Our verdict is Pathogenic. Variant got 11 ACMG points: 11P and 0B. PVS1PM2PP5
The NM_153704.6(TMEM67):c.2301delT(p.Asp768IlefsTer5) variant causes a frameshift change involving the alteration of a conserved nucleotide. The variant allele was found at a frequency of 0.00000277 in 1,441,776 control chromosomes in the GnomAD database, with no homozygous occurrence. Variant has been reported in ClinVar as Likely pathogenic (no stars). Variant results in nonsense mediated mRNA decay.
TMEM67 (HGNC:28396): (transmembrane protein 67) The protein encoded by this gene localizes to the primary cilium and to the plasma membrane. The gene functions in centriole migration to the apical membrane and formation of the primary cilium. Multiple transcript variants encoding different isoforms have been found for this gene. Defects in this gene are a cause of Meckel syndrome type 3 (MKS3) and Joubert syndrome type 6 (JBTS6). [provided by RefSeq, Nov 2008]
Verdict is Pathogenic. Variant got 11 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 8-93803661-GT-G is Pathogenic according to our data. Variant chr8-93803661-GT-G is described in ClinVar as [Likely_pathogenic]. Clinvar id is 56772.Status of the report is no_assertion_criteria_provided, 0 stars. Variant chr8-93803661-GT-G is described in Lovd as [Pathogenic].
Sydney Genome Diagnostics, Children's Hospital Westmead
Significance: Pathogenic
Review Status: no assertion criteria provided
Collection Method: clinical testing
This fetus is also heterozygous for a second known pathogenic variant, c.2301del, in the TMEM67 gene. This frameshifting variant (dbSNP: rs386834191) is predicted to create a premature stop codon downstream (p.Asp768Ilefs*5), and may result in a null allele due to nonsense-mediated mRNA decay. This variant has been previously reported in a fetus with Meckel syndrome (Iannicelli et al 2010 Hum Mutat 31:E1319-1331). Other truncating variants downstream have also been reported in fetuses with Meckel syndrome (Iannicelli et al 2010 Hum Mutat 31:E1319-1331; Khaddour et al 2007 Hum Mutat 28:523-524). -
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Juha Muilu Group; Institute for Molecular Medicine Finland (FIMM)