rs879254770

Variant summary

Our verdict is Pathogenic. Variant got 18 ACMG points: 18P and 0B. PVS1PM2PP5_Very_Strong

The NM_000527.5(LDLR):​c.1056_1060+3delCGAAGGTG​(p.Cys352TyrfsTer3) variant causes a frameshift, splice donor, splice region, intron change involving the alteration of a conserved nucleotide. The variant allele was found at a frequency of 0.00000186 in 1,613,240 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. C352C) has been classified as Benign. Variant results in nonsense mediated mRNA decay.

Frequency

Genomes: 𝑓 0.0000066 ( 0 hom., cov: 32)
Exomes 𝑓: 0.0000014 ( 0 hom. )

Consequence

LDLR
NM_000527.5 frameshift, splice_donor, splice_region, intron

Scores

Not classified

Clinical Significance

Pathogenic/Likely pathogenic criteria provided, multiple submitters, no conflicts P:12

Conservation

PhyloP100: 9.55
Variant links:
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]

Genome browser will be placed here

ACMG classification

Classification made for transcript

Verdict is Pathogenic. Variant got 18 ACMG points.

PVS1
Loss of function variant, product undergoes nonsense mediated mRNA decay. LoF is a known mechanism of disease.
PM2
Very rare variant in population databases, with high coverage;
PP5
Variant 19-11110764-ATGCGAAGG-A is Pathogenic according to our data. Variant chr19-11110764-ATGCGAAGG-A is described in ClinVar as [Likely_pathogenic]. Clinvar id is 251620.Status of the report is criteria_provided_multiple_submitters_no_conflicts, 2 stars. Variant chr19-11110764-ATGCGAAGG-A is described in Lovd as [Pathogenic].

Transcripts

RefSeq

Gene Transcript HGVSc HGVSp Effect Exon rank MANE Protein UniProt
LDLRNM_000527.5 linkc.1056_1060+3delCGAAGGTG p.Cys352TyrfsTer3 frameshift_variant, splice_donor_variant, splice_region_variant, intron_variant Exon 7 of 18 ENST00000558518.6 NP_000518.1 P01130-1A0A024R7D5

Ensembl

Gene Transcript HGVSc HGVSp Effect Exon rank TSL MANE Protein Appris UniProt
LDLRENST00000558518.6 linkc.1054_1060+1delTGCGAAGG p.Cys352TyrfsTer3 frameshift_variant, splice_donor_variant, splice_region_variant, intron_variant Exon 7 of 18 1 NM_000527.5 ENSP00000454071.1 P01130-1

Frequencies

GnomAD3 genomes
AF:
0.00000657
AC:
1
AN:
152178
Hom.:
0
Cov.:
32
show subpopulations
Gnomad AFR
AF:
0.0000241
Gnomad AMI
AF:
0.00
Gnomad AMR
AF:
0.00
Gnomad ASJ
AF:
0.00
Gnomad EAS
AF:
0.00
Gnomad SAS
AF:
0.00
Gnomad FIN
AF:
0.00
Gnomad MID
AF:
0.00
Gnomad NFE
AF:
0.00
Gnomad OTH
AF:
0.00
GnomAD4 exome
AF:
0.00000137
AC:
2
AN:
1461062
Hom.:
0
AF XY:
0.00000138
AC XY:
1
AN XY:
726854
show subpopulations
Gnomad4 AFR exome
AF:
0.0000597
Gnomad4 AMR exome
AF:
0.00
Gnomad4 ASJ exome
AF:
0.00
Gnomad4 EAS exome
AF:
0.00
Gnomad4 SAS exome
AF:
0.00
Gnomad4 FIN exome
AF:
0.00
Gnomad4 NFE exome
AF:
0.00
Gnomad4 OTH exome
AF:
0.00
GnomAD4 genome
AF:
0.00000657
AC:
1
AN:
152178
Hom.:
0
Cov.:
32
AF XY:
0.00
AC XY:
0
AN XY:
74338
show subpopulations
Gnomad4 AFR
AF:
0.0000241
Gnomad4 AMR
AF:
0.00
Gnomad4 ASJ
AF:
0.00
Gnomad4 EAS
AF:
0.00
Gnomad4 SAS
AF:
0.00
Gnomad4 FIN
AF:
0.00
Gnomad4 NFE
AF:
0.00
Gnomad4 OTH
AF:
0.00
Bravo
AF:
0.00000378

ClinVar

Significance: Pathogenic/Likely pathogenic
Submissions summary: Pathogenic:12
Revision: criteria provided, multiple submitters, no conflicts
LINK: link

Submissions by phenotype

Hypercholesterolemia, familial, 1 Pathogenic:5
Jun 05, 2017
Human Genome Sequencing Center Clinical Lab, Baylor College of Medicine
Significance: Pathogenic
Review Status: criteria provided, single submitter
Collection Method: clinical testing

This c.1056_1060+3del (p.Cys352*) variant has not been observed in our cohort database nor has been detected in the ExAC population database. This variant deletes 8 nucleotides from cDNA postion c.1056 to c.1060+3, which includes the donor splice site of intron 7 of the LDLR gene. Computer algorithm predict the use of an alternative splice site at position c.1060+12_1060+13 and the creation of a non sense variant and a stop codon at amino acid position 352 of the LDLR protein. This variant is thus classified as pathogenic. -

Dec 16, 2016
Centre de Génétique Moléculaire et Chromosomique, Unité de génétique de l'Obésité et des Dyslipidémies, APHP, GH Hôpitaux Universitaires Pitié-Salpêtrière / Charles-Foix
Significance: Pathogenic
Review Status: criteria provided, single submitter
Collection Method: clinical testing

subjects mutated among 2600 FH index cases screened = 4 , family member =1 -

Mar 30, 2017
U4M - Lille University & CHRU Lille, Université de Lille - CHRU de Lille
Significance: Pathogenic
Review Status: criteria provided, single submitter
Collection Method: clinical testing

- -

Mar 25, 2016
LDLR-LOVD, British Heart Foundation
Significance: Pathogenic
Review Status: criteria provided, single submitter
Collection Method: literature only

- -

Dec 18, 2023
All of Us Research Program, National Institutes of Health
Significance: Pathogenic
Review Status: criteria provided, single submitter
Collection Method: clinical testing

This variant deletes eight nucleotides spanning the boundary of exon 7 and intron 7 of the LDLR gene, deleting the canonical splice donor site, and creating a premature translation stop signal at the deletion boundary. Use of a downstream cryptic donor would allow use of this stop codon and would result in a protein truncation (p.Cys352*). However in-frame skipping of exon 7 may also occur. To our knowledge RNA studies on this variant have not been reported. This variant has been reported in individuals affected with familial hypercholesterolemia (PMID: 16389549, 28008010, 32220565, 34037665). This variant has also been observed in compound heterozygous state with a known pathogenic LDLR variant in an individual affected with severe homozygous familial hypercholesterolemia, a phenotype expected of having two deleterious LDLR variants (PMID: 34029164). This variant has been identified in 1/31382 chromosomes in the general population by the Genome Aggregation Database (gnomAD). Loss of LDLR function is a known mechanism of disease (clinicalgenome.org). Based on the available evidence, this variant is classified as Pathogenic. -

not provided Pathogenic:3
Apr 13, 2023
Quest Diagnostics Nichols Institute San Juan Capistrano
Significance: Pathogenic
Review Status: criteria provided, single submitter
Collection Method: clinical testing

The LDLR c.1056_1060+3del variant disrupts a canonical splice-donor site and interferes with normal LDLR mRNA splicing. It is also predicted to create a premature stop codon (p.Cys352*) that may disrupt normal LDLR protein synthesis. The frequency of this variant in the general population, 0.000032 (1/31382 chromosomes, http://gnomad.broadinstitute.org), is consistent with pathogenicity. In the published literature, the variant has been reported in multiple individuals with clinical features of familial hypercholesterolemia (PMIDs: 34363016 (2021), 34037665 (2021), 32220565 (2020), 30586733 (2019), 28008010 (2016), 16389549 (2006)). Based on the available information, this variant is classified as pathogenic. -

Feb 11, 2022
AiLife Diagnostics, AiLife Diagnostics
Significance: Pathogenic
Review Status: criteria provided, single submitter
Collection Method: clinical testing

- -

Sep 20, 2024
GeneDx
Significance: Likely pathogenic
Review Status: criteria provided, single submitter
Collection Method: clinical testing

Identified in a patient with early onset myocardial infarction in published literature (PMID: 30586733); Not observed at significant frequency in large population cohorts (gnomAD); Deletions involving coding exons of this gene are a known mechanism of disease (HGMD); Canonical splice site variant predicted to result in an in-frame loss of the adjacent exon in a gene for which loss of function is a known mechanism of disease; This variant is associated with the following publications: (PMID: 31447099, 28008010, 34037665, 32220565, 34363016, 16389549, 37589137, 30586733) -

Familial hypercholesterolemia Pathogenic:2
Mar 21, 2023
Women's Health and Genetics/Laboratory Corporation of America, LabCorp
Significance: Pathogenic
Review Status: criteria provided, single submitter
Collection Method: clinical testing

Variant summary: Several computational tools predict a significant impact on normal splicing: Three predict the variant abolishes a 5' splicing donor site. However, these predictions have yet to be confirmed by functional studies. The variant was absent in 250660 control chromosomes. c.1056_1060+3delCGAAGGTG has been reported in the literature in individuals affected with Familial Hypercholesterolemia and in an individual with early onset myocardial infarction (Humphries_2006, Khera_2019, Abul-Husn_2016). To our knowledge, no experimental evidence demonstrating an impact on protein function has been reported. Nine clinical diagnostic laboratories have submitted clinical-significance assessments for this variant to ClinVar after 2014 without evidence for independent evaluation. All laboratories classified the variant as pathogenic/likely pathogenic. Based on the evidence outlined above, the variant was classified as pathogenic. -

Jan 19, 2025
Labcorp Genetics (formerly Invitae), Labcorp
Significance: Pathogenic
Review Status: criteria provided, single submitter
Collection Method: clinical testing

This variant results in the deletion of exon 7 (c.1056_1060+3del) of the LDLR gene. It is expected to disrupt RNA splicing. Variants that disrupt the donor or acceptor splice site typically lead to a loss of protein function (PMID: 16199547), and loss-of-function variants in LDLR are known to be pathogenic (PMID: 20809525, 28645073). This variant is present in population databases (no rsID available, gnomAD 0.01%). This variant has been observed in individuals with clinical features of familial hypercholesterolemia (PMID: 16389549, 28008010, 30586733; internal data). Invitae Evidence Modeling of clinical and family history, age, sex, and reported ancestry of multiple individuals with this LDLR variant has been performed. This variant is expected to be pathogenic with a positive predictive value of at least 99%. This is a validated machine learning model that incorporates the clinical features of 363,995 individuals referred to our laboratory for LDLR testing. This variant is also known as p.C331fs and p.Cys352fs. ClinVar contains an entry for this variant (Variation ID: 251620). For these reasons, this variant has been classified as Pathogenic. -

Homozygous familial hypercholesterolemia Pathogenic:1
Oct 16, 2017
Laboratory for Molecular Medicine, Mass General Brigham Personalized Medicine
Significance: Pathogenic
Review Status: criteria provided, single submitter
Collection Method: clinical testing

The c.1056_1060+3del variant in LDLR has been reported in 1 individual with fami lial hypercholesterolemia (FH; Humphries 2006) and in several individuals with F H in ClinVar (Variation ID# 251620). This variant has also been identified in 1/ 8722 African chromosomes by the Genome Aggregation Database (GnomAD, http://gnom ad.broadinstitute.org; dbSNP rs879254770). This frequency is low enough to be co nsistent with the frequency of FH in the general population. This deletion spans the (+/- 1,2) invariant region of the 5' splice consensus sequence and is predi cted to cause altered splicing leading to an abnormal or absent protein. Heteroz ygous loss of function of the LDLR gene is an established disease mechanism in F H. In summary, this variant meets criteria to be classified as pathogenic for FH in an autosomal dominant manner based upon the predicted impact to the protein, presence in multiple affected individuals and very low frequency in the general population. -

Cardiovascular phenotype Pathogenic:1
Mar 21, 2023
Ambry Genetics
Significance: Pathogenic
Review Status: criteria provided, single submitter
Collection Method: clinical testing

The c.1056_1060+3delCGAAGGTG pathogenic mutation results from a deletion of 8 nucleotides between positions 1056 and 1060+3 and involves the canonical splice donor site after coding exon 7 of the LDLR gene. This alteration has been reported in a familial hypercholesterolemia cohort (Humphries SE et al. J. Mol. Med., 2006 Mar;84:203-14). In addition to the clinical data presented in the literature, alterations that disrupt the canonical splice site are expected to cause aberrant splicing, resulting in an abnormal protein or a transcript that is subject to nonsense-mediated mRNA decay. As such, this alteration is interpreted as a disease-causing mutation. -

Computational scores

Source: dbNSFP v4.3

Name
Calibrated prediction
Score
Prediction

Splicing

Find out detailed SpliceAI scores and Pangolin per-transcript scores at spliceailookup.broadinstitute.org

Publications

LitVar

Below is the list of publications found by LitVar. It may be empty.

Other links and lift over

dbSNP: rs879254770; hg19: chr19-11221440; API