rs747134711
Variant summary
Our verdict is Pathogenic. Variant got 18 ACMG points: 18P and 0B. PM1PM2PM5PP3_StrongPP5_Very_Strong
The NM_000527.5(LDLR):c.1855T>C(p.Phe619Leu) variant causes a missense change involving the alteration of a conserved nucleotide. The variant allele was found at a frequency of 0.00000342 in 1,461,856 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 (★★★). Another variant affecting the same amino acid position, but resulting in a different missense (i.e. F619C) has been classified as Likely pathogenic.
Frequency
Consequence
NM_000527.5 missense
Scores
Clinical Significance
Conservation
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ACMG classification
Verdict is Pathogenic. Variant got 18 ACMG points.
Transcripts
RefSeq
Gene | Transcript | HGVSc | HGVSp | Effect | #exon/exons | MANE | UniProt |
---|---|---|---|---|---|---|---|
LDLR | NM_000527.5 | c.1855T>C | p.Phe619Leu | missense_variant | 13/18 | ENST00000558518.6 |
Ensembl
Gene | Transcript | HGVSc | HGVSp | Effect | #exon/exons | TSL | MANE | Appris | UniProt |
---|---|---|---|---|---|---|---|---|---|
LDLR | ENST00000558518.6 | c.1855T>C | p.Phe619Leu | missense_variant | 13/18 | 1 | NM_000527.5 | P3 |
Frequencies
GnomAD3 genomes ? Cov.: 33
GnomAD3 exomes AF: 0.00000398 AC: 1AN: 251492Hom.: 0 AF XY: 0.00 AC XY: 0AN XY: 135922
GnomAD4 exome AF: 0.00000342 AC: 5AN: 1461856Hom.: 0 Cov.: 33 AF XY: 0.00000275 AC XY: 2AN XY: 727236
GnomAD4 genome ? Cov.: 33
ClinVar
Submissions by phenotype
Hypercholesterolemia, familial, 1 Pathogenic:4Uncertain:2
Uncertain significance, criteria provided, single submitter | clinical testing | Robarts Research Institute, Western University | Aug 22, 2019 | - - |
Likely pathogenic, criteria provided, single submitter | literature only | LDLR-LOVD, British Heart Foundation | Mar 25, 2016 | - - |
Uncertain significance, criteria provided, single submitter | clinical testing | Centre de Génétique Moléculaire et Chromosomique, Unité de génétique de l'Obésité et des Dyslipidémies, APHP, GH Hôpitaux Universitaires Pitié-Salpêtrière / Charles-Foix | Dec 16, 2016 | - - |
Likely pathogenic, criteria provided, single submitter | clinical testing | All of Us Research Program, National Institutes of Health | Aug 28, 2023 | This missense variant (also known as p.Phe598Leu in the mature protein) replaces phenylalanine with leucine at codon 619 in the LDLR type B repeat 6 of the LDLR protein. Computational prediction suggests that this variant may have a deleterious impact on protein structure and function (internally defined REVEL score threshold >= 0.7, PMID: 27666373). Functional studies using lymphocytes from a heterozygous individual affected with familial hypercholesterolemia have shown that this variant causes a 60-65% residual level of LDLR activity and expression (PMID: 9409298). This variant has been reported in several heterozygous individuals affected with familial hypercholesterolemia (PMID: 9409298, 17094996, 17539906, 20236128, 29720182, 34998859; Color internal data; ClinVar SCV000484688.2, SCV000503426.1, SCV001960933.1). This variant has also been observed in compound heterozygous state with a known pathogenic LDLR variant in an individual affected with severe homozygous familial hypercholesterolemia, a phenotype expected of having two deleterious LDLR variants (PMID: 34998859). This variant has been identified in 1/251492 chromosomes in the general population by the Genome Aggregation Database (gnomAD). Different variants affecting the same codon, p.Phe619Ser and p.Phe619Cys, are considered to be disease-causing (ClinVar variation ID: 252084 and 252085), suggesting that phenylalanine at this position is important for LDLR protein function. Based on the available evidence, this variant is classified as Likely Pathogenic. - |
Pathogenic, no assertion criteria provided | research | Laboratorium voor Moleculaire Diagnostiek Experimentele Vasculaire Geneeskunde, Academisch Medisch Centrum | - | - - |
Likely pathogenic, reviewed by expert panel | curation | ClinGen Familial Hypercholesterolemia Variant Curation Expert Panel | Jun 18, 2021 | NM_000527.5(LDLR):c.1855T>C (p.Phe619Leu) variant is classified as Likely pathogenic for Familial Hypercholesterolemia by applying evidence codes (PM2, PP3, PP4, PS3_Supporting, PS4_Supporting) as defined by the ClinGen Familial Hypercholesterolemia Expert Panel LDLR-specific variant curation guidelines (https://doi.org/10.1101/2021.03.17.21252755). The supporting evidence is as follows: PM2 - PopMax MAF = 0.00003266 (0.003266%) in East Asian (gnomAD v2.1.1). PP3 - REVEL: 0,857. PP4 - Variant meets PM2. Variant identified in 2 index cases fulfilling validated clinical criteria for FH from different labs. PS3_supporting - PMID: 9409298 - Level 3 assay - study on htz patient's cultured lymphoblasts, immunoblotting + I125-LDL assay, no precursor detectable, degradation of 125I-LDL 63%. ---- functional study is consistent with damaging effect. PS4_supporting - Variant meets PM2. Variant identified in 2 index cases (1 case with Simon-Broome from Color laboratory; 1 case with DLCN criteria from Cardiovascular Genetics Laboratory (PathWest Laboratory Medicine WA)). - |
Familial hypercholesterolemia Pathogenic:3
Pathogenic, criteria provided, single submitter | clinical testing | Invitae | Nov 15, 2022 | For these reasons, this variant has been classified as Pathogenic. This variant disrupts the p.Phe619 amino acid residue in LDLR. Other variant(s) that disrupt this residue have been determined to be pathogenic (PMID: 20809525). This suggests that this residue is clinically significant, and that variants that disrupt this residue are likely to be disease-causing. 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 LDLR protein function. ClinVar contains an entry for this variant (Variation ID: 252083). This variant is also known as Phe598Leu. This missense change has been observed in individuals with familial hypercholesterolemia (PMID: 9544745, 17539906; Invitae). This variant is present in population databases (rs747134711, gnomAD 0.003%). This sequence change replaces phenylalanine, which is neutral and non-polar, with leucine, which is neutral and non-polar, at codon 619 of the LDLR protein (p.Phe619Leu). - |
Likely pathogenic, criteria provided, single submitter | clinical testing | Women's Health and Genetics/Laboratory Corporation of America, LabCorp | Jan 13, 2022 | Variant summary: LDLR c.1855T>C (p.Phe619Leu) results in a non-conservative amino acid change in the encoded protein sequence. Five of five in-silico tools predict a damaging effect of the variant on protein function. The variant allele was found at a frequency of 4e-06 in 251492 control chromosomes. c.1855T>C has been reported in the literature in individuals affected with Familial Hypercholesterolemia (Sun_1997, Tosi_2007, Taylor_2007, Paththinige_2018). Additionally, experimental studies performed on a heterozygous patient's cultured lymphoblasts showed LDL-receptor expression and activity was reduced to around 60% of wild-type, consistent with damaging effect of the variant (Sun_1997). The variant was classified as likely pathogenic by ClinGen Familial Hypercholesterolemia Expert Panel for Familial Hypercholesterolemia by applying evidence codes (PM2, PP3, PP4, PS3_Supporting, PS4_Supporting) as defined by the ClinGen Familial Hypercholesterolemia Expert Panel LDLR-specific variant curation guidelines. Four other clinical diagnostic laboratories have submitted clinical-significance assessments for this variant to ClinVar after 2014 without evidence for independent evaluation and classified the variant as VUS (3) and likley pathogenic (1). Based on the evidence outlined above, the variant was classified as likely pathogenic. - |
Likely pathogenic, criteria provided, single submitter | clinical testing | Color Diagnostics, LLC DBA Color Health | May 12, 2023 | This missense variant (also known as p.Phe598Leu in the mature protein) replaces phenylalanine with leucine at codon 619 in the LDLR type B repeat 6 of the LDLR protein. Computational prediction suggests that this variant may have a deleterious impact on protein structure and function (internally defined REVEL score threshold >= 0.7, PMID: 27666373). Functional studies using lymphocytes from a heterozygous individual affected with familial hypercholesterolemia have shown that this variant causes a 60-65% residual level of LDLR activity and expression (PMID: 9409298). This variant has been reported in several heterozygous individuals affected with familial hypercholesterolemia (PMID: 9409298, 17094996, 17539906, 20236128, 29720182, 34998859; Color internal data; ClinVar SCV000484688.2, SCV000503426.1, SCV001960933.1). This variant has also been observed in compound heterozygous state with a known pathogenic LDLR variant in an individual affected with severe homozygous familial hypercholesterolemia, a phenotype expected of having two deleterious LDLR variants (PMID: 34998859). This variant has been identified in 1/251492 chromosomes in the general population by the Genome Aggregation Database (gnomAD). Different variants affecting the same codon, p.Phe619Ser and p.Phe619Cys, are considered to be disease-causing (ClinVar variation ID: 252084 and 252085), suggesting that phenylalanine at this position is important for LDLR protein function. Based on the available evidence, this variant is classified as Likely Pathogenic. - |
not provided Pathogenic:1
Likely pathogenic, criteria provided, single submitter | clinical testing | GeneDx | Dec 27, 2022 | Not observed at significant frequency in large population cohorts (gnomAD); Published functional studies using a heterozygous patient's cultured lymphoblasts reveal reduced LDL receptor activity (Sun et al., 1997); In silico analysis supports that this missense variant has a deleterious effect on protein structure/function; Reported in ClinVar as likely pathogenic by the ClinGen Familial Hypercholesterolemia Variant Curation Expert Panel; Also known as p.F598L; This variant is associated with the following publications: (PMID: 17094996, 29720182, 9409298, 17539906, 20236128, 9544745) - |
Cardiovascular phenotype Pathogenic:1
Likely pathogenic, criteria provided, single submitter | clinical testing | Ambry Genetics | Jan 15, 2024 | The p.F619L variant (also known as c.1855T>C), located in coding exon 13 of the LDLR gene, results from a T to C substitution at nucleotide position 1855. The phenylalanine at codon 619 is replaced by leucine, an amino acid with highly similar properties. This variant (also referred to as p.F598L) has been detected in probands reported to have familial hypercholesterolemia (FH), and co-occurred with a second LDLR variant in an individual with features consistent with homozygous FH (Sun XM et al. Arterioscler Thromb Vasc Biol, 1997 Nov;17:3092-101;Sun XM et al. Atherosclerosis, 1998 Jan;136:175-85; Tosi I et al. Atherosclerosis, 2007 Sep;194:102-11;Taylor A et al. Clin Genet, 2007 Jun;71:561-8;Paththinige CS et al. Lipids Health Dis, 2018 May;17:100; Pillai KKB et al. Clin Chim Acta, 2022 Feb;527:47-55). Studies performed on cultured patient cells with this variant showed reduced LDL-R expression and activity (Sun XM et al. Arterioscler Thromb Vasc Biol, 1997 Nov;17:3092-101). This amino acid position is well conserved in available vertebrate species. In addition, this alteration is predicted to be deleterious by in silico analysis. Based on the majority of available evidence to date, this variant is likely to be pathogenic. - |
Computational scores
Source:
Splicing
Find out detailed SpliceAI scores and Pangolin per-transcript scores at