significance:Pathogenic

Review Status:criteria provided, single submitter

Collection Method:clinical testing

Variant summary: The CPT2 c.149C>A (p.Pro50His) variant involves the alteration of a conserved nucleotide and 4/4 in silico tools (SNPsandGO not captured due to low reliability index) predict a damaging outcome. This variant was found in 2/11728 control chromosomes at a frequency of 0.0001705, which does not exceed the estimated maximal expected allele frequency of a pathogenic CPT2 variant (0.0015811). Multiple publications cite the variant in compound heterozygote affected individuals, which were found to have low CPT II activity. In addition, multiple clinical diagnostic laboratories/reputable databases classified this variant as pathogenic. Taken together, this variant is classified as pathogenic. -

not provided

Pathogenic:4

Feb 24, 2022

GeneDx

Significance:Pathogenic

Review Status:criteria provided, single submitter

Collection Method:clinical testing

Common CPT2 pathogenic variant found in approximately 6.5% of mutant alleles in patients with the adult myopathic form of carnitine palmitoyltransferase II (CPT2) deficiency (Bonnefont et al., 2004); Published functional studies in found P50H is associated with significantly reduced carnitine palmitoyltransferase II enzyme activity compared to wild type (Wataya et al. 1998); 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: 10090476, 12707442, 15363638, 22975760, 7711730, 31589614, 12410208, 15622536, 20301431, 31541997, 12673791, 17936304, 16996287, 33673806, 9600456) -

May 27, 2022

Clinical Genetics Laboratory, Skane University Hospital Lund

Significance:Pathogenic

Review Status:criteria provided, single submitter

Collection Method:clinical testing

- -

Dec 13, 2016

Eurofins Ntd Llc (ga)

Significance:Pathogenic

Review Status:criteria provided, single submitter

Collection Method:clinical testing

- -

Nov 19, 2018

Center for Personalized Medicine, Children's Hospital Los Angeles

Significance:Pathogenic

Review Status:criteria provided, single submitter

Collection Method:clinical testing

- -

Carnitine palmitoyl transferase II deficiency, severe infantile form

Pathogenic:4

Mar 02, 2014

Counsyl

Significance:Pathogenic

Review Status:no assertion criteria provided

Collection Method:literature only

This submission and the accompanying classification are no longer maintained by the submitter. For more information on current observations and classification, please contact variantquestions@myriad.com. -

Nov 01, 2002

OMIM

Significance:Pathogenic

Review Status:no assertion criteria provided

Collection Method:literature only

- -

Jan 17, 2020

Baylor Genetics

Significance:Pathogenic

Review Status:criteria provided, single submitter

Collection Method:clinical testing

This variant was determined to be pathogenic according to ACMG Guidelines, 2015 [PMID:25741868]. -

Apr 11, 2023

Genome-Nilou Lab

Significance:Pathogenic

Review Status:criteria provided, single submitter

Collection Method:clinical testing

- -

Carnitine palmitoyl transferase II deficiency, myopathic form

Pathogenic:3

Jun 01, 2021

Clinical Genomics Laboratory, Stanford Medicine

Significance:Pathogenic

Review Status:criteria provided, single submitter

Collection Method:clinical testing

• The p.Pro50His variant in the CPT2 gene has been previously reported in the homozygous or compound heterozygous state in many individuals affected with CPT II deficiency, and is recognized as one of the most common disease-causing variants identified in individuals with the myopathic presentation of disease (Taggart et al., 1999; Wieser et al., 2003; Ørngreen et al., 2005; Isackson et al., 2006). • The p.Pro50His variant is typically associated with the later-onset myopathic form of disease, but has been reported in association with the severe infantile form when compound heterozygous with a truncating variant (Vladutiu et al., 2002). • Heterozygous carriers of the p.Pro50His variant have been rarely reported to be clinically affected with adult- onset myopathy (Isackson et al., 2006). • • • These data were assessed using the ACMG/AMP variant interpretation guidelines. In summary, there is sufficient evidence to classify the p.Pro50His variant as pathogenic for autosomal recessive CPT II deficiency based on the information above. [ACMG evidence codes used: PM3_Very Strong; PM2; PS3_Supporting; PP3]This variant has been identified in 17/10,486 European (Finnish) chromosomes (32/164,218 chromosomesoverall) by the Genome Aggregation Database (http://gnomad.broadinstitute.org/). Although this variant hasbeen seen in the general population, its frequency is low enough to be consistent with a recessive carrierfrequency.Functional studies of the p.Pro50His variant are supportive of a deleterious effect to the protein and haveshown decreased stability of the mutant CPT II protein (Verderio et al., 1995) -

Nov 01, 2002

OMIM

Significance:Pathogenic

Review Status:no assertion criteria provided

Collection Method:literature only

- -

Apr 11, 2023

Molecular Genetics, Royal Melbourne Hospital

Significance:Pathogenic

Review Status:criteria provided, single submitter

Collection Method:clinical testing

This sequence change in CPT2 is predicted to replace proline with histidine at codon 50, p.(Pro50His). The proline residue is highly conserved (65/65 vertebrates, UCSC), and is located in the carnitine o-acyltransferase domain. There is a moderate physicochemical difference between proline and histidine. The highest population minor allele frequency in the population database gnomAD v2.1 is 0.16% (17/10,486 alleles) in the Finnish population. However, the highest continental population minor allele frequency is 0.02% (11/64,794 alleles) in the European (non-Finnish) population, which is consistent with recessive disease. This variant is one of the most common pathogenic variants associated with the myopathic form of CPTII deficiency identified in Europeans (PMID: 20301431). It has been detected in multiple individuals CPTII deficiency diagnosed on muscle biopsy in the homozygous state or compound heterozygous for the variant and a pathogenic or likely pathogenic variant (PMID: 7711730, 12673791, 12707442, 16996287). In vitro enzyme assays demonstrated the variant has reduced enzyme function at different temperatures indicating that this variant impacts protein function (PMID: 34063237). Multiple lines of computational evidence predict a deleterious effect for the missense substitution (6/6 algorithms). Based on the classification scheme RMH Modified ACMG Guidelines v1.5.1, this variant is classified as PATHOGENIC. Following criteria are met: PM3_VeryStrong, PS3_Supporting, PM2_Supporting, PP3, PP4. -

Carnitine palmitoyl transferase II deficiency, myopathic form;C1833511:Carnitine palmitoyl transferase II deficiency, severe infantile form;C1833518:Carnitine palmitoyl transferase II deficiency, neonatal form;C3280160:Encephalopathy, acute, infection-induced, susceptibility to, 4

Pathogenic:1

Mar 26, 2024

Fulgent Genetics, Fulgent Genetics

Significance:Pathogenic

Review Status:criteria provided, single submitter

Collection Method:clinical testing

- -

Encephalopathy, acute, infection-induced, susceptibility to, 4

Pathogenic:1

Mar 24, 2024

Baylor Genetics

Significance:Pathogenic

Review Status:criteria provided, single submitter

Collection Method:clinical testing

- -

Computational scores

Source: dbNSFP v4.3

Name

Calibrated prediction

Score

Prediction

AlphaMissense

Pathogenic

0.87

BayesDel_addAF

Pathogenic

0.35

BayesDel_noAF

Pathogenic

0.55

CADD

Pathogenic

(source)

DANN

Uncertain

1.0

DEOGEN2

Pathogenic

0.81

D;.;.;T;T;T

Eigen

Pathogenic

0.89

Eigen_PC

Pathogenic

0.78

FATHMM_MKL

Uncertain

0.86

LIST_S2

Uncertain

0.87

D;D;D;D;T;D

MetaRNN

Benign

0.016

T;T;T;T;T;T

MetaSVM

Pathogenic

1.1

MutationAssessor

Pathogenic

4.3

H;.;.;.;.;.

PhyloP100

4.6

PrimateAI

Uncertain

0.64

PROVEAN

Pathogenic

-6.8

D;.;.;.;.;.

REVEL

Pathogenic

0.95

Sift

Uncertain

0.0010

D;.;.;.;.;.

Sift4G

Uncertain

0.0050

D;.;.;.;.;.

Polyphen

1.0

D;.;.;.;.;.

Vest4

0.73

MutPred

0.92

Loss of glycosylation at P50 (P = 0.0582);Loss of glycosylation at P50 (P = 0.0582);Loss of glycosylation at P50 (P = 0.0582);Loss of glycosylation at P50 (P = 0.0582);Loss of glycosylation at P50 (P = 0.0582);Loss of glycosylation at P50 (P = 0.0582);

MVP

1.0

MPC

0.59

ClinPred

0.54

GERP RS

4.7

PromoterAI

-0.020

Neutral

(source)

RBP_binding_hub_radar

0.0

RBP_regulation_power_radar

1.0

Varity_R

0.97

gMVP

0.81

Mutation Taster

=45/55

disease causing (ClinVar)

(source)

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

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Variant summary

Frequency

Consequence

Scores

Clinical Significance

Conservation

Publications

ACMG classification

Transcripts

RefSeq

Ensembl

Frequencies

Age Distribution

Age Distribution

ClinVar

Submissions by phenotype

Computational scores

Splicing

Publications

Other links and lift over