rs78300695

Variant names:

• chr3-48466711-T-TG
• rs78300695
• NM_033629.6:c.58dupG

Variant summary

Our verdict is Pathogenic. The variant received 16 ACMG points: 16P and 0B. PVS1 PP5_Very_Strong

The NM_033629.6(TREX1):​c.58dupG​(p.Glu20GlyfsTer82) variant causes a frameshift change involving the alteration of a non-conserved nucleotide. The variant allele was found at a frequency of 0.0000514 in 1,614,058 control chromosomes in the GnomAD database, with no homozygous occurrence. Variant has been reported in ClinVar as Likely pathogenic (★★). Synonymous variant affecting the same amino acid position (i.e. E20E) has been classified as Likely benign.

• Frequency:
  • Genomes: 𝑓 0.000026 (0 hom., cov: 33)
  • Exomes 𝑓: 0.000054 (0 hom.)
• Consequence: TREX1 NM_033629.6 frameshift
• Clinical Significance: Pathogenic/Likely pathogenic criteria provided, multiple submitters, no conflicts P:11
• Conservation: PhyloP100: 1.62
• Publications: 5 publications found

Genes affected

TREX1 (HGNC:12269): (three prime repair exonuclease 1) This gene encodes a nuclear protein with 3' exonuclease activity. The encoded protein may play a role in DNA repair and serve as a proofreading function for DNA polymerase. Mutations in this gene result in Aicardi-Goutieres syndrome, chilblain lupus, Cree encephalitis, and other diseases of the immune system. Alternative splicing results in multiple transcript variants. [provided by RefSeq, Sep 2012]

ATRIP (HGNC:33499): (ATR interacting protein) This gene encodes an essential component of the DNA damage checkpoint. The encoded protein binds to single-stranded DNA coated with replication protein A. The protein also interacts with the ataxia telangiectasia and Rad3 related protein kinase, resulting in its accumulation at intranuclear foci induced by DNA damage. Multiple transcript variants encoding different isoforms have been found for this gene. [provided by RefSeq, Aug 2012]

ATRIP Gene-Disease associations (from GenCC):

• breast cancer

  Inheritance: AD Classification: MODERATE Submitted by: G2P
• Seckel syndrome

  Inheritance: AR Classification: SUPPORTIVE Submitted by: Orphanet

ATRIP-TREX1 (HGNC:):

ACMG classification

Our verdict: Pathogenic. The variant received 16 ACMG points.

• PVS1: Loss of function variant, product does not undergo nonsense mediated mRNA decay. Variant is located in the 3'-most exon, not predicted to undergo nonsense mediated mRNA decay. There are 80 pathogenic variants in the truncated region.
• PP5: Variant 3-48466711-T-TG is Pathogenic according to our data. Variant chr3-48466711-T-TG is described in ClinVar as Pathogenic/Likely_pathogenic. ClinVar VariationId is 126390.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
TREX1	NM_033629.6	c.58dupG	p.Glu20GlyfsTer82	frameshift_variant	Exon 2 of 2	ENST00000625293.3	NP_338599.1
ATRIP	NM_130384.3	c.*1159dupG		3_prime_UTR_variant	Exon 13 of 13	ENST00000320211.10	NP_569055.1

Ensembl

Gene	Transcript	HGVSc	HGVSp	Effect	Exon rank	TSL	MANE	Protein	Appris	UniProt
TREX1	ENST00000625293.3	c.58dupG	p.Glu20GlyfsTer82	frameshift_variant	Exon 2 of 2	6	NM_033629.6	ENSP00000486676.2
ATRIP	ENST00000320211.10	c.*1159dupG		3_prime_UTR_variant	Exon 13 of 13	1	NM_130384.3	ENSP00000323099.3

Frequencies

GnomAD3 genomes AF: 0.0000263 AC: 4 AN: 152118 Hom.: 0 Cov.: 33

Gnomad AFR AF: 0.00

Gnomad AMI AF: 0.00

Gnomad AMR AF: 0.00

Gnomad ASJ AF: 0.00

Gnomad EAS AF: 0.00

Gnomad SAS AF: 0.000828

Gnomad FIN AF: 0.00

Gnomad MID AF: 0.00

Gnomad NFE AF: 0.00

Gnomad OTH AF: 0.00

GnomAD2 exomes AF: 0.000127 AC: 32 AN: 251392 AF XY: 0.000169

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 FIN exome AF: 0.00

Gnomad NFE exome AF: 0.00

Gnomad OTH exome AF: 0.00

GnomAD4 exome AF: 0.0000540 AC: 79 AN: 1461822 Hom.: 0 Cov.: 31 AF XY: 0.0000756 AC XY: 55 AN XY: 727220

African (AFR) AF: 0.00 AC: 0 AN: 33480

American (AMR) AF: 0.00 AC: 0 AN: 44722

Ashkenazi Jewish (ASJ) AF: 0.00 AC: 0 AN: 26136

East Asian (EAS) AF: 0.00 AC: 0 AN: 39700

South Asian (SAS) AF: 0.000893 AC: 77 AN: 86258

European-Finnish (FIN) AF: 0.00 AC: 0 AN: 53356

Middle Eastern (MID) AF: 0.00 AC: 0 AN: 5768

European-Non Finnish (NFE) AF: 0.00 AC: 0 AN: 1112006

Other (OTH) AF: 0.0000331 AC: 2 AN: 60396

GnomAD4 genome AF: 0.0000263 AC: 4 AN: 152236 Hom.: 0 Cov.: 33 AF XY: 0.0000403 AC XY: 3 AN XY: 74434

African (AFR) AF: 0.00 AC: 0 AN: 41558

American (AMR) AF: 0.00 AC: 0 AN: 15298

Ashkenazi Jewish (ASJ) AF: 0.00 AC: 0 AN: 3464

East Asian (EAS) AF: 0.00 AC: 0 AN: 5160

South Asian (SAS) AF: 0.000829 AC: 4 AN: 4828

European-Finnish (FIN) AF: 0.00 AC: 0 AN: 10612

Middle Eastern (MID) AF: 0.00 AC: 0 AN: 294

European-Non Finnish (NFE) AF: 0.00 AC: 0 AN: 67996

Other (OTH) AF: 0.00 AC: 0 AN: 2114

Alfa AF: 0.00 Hom.: 0

Bravo AF: 0.00000756

ClinVar

Significance: Pathogenic/Likely pathogenic

Submissions summary: Pathogenic:11

Revision: criteria provided, multiple submitters, no conflicts

Submissions by phenotype

Aicardi-Goutieres syndrome 1 Pathogenic:6

Mar 13, 2014

GeneReviews

Significance: Pathogenic

Review Status: no assertion criteria provided

Collection Method: literature only

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Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences

Significance: Pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

- -

May 02, 2023

Broad Center for Mendelian Genomics, Broad Institute of MIT and Harvard

Significance: Pathogenic

Review Status: criteria provided, single submitter

Collection Method: curation

The homozygous p.Glu20GlyfsTer82 variant in TREX1 was identified by our study in one individual with Aicardi Goutieres syndrome. The p.Glu20GlyfsTer82 variant in TREX1 has been previously reported in 12 unrelated individuals with Aicardi Goutieres syndrome 1 (PMID: 26938784, PMID: 33235754, PMID: 25604658, PMID: 16845398) but has been identified in 0.1% (32/30616) of South Asian chromosomes by the Genome Aggregation Database (gnomAD, http://gnomad.broadinstitute.org; dbSNP ID: rs770193197). Although this variant has been seen in the general population in a heterozygous state, its frequency is not high enough to rule out a pathogenic role. Of these 12 previously reported unrelated individuals (PMID: 26938784, PMID: 33235754, PMID: 25604658, PMID: 16845398), 7 were homozygotes (PMID: 16845398, PMID: 25604658), 1 was a compound heterozygote who carried a likely pathogenic variant in trans (PMID: 26938784, ClinVar ID: 369666), and 2 were compound heterozygotes who carried pathogenic or likely pathogenic variants in unknown phase (PMID: 33235754, ClinVar Variation ID: 126384, 126392), which increases the likelihood that the p.Glu20GlyfsTer82 variant is pathogenic. This variant has also been reported in ClinVar (Variation ID: 126390) and has been interpreted as pathogenic by Invitae, Rady Children's Institute for Genomic Medicine, Murdoch Childrens Research Institute Victorian Clinical Genetics Services, GeneReviews, and Sanjay Gandhi Post Graduate Institute of Medical Sciences Department of Medical Genetics. This variant is predicted to cause a frameshift, which alters the protein’s amino acid sequence beginning at position 20 and leads to a premature termination codon 82 amino acids downstream. This termination codon occurs within the last exon and is more likely to escape nonsense mediated decay (NMD) and result in a truncated protein. Loss of function of the TREX1 gene is an established disease mechanism in autosomal recessive Aicardi Goutieres syndrome 1. In summary, this variant meets criteria to be classified as pathogenic for autosomal recessive Aicardi Goutieres syndrome 1. ACMG/AMP Criteria applied: PVS1_Strong, PM3_Strong (Richards 2015). -

Jun 11, 2020

Victorian Clinical Genetics Services, Murdoch Childrens Research Institute

Significance: Pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

Based on the classification scheme VCGS_Germline_v1.1.1, this variant is classified as Pathogenic. Following criteria are met: 0102 - Loss-of-function is a known mechanism of disease for this gene. (N) 0104 - Dominant Negative is a mechanism of disease for this gene, where heterodimers with wildtype protein result in impaired function (OMIM). (N) 0108 - This gene is known to be associated with both recessive and dominant disease. Aicardi-Goutieres syndrome is predominantly a recessive condition, however there have been rare cases of a dominant form of the disease reported (OMIM). (N) 0204 - Variant is predicted to result in a truncated protein with more than 1/3 of the protein affected (exon 2 of 2). (P) 0252 - Variant is homozygous (testing performed by Perkin Elmer). (N) 0304 - Variant is present in gnomAD <0.01 for a recessive condition (32 heterozygotes, 0 homozygotes). (P) 0701 - Comparable variants have very strong previous evidence for pathogenicity. Many pathogenic truncating variants have been reported downstream (ClinVar). (P) 0801 – Very strong previous evidence of pathogenicity in unrelated individuals. This variant has been previously reported in patients with Aicardi-Goutieres syndrome (ClinVar, PMID: 25604658). (P) 1205 - Variant is biallelic. (N) Legend: (P) - Pathogenic, (N) - Neutral, (B) - Benign -

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Lifecell International Pvt. Ltd

Significance: Pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

A Homozygote Frameshift variant c.26_27insG in Exon 2 of the TREX1 gene that results in the amino acid substitution p.Glu10fs*82 was identified. The observed variant has a minor allele frequency of 0.00013% in gnomAD exomes and novel in gnomAD genomes, respectively. The severity of the impact of this variant on the protein is high, based on the effect of the protein and REVEL score. Rare Exome Variant Ensemble Learner (REVEL) is an ensembl method for predicting the pathogenicity of missense variants based on a combination of scores from 13 individual tools: MutPred, FATHMM v2.3, VEST 3.0, PolyPhen-2, SIFT, PROVEAN, MutationAssessor, MutationTaster, LRT, GERP++, SiPhy, phyloP, and phastCons. The REVEL score for an individual missense variant can range from 0 to 1, with higher scores reflecting greater likelihood that the variant is disease-causing. ClinVar has also classified this variant as Pathogenic [Variation ID: 126390]. The observed variant has been previously reported as a compound heterozygous and a homozygous mutation in patients with Aicardi-Goutieres syndrome (Dillon OJ, et.al., 2018). For these reasons, this variant has been classified as Pathogenic. -

Jul 22, 2023

Neuberg Centre For Genomic Medicine, NCGM

Significance: Pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

The frameshift variant c.58dup p.Glu20GlyfsTer82 in the TREX1 gene has been reported previously individuals affected with Aicardi-Goutières syndrome Crow et al., 2006; Crow et al., 2015. This variant causes a frameshift starting with codon Glutamic Acid 20, changes this amino acid to Glycine residue, and creates a premature Stop codon at position 82 of the new reading frame. This variant is reported with the allele frequency 0.01% in the gnomAD Exomes. It is submitted to ClinVar as Pathogenic. This variant is predicted to cause loss of normal protein function through protein truncation. Loss of function variants have been previously reported to be disease causing. For these reasons, this variant has been classified as Pathogenic. -

TREX1-related disorder Pathogenic:2

Aug 27, 2024

PreventionGenetics, part of Exact Sciences

Significance: Pathogenic

Review Status: no assertion criteria provided

Collection Method: clinical testing

The TREX1 c.58dupG variant is predicted to result in a frameshift and premature protein termination (p.Glu20Glyfs*82). This variant (aka c.223dup, p.Glu75Glyfs*82) has been reported in the homozygous or compound heterozygous states in multiple individuals with Aicardi-Goutières syndrome (Crow et al. 2006. PubMed ID: 16845398; Crow et al. 2015. PubMed ID: 25604658. Table S1; Lim et al. 2015. PubMed ID: 26182405. Supplementary file 1; Dillon et al. 2018. PubMed ID: 29453417. Table S1). This variant is reported in 0.10% of alleles in individuals of South Asian descent in gnomAD. Frameshift variants in TREX1 are expected to be pathogenic. This variant is interpreted as pathogenic. -

Oct 28, 2020

Rady Children's Institute for Genomic Medicine, Rady Children's Hospital San Diego

Significance: Pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

This frameshift variant is found in the only exon of TREX1, and frameshift variants located downstream of this variant have been reported as disease-causing variants in the Human Gene Mutation Database (PMID: 24183309, 20301648). This variant has been previously reported as a compound heterozygous and a homozygous change in patients with Aicardi-Goutieres syndrome (PMID: 16845398, 26182405, 28832562, 29453417). It is present in the heterozygous state in the gnomAD population database at a frequency of .013% (32/251392) and thus is presumed to be rare. Based on the available evidence, the c.28dup (p.Glu10GlyfsTer82) variant is classified as Pathogenic. -

not provided Pathogenic:2

Dec 25, 2023

Revvity Omics, Revvity

Significance: Pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

- -

Feb 04, 2025

GeneDx

Significance: Likely pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

Frameshift variant predicted to result in abnormal protein length as the last 295 amino acid(s) are replaced with 81 different amino acid(s), and other similar variants have been reported in HGMD; Also known as c.223dup, p.(E75Gfs*82); This variant is associated with the following publications: (PMID: 34303877, 26182405, 29453417, 28832562, 38277958, 34302356, 35568357, 27943079, 36581356, 16845398, 23466847, 33502066, Jain2021[paper], 25604658, 33235754, 38003924) -

Chilblain lupus 1;C0796126:Aicardi-Goutieres syndrome 1;C1860518:Retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations Pathogenic:1

Jan 30, 2025

Labcorp Genetics (formerly Invitae), Labcorp

Significance: Pathogenic

Review Status: criteria provided, single submitter

Collection Method: clinical testing

This sequence change creates a premature translational stop signal (p.Glu20Glyfs*82) in the TREX1 gene. While this is not anticipated to result in nonsense mediated decay, it is expected to disrupt the last 295 amino acid(s) of the TREX1 protein. This variant is present in population databases (rs748398051, gnomAD 0.1%). This premature translational stop signal has been observed in individual(s) with autosomal recessive Aicardi-Goutieres syndrome and neurological features (PMID: 16845398, 25604658). This variant is also known as 58_59insG (E20fs). ClinVar contains an entry for this variant (Variation ID: 126390). Algorithms developed to predict the effect of sequence changes on RNA splicing suggest that this variant may disrupt the consensus splice site. This variant disrupts a region of the TREX1 protein in which other variant(s) (p.Arg164*) have been determined to be pathogenic (PMID: 16845398, 25604658). This suggests that this is a clinically significant region of the protein, and that variants that disrupt it are likely to be disease-causing. For these reasons, this variant has been classified as Pathogenic. -

Computational scores

Source: dbNSFP v4.3

Name	Calibrated prediction	Score	Prediction
PhyloP100		1.6
Mutation Taster		=0/200	disease causing (ClinVar)

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

Other links and lift over

dbSNP: rs78300695; hg19: chr3-48508110;