Our verdict is Pathogenic. The variant received 21 ACMG points: 21P and 0B. PS1PM1PM2PM5PP2PP3_ModeratePP5_Very_Strong
The NM_001613.4(ACTA2):c.138G>T(p.Met46Ile) variant causes a missense change involving the alteration of a 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 nucleotide change resulting in the same amino acid substitution has been previously reported as Pathogenic in ClinVar. Another variant affecting the same amino acid position, but resulting in a different missense (i.e. M46V) has been classified as Likely pathogenic.
ACTA2 (HGNC:130): (actin alpha 2, smooth muscle) This gene encodes one of six different actin proteins. Actins are highly conserved proteins that are involved in cell motility, structure, integrity, and intercellular signaling. The encoded protein is a smooth muscle actin that is involved in vascular contractility and blood pressure homeostasis. Mutations in this gene cause a variety of vascular diseases, such as thoracic aortic disease, coronary artery disease, stroke, and Moyamoya disease, as well as multisystemic smooth muscle dysfunction syndrome. [provided by RefSeq, Sep 2017]
STAMBPL1 (HGNC:24105): (STAM binding protein like 1) Predicted to enable Lys63-specific deubiquitinase activity and thiol-dependent deubiquitinase. Predicted to be involved in protein K63-linked deubiquitination. Located in membrane. [provided by Alliance of Genome Resources, Apr 2022]
Our verdict: Pathogenic. The variant received 21 ACMG points.
PS1
Transcript NM_001613.4 (ACTA2) is affected with MISSENSE_VARIANT having same AA change as one Pathogenic present in ClinVar.
PM1
In a hotspot region, there are 7 aminoacids with missense pathogenic changes in the window of +-8 aminoacids around while only 0 benign, 12 uncertain in NM_001613.4
PM2
Very rare variant in population databases, with high coverage;
PM5
Other missense variant is known to change same aminoacid residue: Variant chr10-88947380-T-C is described in CliVar as Likely_pathogenic. Clinvar id is 1421069.Status of the report is criteria_provided_single_submitter, 1 stars.
PP2
Missense variant in the ACTA2 gene, where missense mutations are typically associated with disease (based on misZ statistic). The gene has 27 curated pathogenic missense variants (we use a threshold of 10). The gene has 0 curated benign missense variants. Trascript score misZ: 4.6117 (above the threshold of 3.09). GenCC associations: The gene is linked to multisystemic smooth muscle dysfunction syndrome, connective tissue disorder, familial thoracic aortic aneurysm and aortic dissection, Moyamoya disease 5, aortic aneurysm, familial thoracic 6.
PP3
MetaRNN computational evidence supports a deleterious effect, 0.921
PP5
Variant 10-88947378-C-A is Pathogenic according to our data. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr10-88947378-C-A is described in CliVar as Pathogenic/Likely_pathogenic. Clinvar id is 664017.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars.
For these reasons, this variant has been classified as Pathogenic. This variant disrupts the p.Met46 amino acid residue in ACTA2. Other variant(s) that disrupt this residue have been observed in individuals with ACTA2-related conditions (PMID: 30975232; Invitae), which suggests that this may be a clinically significant amino acid residue. 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 ACTA2 protein function. ClinVar contains an entry for this variant (Variation ID: 664017). This missense change has been observed in individuals with clinical features of thoracic aortic aneurysms and dissections (Invitae). This variant is not present in population databases (gnomAD no frequency). This sequence change replaces methionine, which is neutral and non-polar, with isoleucine, which is neutral and non-polar, at codon 46 of the ACTA2 protein (p.Met46Ile). -