rs368505753

chr7-117509069-C-T

Variant summary

Our verdict is Pathogenic. Variant got 16 ACMG points: 16P and 0B. PM1 PM2 PP3_Strong PP5_Very_Strong

The NM_000492.4(CFTR):c.200C>T(p.Pro67Leu) variant causes a missense change. The variant allele was found at a frequency of 0.000109 in 1,612,926 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 Pathogenic,drug response (★★★).

• Frequency:
  • Genomes: 𝑓 0.000033 (0 hom., cov: 33)
  • Exomes 𝑓: 0.00012 (0 hom.)
• Consequence: CFTR NM_000492.4 missense
• Clinical Significance: Pathogenic; drug response reviewed by expert panel P:25 O:1
• Conservation: PhyloP100: 6.12

Genes affected

CFTR (HGNC:1884): (CF transmembrane conductance regulator) This gene encodes a member of the ATP-binding cassette (ABC) transporter superfamily. The encoded protein functions as a chloride channel, making it unique among members of this protein family, and controls ion and water secretion and absorption in epithelial tissues. Channel activation is mediated by cycles of regulatory domain phosphorylation, ATP-binding by the nucleotide-binding domains, and ATP hydrolysis. Mutations in this gene cause cystic fibrosis, the most common lethal genetic disorder in populations of Northern European descent. The most frequently occurring mutation in cystic fibrosis, DeltaF508, results in impaired folding and trafficking of the encoded protein. Multiple pseudogenes have been identified in the human genome. [provided by RefSeq, Aug 2017]

ACMG classification

Verdict is Pathogenic. Variant got 16 ACMG points.

• PM1: In a hotspot region, there are 3 aminoacids with missense pathogenic changes in the window of +-8 aminoacids around while only 0 benign, 12 uncertain in NM_000492.4
• PM2: Very rare variant in population databases, with high coverage
• PP3: MetaRNN computational evidence supports a deleterious effect, 0.974
• PP5: Variant 7-117509069-C-T is Pathogenic according to our data. Variant chr7-117509069-C-T is described in ClinVar as [Pathogenic, drug_response]. Clinvar id is 53425.Status of the report is reviewed_by_expert_panel, 3 stars. Variant chr7-117509069-C-T is described in Lovd as [Pathogenic]. Variant chr7-117509069-C-T is described in Lovd as [Pathogenic].

Transcripts

RefSeq

Gene	Transcript	HGVSc	HGVSp	Effect	#exon/exons	MANE	UniProt
CFTR	NM_000492.4	c.200C>T	p.Pro67Leu	missense_variant	3/27	ENST00000003084.11

Ensembl

Gene	Transcript	HGVSc	HGVSp	Effect	#exon/exons	TSL	MANE	Appris	UniProt
CFTR	ENST00000003084.11	c.200C>T	p.Pro67Leu	missense_variant	3/27	1	NM_000492.4	P2

Frequencies

GnomAD3 genomes AF: 0.0000329 AC: 5 AN: 152202 Hom.: 0 Cov.: 33

Gnomad AFR AF: 0.0000482

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: 0.00

Gnomad MID AF: 0.00

Gnomad NFE AF: 0.0000441

Gnomad OTH AF: 0.00

GnomAD3 exomes AF: 0.0000359 AC: 9 AN: 251004 Hom.: 0 AF XY: 0.0000442 AC XY: 6 AN XY: 135656

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 SAS exome AF: 0.00

Gnomad FIN exome AF: 0.00

Gnomad NFE exome AF: 0.0000793

Gnomad OTH exome AF: 0.00

GnomAD4 exome AF: 0.000117 AC: 171 AN: 1460724 Hom.: 0 Cov.: 29 AF XY: 0.000114 AC XY: 83 AN XY: 726752

Gnomad4 AFR exome AF: 0.0000897

Gnomad4 AMR exome AF: 0.00

Gnomad4 ASJ exome AF: 0.00

Gnomad4 EAS exome AF: 0.00

Gnomad4 SAS exome AF: 0.00

Gnomad4 FIN exome AF: 0.00

Gnomad4 NFE exome AF: 0.000143

Gnomad4 OTH exome AF: 0.000149

GnomAD4 genome AF: 0.0000329 AC: 5 AN: 152202 Hom.: 0 Cov.: 33 AF XY: 0.0000269 AC XY: 2 AN XY: 74348

Gnomad4 AFR AF: 0.0000482

Gnomad4 AMR AF: 0.00

Gnomad4 ASJ AF: 0.00

Gnomad4 EAS AF: 0.00

Gnomad4 SAS AF: 0.00

Gnomad4 FIN AF: 0.00

Gnomad4 NFE AF: 0.0000441

Gnomad4 OTH AF: 0.00

Alfa AF: 0.0000855 Hom.: 0

Bravo AF: 0.0000491

TwinsUK AF: 0.000270 AC: 1

ALSPAC AF: 0.00 AC: 0

ESP6500AA AF: 0.00 AC: 0

ESP6500EA AF: 0.000116 AC: 1

ExAC AF: 0.0000330 AC: 4

EpiCase AF: 0.000164

EpiControl AF: 0.000119

ClinVar

Significance: Pathogenic; drug response

Submissions summary: Pathogenic:25 Other:1

Revision: reviewed by expert panel

Submissions by phenotype

Cystic fibrosis Pathogenic:9

Likely pathogenic, criteria provided, single submitter	literature only	Counsyl	Sep 24, 2014	- -
Pathogenic, reviewed by expert panel	research	CFTR2	Mar 17, 2017	- -
Pathogenic, criteria provided, single submitter	clinical testing	Invitae	Jan 05, 2024	This sequence change replaces proline, which is neutral and non-polar, with leucine, which is neutral and non-polar, at codon 67 of the CFTR protein (p.Pro67Leu). This variant is present in population databases (rs368505753, gnomAD 0.006%). This missense change has been observed in individual(s) with cystic fibrosis (CF), congenital bilateral absence of vas deferens, or other CFTR-related conditions (PMID: 9507391, 16840743, 22658665, 23974870). 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: 53425). 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 CFTR protein function with a positive predictive value of 80%. Experimental studies have shown that this missense change affects CFTR function (PMID: 23891399, 23974870). For these reasons, this variant has been classified as Pathogenic. -
Pathogenic, criteria provided, single submitter	clinical testing	Genome Diagnostics Laboratory, The Hospital for Sick Children	Jul 05, 2021	- -
Pathogenic, criteria provided, single submitter	curation	CFTR-France	Jan 29, 2018	- -
Pathogenic, criteria provided, single submitter	clinical testing	Women's Health and Genetics/Laboratory Corporation of America, LabCorp	Jul 29, 2016	Variant summary: The CFTR c.200C>T (p.Pro67Leu) variant involves the alteration of a conserved nucleotide and is present in ABC transporter type 1, transmembrane domain of the protein. 5/5 in silico tools predict a damaging outcome for this variant. This variant was found in 4/121266 control chromosomes at a frequency of 0.000033, which does not exceed the estimated maximal expected allele frequency of a pathogenic CFTR variant (0.0129603). The variant has been reported in numerous CF-affected individuals in the literature, particularly in patients with non-classic CF with consistent recessive genotypes, and has been shown to display a mean chloride conductance <10% compared to wildtype (Sosnay_2013, Kraus_2007). In addition, multiple clinical diagnostic laboratories/reputable databases have classified this variant as pathogenic. Taken together, this variant is classified as pathogenic. -
Pathogenic, criteria provided, single submitter	clinical testing	Johns Hopkins Genomics, Johns Hopkins University	Oct 16, 2019	Disease-causing CFTR variant (previously reported for this patient by mass spectrometry genotyping). See www.CFTR2.org for phenotype information. -
Pathogenic, criteria provided, single submitter	clinical testing	Ambry Genetics	Jul 26, 2021	The p.P67L pathogenic mutation (also known as c.200C>T), located in coding exon 3 of the CFTR gene, results from a C to T substitution at nucleotide position 200. The proline at codon 67 is replaced by leucine, an amino acid with similar properties. This mutation has been described in a Scottish cohort of individuals with a mild phenotype, including in trans with p.G542* in an 18-year-old male with recurrent chest infections and pancreatic insufficiency as well as in trans with p.F508del in a 1-year-old female with a probable diagnosis of cystic fibrosis (CF) and an initial abnormal sweat chloride level followed by two equivocal sweat chloride tests (Gilfillan A et al. J. Med. Genet., 1998 Feb;35:122-5). In vitro functional studies showed that while CFTR transcripts with this pathogenic mutation had similar mRNA levels compared to wildtype, the amount of processed mature protein was significantly decreased (Van Goor F et al. J. Cyst. Fibros., 2014 Jan;13:29-36). This mutation is associated with borderline sweat chloride levels and pancreatic sufficiency (Sosnay PR et al. Nat. Genet., 2013 Oct;45:1160-7). Based on the supporting evidence, this alteration is interpreted as a disease-causing mutation. -
Pathogenic, criteria provided, single submitter	clinical testing	Rady Children's Institute for Genomic Medicine, Rady Children's Hospital San Diego	May 27, 2020	This variant has been previously reported as a compound heterozygous change in many individuals affected with cystic fibrosis (CF), congenital bilateral absence of vas deferens, or other CFTR-related conditions (PMID: 9507391, 22658665, 23974870, 16840743). Individuals with this variant and a second pathogenic allele are typically found to have lower sweat chloride levels than the average CF (http://cftr2.org/mutation/scientific/P67L/). Experimental studies have shown that this missense change affects the chloride conduction function in vitro (PMID:23974870, 23891399). It is present in the heterozygous state in the gnomAD population database at a frequency of 0.004% (10/282408) and thus is presumed to be rare. In silico analyses support a deleterious effect of the c.200C>T (p.Pro67Leu) variant on protein function. Based on the available evidence, the c.200C>T (p.Pro67Leu) variant is classified as Pathogenic. -

not provided Pathogenic:8

Likely pathogenic, criteria provided, single submitter	clinical testing	Greenwood Genetic Center Diagnostic Laboratories, Greenwood Genetic Center	Feb 02, 2021	PS3, PP2, PM3_Supporting, PM2 -
Pathogenic, criteria provided, single submitter	clinical testing	Quest Diagnostics Nichols Institute San Juan Capistrano	Jun 08, 2022	In the published literature, the variant has been associated with mild CF signs and symptoms with compound heterozygous individuals often being pancreatic sufficient, have abnormal sweat chloride levels, and are responsive to therapeutics (PMID: 6840743 (1983), 23974870 (2013), 25732475 (2015), 28392015 (2017)). The variant has been reported to be common in the Scottish population (PMID: 9507391 (1998)). Functional studies have shown that this variant has a damaging effect on CFTR maturation and function (PMID: 23974870 (2013), 23891399 (2014), 27660821 (2016), 33781744 (2021)). Based on the available information, this variant is classified as pathogenic. -
Pathogenic, no assertion criteria provided	clinical testing	Diagnostic Laboratory, Department of Genetics, University Medical Center Groningen	-	- -
Likely pathogenic, no assertion criteria provided	clinical testing	Joint Genome Diagnostic Labs from Nijmegen and Maastricht, Radboudumc and MUMC+	-	- -
Pathogenic, criteria provided, single submitter	clinical testing	ARUP Laboratories, Molecular Genetics and Genomics, ARUP Laboratories	Oct 02, 2023	The CFTR c.200C>T; p.Pro67Leu variant (rs368505753), is reported in the literature in multiple individuals in the compound heterozygous state affected with cystic fibrosis (Gilfillan 1998, Kingsmore 2021, Raraigh 2022, Sosnay 2013). This variant is reported in ClinVar (Variation ID: 53425) and is observed on ten alleles in the Genome Aggregation Database, indicating it is not a common polymorphism and. In vitro/In vivo functional analyses demonstrate altered CFTR protein folding, reduced mature CTFR protein, and reduced chloride transport (Sabusap 2021, Van Goor 2014). The proline at codon 67 is highly conserved and computational analyses predict that this variant is deleterious (REVEL:0.926). Based on available information, this variant is considered to be pathogenic. References: Gilfillan A, et al. P67L: a cystic fibrosis allele with mild effects found at high frequency in the Scottish population. J Med Genet. 1998. PMID: 9507391 Kingsmore SF, et al. A genome sequencing system for universal newborn screening, diagnosis, and precision medicine for severe genetic diseases. 2021. Am J Hum Genet. PMID: 36007526. Raraigh KS, et al. Complete CFTR gene sequencing in 5,058 individuals with cystic fibrosis informs variant-specific treatment. J Cyst Fibros. 2022. PMID: 34782259. Sabusap CM, et al. The CFTR P67L variant reveals a key role for N-terminal lasso helices in channel folding, maturation, and pharmacologic rescue. 2021. J Biol Chem. PMID: 33781744. Sosnay PR, et al. Defining the disease liability of variants in the cystic fibrosis transmembrane conductance regulator gene. Nat Genet. 2013. PMID: 23974870. Van Goor F, et al. Effect of ivacaftor on CFTR forms with missense mutations associated with defects in protein processing or function. J Cyst Fibros. 2014. PMID: 23891399. -
Pathogenic, criteria provided, single submitter	clinical testing	Revvity Omics, Revvity	Aug 22, 2022	- -
Pathogenic, criteria provided, single submitter	clinical testing	Eurofins Ntd Llc (ga)	Jul 09, 2018	- -
Pathogenic, criteria provided, single submitter	clinical testing	Mayo Clinic Laboratories, Mayo Clinic	Jan 05, 2022	PS3, PM2, PM3_strong, PP3, PP4, PP5 -

CFTR-related disorder Pathogenic:4

Pathogenic, no assertion criteria provided	clinical testing	Genome Diagnostics Laboratory, The Hospital for Sick Children	Jul 05, 2021	- -
Pathogenic, criteria provided, single submitter	clinical testing	PreventionGenetics, part of Exact Sciences	Jan 01, 2024	The CFTR c.200C>T variant is predicted to result in the amino acid substitution p.Pro67Leu. This variant has been reported to be causative for cystic fibrosis (https://cftr2.org, Sosnay et al. 2013. PubMed ID: 23974870; Claustres et al. 1993. PubMed ID: 7691344). In summary, we classify this variant as pathogenic. -
Pathogenic, no assertion criteria provided	clinical testing	Natera, Inc.	Mar 17, 2017	- -
Pathogenic, criteria provided, single submitter	clinical testing	Rady Children's Institute for Genomic Medicine, Rady Children's Hospital San Diego	-	This variant has been previously reported as a compound heterozygous change in multiple individuals with cystic fibrosis (CF) and other CFTR-related disorders (PMID: 9507391, 22658665, 23974870, 16840743). The c.200C>T (p.Pro67Leu) variant is present in the CFTR2 website as a CF disease-causing variant when combined with another CF-causing variant (http://cftr2.org/mutation/scientific/P67L/). In-vitro functional studies showed that this alteration affects the channel function (PMID:23974870, 23891399). It is present in the heterozygous state in the gnomAD population database at a frequency of 0.004% (10/282408) and thus is presumed to be rare. In silico analyses support a deleterious effect of the c.200C>T (p.Pro67Leu) variant on protein function. Based on the available evidence, the c.200C>T (p.Pro67Leu) variant is classified as Pathogenic. -

Cystic fibrosis;C0403814:Congenital bilateral aplasia of vas deferens from CFTR mutation Pathogenic:1

Pathogenic, criteria provided, single submitter

clinical testing

Baylor Genetics

-

- -

Hereditary pancreatitis Pathogenic:1

Pathogenic, criteria provided, single submitter

clinical testing

Mendelics

May 04, 2022

- -

Cystic fibrosis;C0238339:Hereditary pancreatitis;C0403814:Congenital bilateral aplasia of vas deferens from CFTR mutation;C2749757:Bronchiectasis with or without elevated sweat chloride 1 Pathogenic:1

Pathogenic, criteria provided, single submitter

clinical testing

Fulgent Genetics, Fulgent Genetics

Dec 14, 2021

- -

Bronchiectasis with or without elevated sweat chloride 1 Pathogenic:1

Pathogenic, criteria provided, single submitter

clinical testing

Baylor Genetics

Oct 30, 2023

- -

ivacaftor response - Efficacy Other:1

drug response, reviewed by expert panel

curation

PharmGKB

Mar 24, 2021

PharmGKB Level of Evidence 1A: Level 1A clinical annotations describe variant-drug combinations that have variant-specific prescribing guidance available in a current clinical guideline annotation or an FDA-approved drug label annotation. Annotations of drug labels or clinical guidelines must give prescribing guidance for specific variants (e.g. CYP2C9*3, HLA-B*57:01) or provide mapping from defined allele functions to diplotypes and phenotypes to be used as supporting evidence for a level 1A clinical annotation. Level 1A clinical annotations must also be supported by at least one publication in addition to a clinical guideline or drug label with variant-specific prescribing guidance. Drug-variant association: Efficacy

Computational scores

Source: dbNSFP v4.3

Name	Calibrated prediction	Score	Prediction
AlphaMissense	Pathogenic	0.65
BayesDel_addAF	Pathogenic	0.35	D
BayesDel_noAF	Pathogenic	0.45
Cadd	Pathogenic	27
Dann	Uncertain	1.0
DEOGEN2	Pathogenic	0.88	D;.;.;T;.
Eigen	Pathogenic	0.98
Eigen_PC	Pathogenic	0.91
FATHMM_MKL	Uncertain	0.95	D
LIST_S2	Uncertain	0.96	D;D;D;D;D
M_CAP	Pathogenic	0.58	D
MetaRNN	Pathogenic	0.97	D;D;D;D;D
MetaSVM	Pathogenic	1.1	D
MutationAssessor	Pathogenic	4.0	H;.;.;.;H
MutationTaster	Benign	1.0	D;D
PrimateAI	Uncertain	0.58	T
PROVEAN	Pathogenic	-7.1	D;.;.;D;.
REVEL	Pathogenic	0.93
Sift	Pathogenic	0.0	D;.;.;D;.
Sift4G	Pathogenic	0.0	D;.;.;D;.
Polyphen		1.0	D;.;.;.;.
Vest4		0.94
MVP		0.99
MPC		0.017
ClinPred		0.99	D
GERP RS		5.7
Varity_R		0.84
gMVP		0.93

Splicing

Name	Calibrated prediction	Score	Prediction
SpliceAI score (max)		0.020		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: rs368505753; hg19: chr7-117149123;