rs765298019
Variant summary
Our verdict is Pathogenic. Variant got 10 ACMG points: 10P and 0B. PP1PP4PS3_ModeratePM2_SupportingPM3_StrongPM1_Supporting
This summary comes from the ClinGen Evidence Repository: The c.685C>T (NM_000536.4) variant in RAG2 is a missense variant predicted to cause the substitution of Arginine by Tryptophan at amino acid 229 (p.Arg229Trp).The filtering allele frequency (the upper threshold of the 95% CI of (11/1180024 alleles) is 0.000005000 in gnomad v4 for the European (non-Finnish) population, which is lower than the ClinGen SCID VCEP threshold (<0.0000588) for PM2_Supporting, meeting this criterion (PM2_Supporting). No homozygous has been described.This variant is located in the core domain, amino acids 1-383 of RAG2, which is defined as a critical functional domain by the ClinGen SCID VCEP (PMID:26996199); PM1_Supporting.The recombination activity assay showed activity of this variant compared to wildtype RAG2 is 10.5% (SEM 0.5), which is lower than the SCID VCEP threshold (<25%) for PS3_Moderate, meeting this criterion (PS3_Moderate, PMID 29772310).The variant has been reported to segregate in two affected family members (Proband + 1) (PP1); (Proband 30a and 30b, PMID:11133745).At least 9 probands were reported in the literature carrying this variant. 8 of them were homozygous, reaching the maximum of 1 point for homozygous occurrence. Also, 1 proband is compound heterozygous for paternal Arg229Trp and maternal Gly95Arg, which is likely pathogenic according to SCID VCEP specifications, as phase is confirmed; 1 point—a total of 2 points, PM3_Strong.Proband 24 presents: *Diagnostic criteria for SCID/Leaky SCID/Omenn syndrome met 0.5pts + *T-B-NK+ lymphocyte subset profile 0.5pts; total 1pt, PP4 is met (PMID:11133745).In summary, this variant meets the criteria to be classified as Pathogenic for autosomal recessive recombinase activating gene 2 deficiency based on the ACMG/AMP criteria applied, as specified by the ClinGen SCID VCEP. Criteria applied: PM2_Supporting, PM1_Supporting, PS3_Moderate, PP1, PM3_Strong, and PP4 (VCEP specifications version 1.0). LINK:https://erepo.genome.network/evrepo/ui/classification/CA5950542/MONDO:0000573/124
Frequency
Consequence
NM_000536.4 missense
Scores
Clinical Significance
Conservation
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ACMG classification
Verdict is Pathogenic. Variant got 10 ACMG points.
Transcripts
RefSeq
Gene | Transcript | HGVSc | HGVSp | Effect | #exon/exons | MANE | UniProt |
---|---|---|---|---|---|---|---|
RAG2 | NM_000536.4 | c.685C>T | p.Arg229Trp | missense_variant | 2/2 | ENST00000311485.8 |
Ensembl
Gene | Transcript | HGVSc | HGVSp | Effect | #exon/exons | TSL | MANE | Appris | UniProt |
---|---|---|---|---|---|---|---|---|---|
RAG2 | ENST00000311485.8 | c.685C>T | p.Arg229Trp | missense_variant | 2/2 | 1 | NM_000536.4 | P1 |
Frequencies
GnomAD3 genomes ? AF: 0.00000657 AC: 1AN: 152128Hom.: 0 Cov.: 32
GnomAD3 exomes AF: 0.00000398 AC: 1AN: 251144Hom.: 0 AF XY: 0.00000737 AC XY: 1AN XY: 135754
GnomAD4 exome AF: 0.00000889 AC: 13AN: 1461720Hom.: 0 Cov.: 31 AF XY: 0.00000825 AC XY: 6AN XY: 727180
GnomAD4 genome ? AF: 0.00000657 AC: 1AN: 152128Hom.: 0 Cov.: 32 AF XY: 0.00 AC XY: 0AN XY: 74298
ClinVar
Submissions by phenotype
Combined immunodeficiency with skin granulomas Pathogenic:1
Pathogenic, criteria provided, single submitter | clinical testing | Baylor Genetics | Apr 18, 2023 | - - |
Recombinase activating gene 2 deficiency Pathogenic:1
Pathogenic, reviewed by expert panel | curation | ClinGen Severe Combined Immunodeficiency Variant Curation Expert Panel, ClinGen | Apr 01, 2024 | The c.685C>T (NM_000536.4) variant in RAG2 is a missense variant predicted to cause the substitution of Arginine by Tryptophan at amino acid 229 (p.Arg229Trp). The filtering allele frequency (the upper threshold of the 95% CI of (11/1180024 alleles) is 0.000005000 in gnomad v4 for the European (non-Finnish) population, which is lower than the ClinGen SCID VCEP threshold (<0.0000588) for PM2_Supporting, meeting this criterion (PM2_Supporting). No homozygous has been described. This variant is located in the core domain, amino acids 1-383 of RAG2, which is defined as a critical functional domain by the ClinGen SCID VCEP (PMID: 26996199); PM1_Supporting. The recombination activity assay showed activity of this variant compared to wildtype RAG2 is 10.5% (SEM 0.5), which is lower than the SCID VCEP threshold (<25%) for PS3_Moderate, meeting this criterion (PS3_Moderate, PMID 29772310). The variant has been reported to segregate in two affected family members (Proband + 1) (PP1); (Proband 30a and 30b, PMID: 11133745). At least 9 probands were reported in the literature carrying this variant. 8 of them were homozygous, reaching the maximum of 1 point for homozygous occurrence. Also, 1 proband is compound heterozygous for paternal Arg229Trp and maternal Gly95Arg, which is likely pathogenic according to SCID VCEP specifications, as phase is confirmed; 1 point—a total of 2 points, PM3_Strong. Proband 24 presents: *Diagnostic criteria for SCID/Leaky SCID/Omenn syndrome met 0.5pts + *T-B-NK+ lymphocyte subset profile 0.5pts; total 1pt, PP4 is met (PMID: 11133745). In summary, this variant meets the criteria to be classified as Pathogenic for autosomal recessive recombinase activating gene 2 deficiency based on the ACMG/AMP criteria applied, as specified by the ClinGen SCID VCEP. Criteria applied: PM2_Supporting, PM1_Supporting, PS3_Moderate, PP1, PM3_Strong, and PP4 (VCEP specifications version 1.0). - |
Histiocytic medullary reticulosis Pathogenic:1
Pathogenic, no assertion criteria provided | clinical testing | Natera, Inc. | Sep 16, 2020 | - - |
Severe combined immunodeficiency, autosomal recessive, T cell-negative, B cell-negative, NK cell-positive;C2673536:Combined immunodeficiency with skin granulomas Pathogenic:1
Pathogenic, criteria provided, single submitter | clinical testing | Invitae | Oct 12, 2023 | This sequence change replaces arginine, which is basic and polar, with tryptophan, which is neutral and slightly polar, at codon 229 of the RAG2 protein (p.Arg229Trp). This variant is present in population databases (rs765298019, gnomAD 0.002%). This missense change has been observed in individuals with RAG2-related disease (PMID: 11133745, 15025726, 16960852, 28747913). ClinVar contains an entry for this variant (Variation ID: 496624). 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 RAG2 protein function. This variant disrupts the p.Arg229 amino acid residue in RAG2. Other variant(s) that disrupt this residue have been determined to be pathogenic (PMID: 11133745, 24144642, 26915675). This suggests that this residue is clinically significant, and that variants that disrupt this residue are likely to be disease-causing. For these reasons, this variant has been classified as Pathogenic. - |
Inborn error of immunity;C1832322:Severe combined immunodeficiency, autosomal recessive, T cell-negative, B cell-negative, NK cell-positive;C2700553:Histiocytic medullary reticulosis;CN257931:Recombinase activating gene 2 deficiency Uncertain:1
Uncertain significance, criteria provided, single submitter | research | Pediatric Immunology Service, The Chaim Sheba Medical Center at Tel HaShomer | Mar 06, 2018 | - - |
Computational scores
Source:
Splicing
Find out detailed SpliceAI scores and Pangolin per-transcript scores at