rs79891110

Variant summary

Our verdict is Pathogenic. The variant received 14 ACMG points: 14P and 0B. PM1PM2PP3_ModeratePP5_Very_Strong

The NM_000719.7(CACNA1C):​c.1216G>A​(p.Gly406Arg) variant causes a missense, splice region change involving the alteration of a conserved nucleotide. The variant allele was found at a frequency of 0.00000657 in 152,172 control chromosomes in the GnomAD database, with no homozygous occurrence. In-silico tool predicts a pathogenic outcome for this variant. 16/24 in silico tools predict a damaging outcome for this variant. 2/3 splice prediction tools predict no significant impact on normal splicing. Variant has been reported in ClinVar as Pathogenic (★★).

Frequency

Genomes: 𝑓 0.0000066 ( 0 hom., cov: 32)
Exomes 𝑓: 0.0 ( 0 hom. )
Failed GnomAD Quality Control

Consequence

CACNA1C
NM_000719.7 missense, splice_region

Scores

15
3
1
Splicing: ADA: 0.9697
1
1

Clinical Significance

Pathogenic criteria provided, multiple submitters, no conflicts P:11O:2

Conservation

PhyloP100: 10.0

Publications

219 publications found
Variant links:
Genes affected
CACNA1C (HGNC:1390): (calcium voltage-gated channel subunit alpha1 C) This gene encodes an alpha-1 subunit of a voltage-dependent calcium channel. Calcium channels mediate the influx of calcium ions into the cell upon membrane polarization. The alpha-1 subunit consists of 24 transmembrane segments and forms the pore through which ions pass into the cell. The calcium channel consists of a complex of alpha-1, alpha-2/delta, beta, and gamma subunits in a 1:1:1:1 ratio. There are multiple isoforms of each of these proteins, either encoded by different genes or the result of alternative splicing of transcripts. The protein encoded by this gene binds to and is inhibited by dihydropyridine. Alternative splicing results in many transcript variants encoding different proteins. Some of the predicted proteins may not produce functional ion channel subunits. [provided by RefSeq, Oct 2012]
CACNA1C Gene-Disease associations (from GenCC):
  • Timothy syndrome
    Inheritance: AD Classification: DEFINITIVE, STRONG, SUPPORTIVE Submitted by: Ambry Genetics, Orphanet, G2P, Labcorp Genetics (formerly Invitae)
  • neurodevelopmental disorder with hypotonia, language delay, and skeletal defects with or without seizures
    Inheritance: AD Classification: STRONG Submitted by: Ambry Genetics
  • long QT syndrome
    Inheritance: AD Classification: MODERATE Submitted by: ClinGen
  • long QT syndrome 8
    Inheritance: AD Classification: MODERATE Submitted by: Ambry Genetics
  • Brugada syndrome
    Inheritance: AD Classification: SUPPORTIVE, NO_KNOWN Submitted by: Orphanet, ClinGen
  • Brugada syndrome 3
    Inheritance: AD Classification: LIMITED, NO_KNOWN Submitted by: Ambry Genetics, Genomics England PanelApp, Labcorp Genetics (formerly Invitae)
  • intellectual disability
    Inheritance: AD Classification: LIMITED Submitted by: Ambry Genetics
  • short QT syndrome
    Inheritance: AD Classification: LIMITED, NO_KNOWN Submitted by: Ambry Genetics, ClinGen

Genome browser will be placed here

ACMG classification

Classification was made for transcript

Our verdict: Pathogenic. The variant received 14 ACMG points.

PM1
In a hotspot region, there are 2 aminoacids with missense pathogenic changes in the window of +-8 aminoacids around while only 0 benign, 4 uncertain in NM_000719.7
PM2
Very rare variant in population databases, with high coverage;
PP3
MetaRNN computational evidence supports a deleterious effect, 0.936
PP5
Variant 12-2504944-G-A is Pathogenic according to our data. Variant chr12-2504944-G-A is described in ClinVar as Pathogenic. ClinVar VariationId is 17632.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
CACNA1CNM_000719.7 linkc.1216G>A p.Gly406Arg missense_variant, splice_region_variant Exon 8 of 47 ENST00000399655.6 NP_000710.5 Q13936-12
CACNA1CNM_001167623.2 linkc.1217+405G>A intron_variant Intron 8 of 46 ENST00000399603.6 NP_001161095.1 Q13936-37

Ensembl

Gene Transcript HGVSc HGVSp Effect Exon rank TSL MANE Protein Appris UniProt
CACNA1CENST00000399655.6 linkc.1216G>A p.Gly406Arg missense_variant, splice_region_variant Exon 8 of 47 1 NM_000719.7 ENSP00000382563.1 Q13936-12
CACNA1CENST00000682544.1 linkc.1306G>A p.Gly436Arg missense_variant, splice_region_variant Exon 8 of 50 ENSP00000507184.1 A0A804HIR0
CACNA1CENST00000347598.9 linkc.1216G>A p.Gly406Arg missense_variant, splice_region_variant Exon 8 of 49 1 ENSP00000266376.6 Q13936-11
CACNA1CENST00000344100.7 linkc.1216G>A p.Gly406Arg missense_variant, splice_region_variant Exon 8 of 47 1 ENSP00000341092.3 Q13936-14
CACNA1CENST00000327702.12 linkc.1216G>A p.Gly406Arg missense_variant, splice_region_variant Exon 8 of 48 1 ENSP00000329877.7 A0A0A0MR67
CACNA1CENST00000399638.5 linkc.1216G>A p.Gly406Arg missense_variant, splice_region_variant Exon 8 of 48 1 ENSP00000382547.1 Q13936-31
CACNA1CENST00000335762.10 linkc.1216G>A p.Gly406Arg missense_variant, splice_region_variant Exon 8 of 48 5 ENSP00000336982.5 F5H522
CACNA1CENST00000399606.5 linkc.1216G>A p.Gly406Arg missense_variant, splice_region_variant Exon 8 of 48 1 ENSP00000382515.1 Q13936-30
CACNA1CENST00000399621.5 linkc.1216G>A p.Gly406Arg missense_variant, splice_region_variant Exon 8 of 47 1 ENSP00000382530.1 Q13936-24
CACNA1CENST00000399637.5 linkc.1216G>A p.Gly406Arg missense_variant, splice_region_variant Exon 8 of 47 1 ENSP00000382546.1 Q13936-27
CACNA1CENST00000402845.7 linkc.1216G>A p.Gly406Arg missense_variant, splice_region_variant Exon 8 of 47 1 ENSP00000385724.3 Q13936-13
CACNA1CENST00000399629.5 linkc.1216G>A p.Gly406Arg missense_variant, splice_region_variant Exon 8 of 47 1 ENSP00000382537.1 Q13936-32
CACNA1CENST00000682336.1 linkc.1216G>A p.Gly406Arg missense_variant, splice_region_variant Exon 8 of 47 ENSP00000507898.1 A0A804HKE9
CACNA1CENST00000399591.5 linkc.1216G>A p.Gly406Arg missense_variant, splice_region_variant Exon 8 of 46 1 ENSP00000382500.1 Q13936-29
CACNA1CENST00000399595.5 linkc.1216G>A p.Gly406Arg missense_variant, splice_region_variant Exon 8 of 46 1 ENSP00000382504.1 Q13936-25
CACNA1CENST00000399649.5 linkc.1216G>A p.Gly406Arg missense_variant, splice_region_variant Exon 8 of 46 1 ENSP00000382557.1 Q13936-15
CACNA1CENST00000399597.5 linkc.1216G>A p.Gly406Arg missense_variant, splice_region_variant Exon 8 of 47 1 ENSP00000382506.1 Q13936-22
CACNA1CENST00000399601.5 linkc.1216G>A p.Gly406Arg missense_variant, splice_region_variant Exon 8 of 47 1 ENSP00000382510.1 Q13936-20
CACNA1CENST00000399644.5 linkc.1216G>A p.Gly406Arg missense_variant, splice_region_variant Exon 8 of 47 1 ENSP00000382552.1 Q13936-21
CACNA1CENST00000683482.1 linkc.1207G>A p.Gly403Arg missense_variant, splice_region_variant Exon 8 of 47 ENSP00000507169.1 Q13936-35
CACNA1CENST00000682686.1 linkc.1216G>A p.Gly406Arg missense_variant, splice_region_variant Exon 8 of 46 ENSP00000507309.1 Q13936-19
CACNA1CENST00000399603.6 linkc.1217+405G>A intron_variant Intron 8 of 46 5 NM_001167623.2 ENSP00000382512.1 Q13936-37
CACNA1CENST00000406454.8 linkc.1217+405G>A intron_variant Intron 8 of 47 5 ENSP00000385896.3 F5GY28
CACNA1CENST00000399634.6 linkc.1217+405G>A intron_variant Intron 8 of 46 5 ENSP00000382542.2 E9PDI6
CACNA1CENST00000683824.1 linkc.1307+405G>A intron_variant Intron 8 of 47 ENSP00000507867.1 A0A804HKC4
CACNA1CENST00000399617.6 linkc.1217+405G>A intron_variant Intron 8 of 47 5 ENSP00000382526.1 A0A0A0MSA1
CACNA1CENST00000682462.1 linkc.1307+405G>A intron_variant Intron 8 of 46 ENSP00000507105.1 A0A804HIJ8
CACNA1CENST00000683781.1 linkc.1307+405G>A intron_variant Intron 8 of 46 ENSP00000507434.1 A0A804HJB6
CACNA1CENST00000683840.1 linkc.1307+405G>A intron_variant Intron 8 of 46 ENSP00000507612.1 A0A804HJR1
CACNA1CENST00000683956.1 linkc.1307+405G>A intron_variant Intron 8 of 46 ENSP00000506882.1 A0A804HI37
CACNA1CENST00000399641.6 linkc.1217+405G>A intron_variant Intron 8 of 46 1 ENSP00000382549.1 Q13936-23
CACNA1CENST00000682835.1 linkc.1217+405G>A intron_variant Intron 8 of 46 ENSP00000507282.1 A0A804HIZ0
CACNA1CENST00000480911.6 linkn.1113+11558G>A intron_variant Intron 7 of 26 5 ENSP00000437936.2 F5H638

Frequencies

GnomAD3 genomes
AF:
0.00000658
AC:
1
AN:
152054
Hom.:
0
Cov.:
32
show subpopulations
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:
0.000209
Gnomad FIN
AF:
0.00
Gnomad MID
AF:
0.00
Gnomad NFE
AF:
0.00
Gnomad OTH
AF:
0.00
GnomAD4 exome
Data not reliable, filtered out with message: AC0
AF:
0.00
AC:
0
AN:
1312642
Hom.:
0
Cov.:
21
AF XY:
0.00
AC XY:
0
AN XY:
661428
African (AFR)
AF:
0.00
AC:
0
AN:
30456
American (AMR)
AF:
0.00
AC:
0
AN:
44402
Ashkenazi Jewish (ASJ)
AF:
0.00
AC:
0
AN:
25156
East Asian (EAS)
AF:
0.00
AC:
0
AN:
39042
South Asian (SAS)
AF:
0.00
AC:
0
AN:
82952
European-Finnish (FIN)
AF:
0.00
AC:
0
AN:
53286
Middle Eastern (MID)
AF:
0.00
AC:
0
AN:
5516
European-Non Finnish (NFE)
AF:
0.00
AC:
0
AN:
976280
Other (OTH)
AF:
0.00
AC:
0
AN:
55552
GnomAD4 genome
AF:
0.00000657
AC:
1
AN:
152172
Hom.:
0
Cov.:
32
AF XY:
0.0000134
AC XY:
1
AN XY:
74392
show subpopulations
⚠️ The allele balance in gnomAD version 4 Genomes is significantly skewed from the expected value of 0.5.
African (AFR)
AF:
0.00
AC:
0
AN:
41532
American (AMR)
AF:
0.00
AC:
0
AN:
15290
Ashkenazi Jewish (ASJ)
AF:
0.00
AC:
0
AN:
3470
East Asian (EAS)
AF:
0.00
AC:
0
AN:
5184
South Asian (SAS)
AF:
0.000209
AC:
1
AN:
4780
European-Finnish (FIN)
AF:
0.00
AC:
0
AN:
10604
Middle Eastern (MID)
AF:
0.00
AC:
0
AN:
292
European-Non Finnish (NFE)
AF:
0.00
AC:
0
AN:
67996
Other (OTH)
AF:
0.00
AC:
0
AN:
2114
⚠️ The allele balance in gnomAD version 4 Genomes is significantly skewed from the expected value of 0.5. (p-value = 0), which strongly suggests a high chance of mosaicism in these individuals.
Allele Balance Distribution
Red line indicates average allele balance
Average allele balance: 0.275
Heterozygous variant carriers
0
0
1
1
2
2
0.00
0.20
0.40
0.60
0.80
0.95
Allele balance
Alfa
AF:
0.00
Hom.:
0

ClinVar

Significance: Pathogenic
Submissions summary: Pathogenic:11Other:2
Revision: criteria provided, multiple submitters, no conflicts
LINK: link

Submissions by phenotype

not provided Pathogenic:4
-
Laboratory of Diagnostic Genome Analysis, Leiden University Medical Center (LUMC)
Significance:Pathogenic
Review Status:no assertion criteria provided
Collection Method:clinical testing

- -

-
Joint Genome Diagnostic Labs from Nijmegen and Maastricht, Radboudumc and MUMC+
Significance:Pathogenic
Review Status:no assertion criteria provided
Collection Method:clinical testing

- -

Apr 25, 2016
Stanford Center for Inherited Cardiovascular Disease, Stanford University
Significance:Pathogenic
Review Status:no assertion criteria provided
Collection Method:provider interpretation

- -

Feb 23, 2024
GeneDx
Significance:Pathogenic
Review Status:criteria provided, single submitter
Collection Method:clinical testing

Not observed at significant frequency in large population cohorts (gnomAD); Published functional studies demonstrate G406R reduces channel inactivation, leading to aberrant intracellular calcium levels in multiple tissues (PMID: 15454078); In silico analysis supports that this missense variant has a deleterious effect on protein structure/function; This variant is associated with the following publications: (PMID: 19074970, 26822303, 23580742, 27593853, 17224476, 29739816, 30027834, 21910241, 23631430, 23678275, 23313911, 21878566, 28211989, 15454078, 30023270, 22581653, 15863612, 16360093, 28718902, 29845439, 30513141, 30530868, 31737537, 34079780, 28371864, 27034553, 23690510, 31805042, 32161207, 27868338, 30384889, 30998997, 31395954) -

Timothy syndrome Pathogenic:2Other:1
-
GeneReviews
Significance:not provided
Review Status:no classification provided
Collection Method:literature only

Classic Timothy syndrome phenotype -

Apr 04, 2018
Center For Human Genetics And Laboratory Diagnostics, Dr. Klein, Dr. Rost And Colleagues
Significance:Pathogenic
Review Status:criteria provided, single submitter
Collection Method:clinical testing

- -

Mar 10, 2011
OMIM
Significance:Pathogenic
Review Status:no assertion criteria provided
Collection Method:literature only

- -

Timothy syndrome;C2678478:Brugada syndrome 3;C5774213:Neurodevelopmental disorder with hypotonia, language delay, and skeletal defects with or without seizures;CN260585:Long qt syndrome 8 Pathogenic:1
-
Center for Genomics, Ann and Robert H. Lurie Children's Hospital of Chicago
Significance:Pathogenic
Review Status:criteria provided, single submitter
Collection Method:clinical testing

This variant, located in the alternatively spliced exon 8A of the CACNA1C gene, is a well-established pathogenic variant that is referenced in the GeneReviews article for CACNA1C-Related Disorders as the predominant cause of classic Timothy syndrome (Napolitano 2021 PMID: 20301577). It has been reported in the literature and in ClinVar in numerous individuals with Timothy syndrome, including several instances of this variant as either de novo or mosaic; additionally, multiple individuals are reported to have inherited this variant from unaffected or mildly affected parents as a result of low-level somatic and/or germline mosaicism (Selected publications: Splawski 2004 PMID: 15454078; Etheridge 2011 PIMD: 21910241; Dufendach 2013 PMID: 23690510; Kawaida 2016 PMID: 27593853; Walsh 2018 PIMD: 28371864; ClinVar Variation ID: 17632). It is present in a single heterozygote in the Genome Aggregation Database (Highest reported MAF: 0.02% [1/4784]; https://gnomad.broadinstitute.org/variant/12-2504944-G-A?dataset=gnomad_r3); please note, disease-causing variants may be present in control databases at low frequencies, reflective of the general population, incomplete penetrance, and/or variable expressivity. In vitro functional studies demonstrate a deleterious effect of this variant on calcium channel function (Selected publications: Splawski 2004 PMID: 15454078; Yarotskyy 2009 PMID: 19074970). A mouse model with this variant recapitulated various abnormal neurodevelopmental features seen in individuals with Timothy syndrome (Bader 2011 PIMD: 21878566). Evolutionary conservation and computational prediction tools strongly support that this variant impacts the protein. In summary, this variant is classified as pathogenic. -

CACNA1C-related disorder Pathogenic:1
Feb 13, 2019
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 variant is located in the last amino acid of exon 8. This variant has been previously reported in multiple studies as a de novo heterozygous change in patients with Timothy Syndrome (PMID: 28371864, 23690510, 28211989, 15454078). A functional study showed this variant impairs voltage-dependent channel inactivation causing maintained inward calcium currents (PMID: 15454078). It is absent from the ExAC and gnomAD population databases and thus is presumed to be rare. The c.1216G>A (p.Gly406Arg) variant affects a highly conserved amino acid and is predicted by multiple in silico tools to have a deleterious effect on protein function. Based on the available evidence, the c.1216G>A (p.Gly406Arg) variant is classified as pathogenic. -

Long qt syndrome 8 Pathogenic:1
Feb 16, 2024
Baylor Genetics
Significance:Pathogenic
Review Status:criteria provided, single submitter
Collection Method:clinical testing

- -

Long QT syndrome Pathogenic:1
Sep 13, 2022
Labcorp Genetics (formerly Invitae), Labcorp
Significance:Pathogenic
Review Status:criteria provided, single submitter
Collection Method:clinical testing

This sequence change replaces glycine, which is neutral and non-polar, with arginine, which is basic and polar, at codon 406 of the CACNA1C protein (p.Gly406Arg). This variant is not present in population databases (gnomAD no frequency). This missense change has been observed in individual(s) with Timothy syndrome (PMID: 15454078, 15863612, 21910241, 23578275, 23580742, 23690510, 26227324). In at least one individual the variant was observed to be de novo. ClinVar contains an entry for this variant (Variation ID: 17632). Algorithms developed to predict the effect of missense changes on protein structure and function are either unavailable or do not agree on the potential impact of this missense change (SIFT: "Deleterious"; PolyPhen-2: "Probably Damaging"; Align-GVGD: "Class C15"). Experimental studies have shown that this missense change affects CACNA1C function (PMID: 15454078, 15863612, 18250309, 19074970, 26822303). Algorithms developed to predict the effect of sequence changes on RNA splicing suggest that this variant may create or strengthen a splice site. For these reasons, this variant has been classified as Pathogenic. -

Cardiovascular phenotype Pathogenic:1
May 03, 2022
Ambry Genetics
Significance:Pathogenic
Review Status:criteria provided, single submitter
Collection Method:clinical testing

The p.G406R pathogenic mutation (also known as c.1216G>A), located in coding exon 8A of the CACNA1C gene, results from a G to A substitution at nucleotide position 1216. The glycine at codon 406 is replaced by arginine, an amino acid with dissimilar properties. This mutation has been detected in numerous individuals with Timothy syndrome (TS), including de novo cases and those due to parental mosaicism; incomplete TS has been described in some cases of somatic mosaicism with this mutation (Splawski I et al. Cell, 2004 Oct;119:19-31; Etheridge SP et al. Am. J. Med. Genet. A, 2011 Oct;155A:2578-83; An HS et al. J. Korean Med. Sci., 2013 May;28:788-91;Dufendach KA et al. Pediatrics, 2013 Jun;131:e1991-5; Walsh MA et al. Europace, 2018 02;20:377-385). Functional studies demonstrated altered gating kinetics and prolonged action potential duration, while mouse models with this mutation showed neurobehavioral and brain changes consistent with TS clinical findings (Splawski I et al. Cell, 2004 Oct;119:19-31; Bader PL et al. Proc. Natl. Acad. Sci. U.S.A., 2011 Sep;108:15432-7; Krey JF et al. Nat. Neurosci., 2013 Feb;16:201-9). This variant is considered to be rare based on population cohorts in the Genome Aggregation Database (gnomAD). In addition, this alteration is predicted to be deleterious by in silico analysis. Based on the supporting evidence, this alteration is interpreted as a disease-causing mutation. -

Congenital long QT syndrome Other:1
-
Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust
Significance:not provided
Review Status:no classification provided
Collection Method:literature only

This variant has been reported in the following publications (PMID:15454078;PMID:15863612;PMID:17224476;PMID:19074970;PMID:21878566). -

Computational scores

Source: dbNSFP v4.3

Name
Calibrated prediction
Score
Prediction
AlphaMissense
Pathogenic
1.0
CardioboostArm
Pathogenic
1.0
BayesDel_addAF
Pathogenic
0.54
D
BayesDel_noAF
Pathogenic
0.54
CADD
Pathogenic
35
DANN
Pathogenic
1.0
DEOGEN2
Uncertain
0.68
D;.;.;.;.;.;.;.;.;.;.;.;.;.;.;T;.;.
Eigen
Pathogenic
1.0
Eigen_PC
Pathogenic
0.95
FATHMM_MKL
Pathogenic
1.0
D
M_CAP
Pathogenic
0.80
D
MetaRNN
Pathogenic
0.94
D;D;D;D;D;D;D;D;D;D;D;D;D;D;D;D;D;D
MetaSVM
Pathogenic
1.1
D
MutationAssessor
Pathogenic
3.3
.;M;.;M;M;M;M;M;M;M;M;M;M;M;M;.;M;M
PhyloP100
10
PrimateAI
Pathogenic
0.96
D
PROVEAN
Pathogenic
-6.8
D;D;D;D;D;D;D;D;D;D;D;D;D;D;D;D;D;D
REVEL
Pathogenic
0.96
Sift
Uncertain
0.0050
D;D;D;D;D;D;D;D;D;D;D;D;D;D;D;D;D;D
Sift4G
Uncertain
0.023
D;D;D;D;D;D;D;D;D;D;D;D;D;D;D;D;D;D
Polyphen
1.0, 0.96
.;D;.;D;D;D;D;D;D;D;D;D;D;D;D;.;D;D
Vest4
0.95
MutPred
0.71
Loss of ubiquitination at K410 (P = 0.0816);Loss of ubiquitination at K410 (P = 0.0816);Loss of ubiquitination at K410 (P = 0.0816);Loss of ubiquitination at K410 (P = 0.0816);Loss of ubiquitination at K410 (P = 0.0816);Loss of ubiquitination at K410 (P = 0.0816);Loss of ubiquitination at K410 (P = 0.0816);Loss of ubiquitination at K410 (P = 0.0816);Loss of ubiquitination at K410 (P = 0.0816);Loss of ubiquitination at K410 (P = 0.0816);Loss of ubiquitination at K410 (P = 0.0816);Loss of ubiquitination at K410 (P = 0.0816);Loss of ubiquitination at K410 (P = 0.0816);Loss of ubiquitination at K410 (P = 0.0816);Loss of ubiquitination at K410 (P = 0.0816);Loss of ubiquitination at K410 (P = 0.0816);Loss of ubiquitination at K410 (P = 0.0816);Loss of ubiquitination at K410 (P = 0.0816);
MVP
0.99
MPC
2.4
ClinPred
1.0
D
GERP RS
5.3
gMVP
0.99
Mutation Taster
=0/100
disease causing (ClinVar)

Splicing

Name
Calibrated prediction
Score
Prediction
dbscSNV1_ADA
Pathogenic
0.97
dbscSNV1_RF
Benign
0.67
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

Publications

Other links and lift over

dbSNP: rs79891110; hg19: chr12-2614110; COSMIC: COSV100223378; API