ClinVar Miner

Submissions for variant NM_000249.3(MLH1):c.-27C>A (rs587779001)

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Total submissions: 6
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Submitter RCV SCV Clinical significance Condition Last evaluated Review status Method Comment
Ambry Genetics RCV000132376 SCV000187467 pathogenic Hereditary cancer-predisposing syndrome 2018-03-05 criteria provided, single submitter clinical testing Lines of evidence used in support of classification: Detected in individual satisfying established diagnostic critera for classic disease without a clear mutation,Other strong data supporting pathogenic classification,Deficient protein function in appropriate functional assay(s)
Counsyl RCV000662782 SCV000785591 likely pathogenic Lynch syndrome II 2017-09-26 criteria provided, single submitter clinical testing
GeneDx RCV000214578 SCV000279472 pathogenic not provided 2018-11-27 criteria provided, single submitter clinical testing This variant is denoted MLH1 c.-27C>A and describes a nucleotide substitution 27 base pairs upstream of the ATG translational start site in the 5' untranslated region (UTR). The surrounding sequence, with the base that is substituted in brackets, is TAGA[C/A]GTTT. MLH1 c.-27C>A has been consistently reported to be located in cis with MLH1 c.85G>T (p.Ala29Ser) as a haplotype and has been observed in at least five families with Lynch syndrome associated cancers (Raevaara 2005, Hitchins 2011, Ward 2013, Kwok 2014). This haplotype co-segregated with colorectal cancer in at least three families and tumor analyses of respective cancers exhibited microsatellite instability and abnormal MLH1 staining on immunohistochemistry (Raevaara, 2005, Hitchins 2011, Ward 2013, Kwok 2014). Although this variant does not appear to affect the start codon or the Kozak translational consensus sequence, functional studies show this haplotype to be associated with constitutional MLH1 promoter methylation and reduced allelic expression (Hitchins 2011, Kwok 2014). Furthermore, in vitro analyses of MLH1 c.-27C>A in isolation showed significantly reduced promoter activity (Hitchins 2011). MLH1 c.-27C>A occurs at a position that is not conserved. MLH1 c.-27C>A was not observed in large population cohorts (Lek 2016). Based on the current evidence, we consider this variant to be pathogenic.
International Society for Gastrointestinal Hereditary Tumours (InSiGHT) RCV000075058 SCV000106611 uncertain significance Lynch syndrome I 2018-06-13 reviewed by expert panel curation Note: haplotype c.[-27C>A(;)85G>T] is Class 5 Pathogenic
Invitae RCV000695005 SCV000823479 pathogenic Hereditary nonpolyposis colon cancer 2018-11-16 criteria provided, single submitter clinical testing This sequence change falls in the promoter region of the MLH1 gene. It does not change the encoded amino acid sequence of the MLH1 protein, but occurs in a region important for transcription of the MLH1 gene. This variant is not present in population databases (ExAC no frequency). This variant has been reported on the same chromosome with the c.85G>T (p.Ala29Ser) missense MLH1 variant in numerous individuals affected with Lynch syndrome (PMID: 21840485, 16083711, 22878509), and was reported to segregate with disease in several families (PMID: 24084575, 21840485). ClinVar contains an entry for this variant (Variation ID: 89589). Experimental studies have shown that the combined c.-27C>A and c.85G>T haplotype is associated with constitutional MLH1 promoter methylation, which reduces the promoter activity. Moreover, the c.-27C>A alone diminishes promoter activity to a similar extent as the combined haplotype (PMID: 21840485, 22878509). For these reasons, this variant has been classified as Pathogenic.
Mayo Clinic Genetic Testing Laboratories,Mayo Clinic RCV000583780 SCV000691839 uncertain significance not specified no assertion criteria provided clinical testing

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