rs777640882

Variant names:

• chr19-11102740-C-G
• rs777640882
• NM_000527.5:c.267C>G

Your query was ambiguous. Multiple possible variants found:

• chr19-11102740-C-G
• chr19-11102740-C-T

Variant summary

Our verdict is Pathogenic. The variant received 19 ACMG points: 19P and 0B. PM1 PM2 PM5 PP2 PP3_Strong PP5_Very_Strong

The NM_000527.5(LDLR):​c.267C>G​(p.Cys89Trp) variant causes a missense change involving the alteration of a non-conserved nucleotide. The variant was absent in control chromosomes in GnomAD project. 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. C89R) has been classified as Likely pathogenic.

• Frequency: Genomes: not found (cov: 31)
• Consequence: LDLR NM_000527.5 missense
• Clinical Significance: Pathogenic/Likely pathogenic criteria provided, multiple submitters, no conflicts P:4
• Conservation: PhyloP100: -0.826
• Publications: 4 publications found

Genes affected

LDLR (HGNC:6547): (low density lipoprotein receptor) The low density lipoprotein receptor (LDLR) gene family consists of cell surface proteins involved in receptor-mediated endocytosis of specific ligands. The encoded protein is normally bound at the cell membrane, where it binds low density lipoprotein/cholesterol and is taken into the cell. Lysosomes release the cholesterol, which is made available for repression of microsomal enzyme 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, the rate-limiting step in cholesterol synthesis. At the same time, a reciprocal stimulation of cholesterol ester synthesis takes place. Mutations in this gene cause the autosomal dominant disorder, familial hypercholesterolemia. Alternate splicing results in multiple transcript variants.[provided by RefSeq, May 2022]

LDLR Gene-Disease associations (from GenCC):

• hypercholesterolemia, familial, 1

  Inheritance: AD, SD Classification: DEFINITIVE, STRONG Submitted by: Genomics England PanelApp, Labcorp Genetics (formerly Invitae), Laboratory for Molecular Medicine, ClinGen
• homozygous familial hypercholesterolemia

  Inheritance: AR Classification: SUPPORTIVE Submitted by: Orphanet

ACMG classification

Our verdict: Pathogenic. The variant received 19 ACMG points.

• PM1: In a hotspot region, there are 27 aminoacids with missense pathogenic changes in the window of +-8 aminoacids around while only 0 benign, 15 uncertain in NM_000527.5
• PM2: Very rare variant in population databases, with high coverage
• PM5: Other missense variant is known to change same aminoacid residue: Variant chr19-11102738-T-C is described in ClinVar as Likely_pathogenic. ClinVar VariationId is 251102.Status of the report is reviewed_by_expert_panel, 3 stars.
• PP2: Missense variant in the gene, where a lot of missense mutations are associated with disease in ClinVar. The gene has 678 curated pathogenic missense variants (we use a threshold of 10). The gene has 92 curated benign missense variants. Gene score misZ: 0.12407 (below the threshold of 3.09). Trascript score misZ: 0.59338 (below the threshold of 3.09). GenCC associations: The gene is linked to hypercholesterolemia, familial, 1, homozygous familial hypercholesterolemia.
• PP3: MetaRNN computational evidence supports a deleterious effect, 0.994
• PP5: Variant 19-11102740-C-G is Pathogenic according to our data. Variant chr19-11102740-C-G is described in ClinVar as Pathogenic/Likely_pathogenic. ClinVar VariationId is 251104.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars.

Transcripts

RefSeq

Gene	Transcript	HGVSc	HGVSp	Effect	Exon rank	MANE	Protein	UniProt
LDLR	NM_000527.5	c.267C>G	p.Cys89Trp	missense_variant	Exon 3 of 18	ENST00000558518.6	NP_000518.1

Ensembl

Gene	Transcript	HGVSc	HGVSp	Effect	Exon rank	TSL	MANE	Protein	Appris	UniProt
LDLR	ENST00000558518.6	c.267C>G	p.Cys89Trp	missense_variant	Exon 3 of 18	1	NM_000527.5	ENSP00000454071.1

Frequencies

GnomAD3 genomes Cov.: 31

GnomAD4 exome Cov.: 31

GnomAD4 genome Cov.: 31

ClinVar

Significance: Pathogenic/Likely pathogenic

Submissions summary: Pathogenic:4

Revision: criteria provided, multiple submitters, no conflicts

Submissions by phenotype

Hypercholesterolemia, familial, 1 Pathogenic:2

Mar 25, 2016

LDLR-LOVD, British Heart Foundation

Significance: Likely pathogenic

Review Status: criteria provided, single submitter

Collection Method: literature only

- -

Mar 01, 2016

Fundacion Hipercolesterolemia Familiar

Significance: Likely pathogenic

Review Status: criteria provided, single submitter

Collection Method: research

- -

Cardiovascular phenotype Pathogenic:1

Dec 11, 2017

Ambry Genetics

Significance: Pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

The p.C89W pathogenic mutation (also known as c.267C>G), located in coding exon 3 of the LDLR gene, results from a C to G substitution at nucleotide position 267. The cysteine at codon 89 is replaced by tryptophan, an amino acid with highly dissimilar properties. This alteration has been detected in several individuals with familial hypercholesterolemia (FH) and has been shown to segregrate with disease in two families (Heath KE et al. Atherosclerosis. 1999;143:41-54; Chaves FJ et al. J. Clin. Endocrinol. Metab. 2001;86:4926-32; Jelassi A et al. Atherosclerosis. 2009;203:449-53; Garcia-Garcia AB et al. Atherosclerosis. 2011;218:423-30). In addition, functional studies indicated that this variant causes a reduction in LDLR activity (Garcia-Garcia AB et al. Atherosclerosis. 2011;218:423-30). Three other alterations at the same codon (p.C89R, p.C89G, and p.C89Y) have also been associated with FH (Day IN et al. Hum Mutat. 1997;10(2):116-27; Bertolini S et al. Arterioscler Thromb Vasc Biol. 1999;19(2):408-18; Marduel M et al. Hum Mut. 2010;31(11):E1811-24). Based on the supporting evidence, this alteration is interpreted as a disease-causing mutation. -

Familial hypercholesterolemia Pathogenic:1

Mar 22, 2024

GENinCode PLC

Significance: Pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

The LDLR c.267C>G p.(Cys89Trp) variant has been seen in FH patients meeting clinical criteria, including after alternative causes of high cholesterol were excluded (PS4_SUPPORTING, PP4_SUPPORTING; PMIDs 10208479, 11668640, 18757057). Variant segregates with FH phenotype in >= 6 informative meioses from 2 families (PP1_STRONG; PMIDs 18757057, 21868016), although the variant is present in two family members with reportedly normal cholesterol levels (PMID 21868016). This variant has been seen in the homozygous state in two siblings with homozygous FH phenotypes, where phase has been confirmed by parental testing (PM3_MODERATE; PMIDs 18757057, 22417841). This variant is absent from gnomAD v2.1.1 (PM2_MODERATE). This is a missense change of a highly conserved cysteine residue and meets PM2 (PM1_MODERATE). Functional analysis of transfected COS-7 cells, showed <70% LDLR activity compared to wild type (PS3_STRONG; PMID 21868016) and the REVEL score is 0.792 (PP3_SUPPORTING). Based on the evidence listed above, we have classified this variant as Pathogenic. -

Computational scores

Source: dbNSFP v4.3

Name	Calibrated prediction	Score	Prediction
AlphaMissense	Pathogenic	0.98
BayesDel_addAF	Pathogenic	0.49	D
BayesDel_noAF	Pathogenic	0.47
CADD	Benign	15
DANN	Benign	0.94
DEOGEN2	Pathogenic	0.98	D;.;.;.;.
Eigen	Benign	-0.57
Eigen_PC	Benign	-0.89
FATHMM_MKL	Benign	0.55	D
LIST_S2	Pathogenic	0.99	D;D;D;D;D
M_CAP	Pathogenic	0.98	D
MetaRNN	Pathogenic	0.99	D;D;D;D;D
MetaSVM	Pathogenic	1.0	D
MutationAssessor	Pathogenic	4.4	H;.;H;H;H
PhyloP100		-0.83
PrimateAI	Uncertain	0.59	T
PROVEAN	Pathogenic	-10	D;D;D;D;D
REVEL	Pathogenic	0.79
Sift	Pathogenic	0.0	D;D;D;D;D
Sift4G	Pathogenic	0.0	D;D;D;D;D
Polyphen		1.0	D;.;.;.;.
Vest4		0.78
MutPred		0.99		Gain of MoRF binding (P = 0.0433);Gain of MoRF binding (P = 0.0433);Gain of MoRF binding (P = 0.0433);Gain of MoRF binding (P = 0.0433);Gain of MoRF binding (P = 0.0433);
MVP		0.94
MPC		0.95
ClinPred		1.0	D
GERP RS		-3.3
Varity_R		1.0
gMVP		1.0
Mutation Taster		=0/100	disease causing (ClinVar)

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

Other links and lift over

dbSNP: rs777640882; hg19: chr19-11213416;