Submissions for variant NM_000527.5(LDLR):c.2096C>T (p.Pro699Leu)

Total submissions: 22

Submitter	RCV	SCV	Clinical significance	Condition	Last evaluated	Review status	Method	Comment
ClinGen Familial Hypercholesterolemia Variant Curation Expert Panel	RCV000237906	SCV001960938	uncertain significance	Hypercholesterolemia, familial, 1	2021-06-18	reviewed by expert panel	curation	NM_000527.5(LDLR):c.2096C>T (p.Pro699Leu) variant is classified as Uncertain significance for Familial Hypercholesterolemia by applying evidence codes (BS4, PP1_Strong and PP3) as defined by the ClinGen Familial Hypercholesterolemia Expert Panel LDLR-specific variant curation guidelines (https://doi.org/10.1101/2021.03.17.21252755). The supporting evidence is as follows: BS4 - Variant does not segregate with FH phenotype in 11 informative meioses in 6 families (Laboratory of Genetics and Molecular Cardiology). PP1_strong - Variant segregates with FH phenotype in 58 informative meioses in 9 families from Laboratory of Genetics and Molecular Cardiology. PP3 - REVEL: 0,92.
LDLR-LOVD, British Heart Foundation	RCV000237906	SCV000295871	likely pathogenic	Hypercholesterolemia, familial, 1	2016-03-25	criteria provided, single submitter	literature only
Robarts Research Institute, Western University	RCV000237906	SCV000484739	likely pathogenic	Hypercholesterolemia, familial, 1		criteria provided, single submitter	clinical testing
Centre de Génétique Moléculaire et Chromosomique, Unité de génétique de l'Obésité et des Dyslipidémies, APHP, GH Hôpitaux Universitaires Pitié-Salpêtrière / Charles-Foix	RCV000237906	SCV000503463	likely pathogenic	Hypercholesterolemia, familial, 1	2016-12-16	criteria provided, single submitter	clinical testing	subject mutated among 2600 FH index cases screened = 1 , family members = 3 with co-segregation / previously described in association with FH/software prediction damaging
Molecular Genetics Laboratory, Centre for Cardiovascular Surgery and Transplantation	RCV000237906	SCV000540843	likely pathogenic	Hypercholesterolemia, familial, 1	2016-11-05	criteria provided, single submitter	clinical testing
Labcorp Genetics (formerly Invitae), Labcorp	RCV000589820	SCV000544654	pathogenic	Familial hypercholesterolemia	2024-01-24	criteria provided, single submitter	clinical testing	This sequence change replaces proline, which is neutral and non-polar, with leucine, which is neutral and non-polar, at codon 699 of the LDLR protein (p.Pro699Leu). This variant is present in population databases (rs201573863, gnomAD 0.04%). This missense change has been observed in individuals with familial hypercholesterolemia (PMID: 7489239, 10882754, 21310417, 21642693, 22390909, 23375686, 25461735, 26892515, 27765764). This variant is also known as Pro678Leu. ClinVar contains an entry for this variant (Variation ID: 252219). 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 LDLR protein function with a positive predictive value of 95%. For these reasons, this variant has been classified as Pathogenic.
U4M - Lille University & CHRU Lille, Université de Lille - CHRU de Lille	RCV000237906	SCV000583929	pathogenic	Hypercholesterolemia, familial, 1	2017-03-30	criteria provided, single submitter	clinical testing
Laboratory of Genetics and Molecular Cardiology, University of São Paulo	RCV000237906	SCV000588634	uncertain significance	Hypercholesterolemia, familial, 1	2016-03-01	criteria provided, single submitter	research
Fundacion Hipercolesterolemia Familiar	RCV000237906	SCV000607675	uncertain significance	Hypercholesterolemia, familial, 1	2016-03-01	criteria provided, single submitter	research
Women's Health and Genetics/Laboratory Corporation of America, LabCorp	RCV000589820	SCV000697211	pathogenic	Familial hypercholesterolemia	2023-09-21	criteria provided, single submitter	clinical testing	Variant summary: LDLR c.2096C>T (p.Pro699Leu) results in a non-conservative amino acid change located in the EGF-like domain (IPR000742) of the encoded protein sequence. Five of five in-silico tools predict a damaging effect of the variant on protein function. The variant allele was found at a frequency of 2e-05 in 251028 control chromosomes. c.2096C>T has been reported in the literature as a heterozygous genotype in multiple individuals affected with autosomal dominant Familial Hypercholesterolemia (example, Schuster_1995, Huijgen_2012, Bertolini_2013, Jannes_2015, Wang_2016, Tichy_2012, Ahmad_2012, Marco-Benedi_2022, Sharifi_2016) to include at-least one compound heterozygous proband with severe Hypercholesterolemia whose obligate carrier father with this variant was reportedly unaffected, i.e., normal cholesterol levels at age 39 (Schuster_1995). This same study also reported co-segregation with Hypercholesterolemia in a second family but did not provide primary evidence supporting this finding (Schuster_1995). As the variant allele was transmitted much more often than the reference allele to affected members in tested families, these data indicate that the variant is very likely to be associated with disease. To our knowledge, no experimental evidence demonstrating an impact on protein function has been reported. The following publications have been ascertained in the context of this evaluation (PMID: 23064986, 23375686, 22698793, 22390909, 25461735, Wang_2016 has NO_PMID, 7489239, 34456049, 26892515). Multiple submitters including an expert panel (ClinGen Familial Hypercholesterolemia Variant Curation Expert Panel) have cited clinical-significance assessments for this variant to ClinVar after 2014 with conflicting assessments but a predominant consensus as Pathogenic/Likely pathogenic (n=12) and VUS (n=4 to include the Expert Panel). Some submitters cite overlapping evidence utilized in the context of this evaluation while the Expert Panel cites both apparent non-segregation and co-segregation without providing primary evidence for independent corroboration. Based on the evidence outlined above, the variant was classified as pathogenic.
Color Diagnostics, LLC DBA Color Health	RCV000589820	SCV000911498	likely pathogenic	Familial hypercholesterolemia	2023-11-03	criteria provided, single submitter	clinical testing	This missense variant replaces proline with leucine at codon 699 in the EGF-like repeat C of the EGF precursor homology domain of the LDLR protein. This variant is also known as p.Pro678Leu in the mature protein. Computational prediction suggests that this variant may have a deleterious impact on protein structure and function (internally defined REVEL score threshold >= 0.7, PMID: 27666373). A functional study using transfected HeLa cells has shown that this variant causes LDLR protein misfolding and retention in the endoplasmic reticulum (PMID: 20089850). This variant has been reported in over 20 individuals affected with familial hypercholesterolemia (PMID: 10882754, 11810272, 11851376, 19318025, 21310417, 21642693, 22698793, 23064986, 23375686, 26892515, 27824480, 33994402, 34037665, 35137788). While this variant has been shown to segregate with disease, with 58 informative meioses across 9 families, it has also shown non-segregation in 11 informative meioses across 6 families (ClinVar SCV001960938.1). This variant has been identified in 11/282422 chromosomes in the general population by the Genome Aggregation Database (gnomAD). Based on the available evidence, this variant is classified as Likely Pathogenic.
Laboratory for Molecular Medicine, Mass General Brigham Personalized Medicine	RCV000826172	SCV000967711	likely pathogenic	Homozygous familial hypercholesterolemia	2019-03-26	criteria provided, single submitter	clinical testing	The p.Pro699Leu variant in LDLR (also reported as p.Pro678Leu in the literature) has been reported in the heterozygous state at least 11 individuals with familial hypercholesterolemia (FH) and 7 individuals with suspected FH (Thiart 2000, Fouchier 2001, Van Gaal 2001, Huijgen 2011, Tichy 2012, Bertolini 2013, Jannes 2015, Wang 2016, Sharif 2016). It was also identified in 1 individual with homozygous FH who had a second pathogenic loss of function variant in LDLR (Schuster 1995). This variant was also present in this individual's father who had normal cholesterol levels, suggesting reduced penetrance. The p.Pro699Leu variant has been reported by other clinical laboratories in ClinVar (Variation ID# 252219) and has been identified in 9/24032 African chromosomes by the Genome Aggregation Database (GnomAD, http://gnomad.broadinstitute.org; dbSNP rs201573863). This frequency is low enough to be consistent with the frequency of FH in the general population. Computational prediction tools and conservation analysis suggest that the p.Pro699Leu variant may impact the protein. In summary, although additional studies are required to fully establish its clinical significance, the p.Pro699Leu variant is likely pathogenic. The ACMG/AMP Criteria applied (Richards 2015): PS4, PM2_supporting, PP3.
Division of Medical Genetics, University of Washington	RCV000237906	SCV001424793	pathogenic	Hypercholesterolemia, familial, 1	2019-09-10	criteria provided, single submitter	clinical testing	This variant has an overall allele frequency of 0.00004 in the Broad Institute gnomAD Browser (https://gnomad.broadinstitute.org/). In silico analyses indicate this is an evolutionarily conserved residue. This variant has been reported in the literature in multiple individuals and families with familial hypercholesterolemia (Schuster 1995, Thiart 2000, Fouchier 2001, Van Gaal 2001, Huijgen 2011, Tichy 2012, Bertolini 2013, Janness 2015, Sharifi 2016, Wang 2016). Thus, this variant is interpreted as pathogenic.
Quest Diagnostics Nichols Institute San Juan Capistrano	RCV001284644	SCV001470534	pathogenic	not provided	2019-11-21	criteria provided, single submitter	clinical testing	The best available variant frequency is uninformative because it is below the disease allele frequency. Predicted to have a damaging effect on the protein. In multiple individuals, this variant has been seen with a single recessive pathogenic variant in the same gene, suggesting this variant may also be pathogenic. This variant is statistically more frequent in affected individuals than in the general population and/or healthy controls.
Human Genome Sequencing Center Clinical Lab, Baylor College of Medicine	RCV000237906	SCV001754790	likely pathogenic	Hypercholesterolemia, familial, 1	2019-10-31	criteria provided, single submitter	clinical testing	The c.2096C>T (p.Pro699Leu) variant in exon 14 of LDLR gene results in an amino acid change at residue 699 from a proline to a leucine. This variant has been reported in multiple unrelated individuals and families with familial hypercholesterolemia (PMID: 21642693, 7489239, 21310417, 26892515, 25461735, 10882754). Multiple lines of in silico algorithms have predicted this p.Pro699Leu change to be deleterious. Functional studies (PMID: 20089850) demonstrated that the mutant protein misfolded with a loss of normal protein tracking pattern. Therefore, this variant c.2096C>T (p.Pro699Leu) of LDLR is classified as likely pathogenic.
GeneDx	RCV001284644	SCV002498865	likely pathogenic	not provided	2024-05-03	criteria provided, single submitter	clinical testing	Reported in the heterozygous state in numerous individuals from different ethnic backgrounds with a clinical diagnosis of FH (PMID: 10882754, 11810272, 11851376, 19318025, 21310417, 21642693, 22698793, 23375686, 24507775, 25461735, 26892515, 31106297, 35339733, 34456049, 35480308); Located in the third EGF-like repeat within the LDL-receptor EGF precursor homology domain (PMID: 12459547, 2988123); In silico analysis supports that this missense variant has a deleterious effect on protein structure/function; Also known as p.(P678L); This variant is associated with the following publications: (PMID: 11810272, 21310417, 26892515, 10882754, 19318025, 23375686, 22390909, 11851376, 24507775, 21642693, 25461735, 22698793, 34040191, 32719484, 34037665, 33740630, 33303402, 30586733, 32041611, 35339733, 32220565, 23064986, 27824480, 34234266, 27765764, 33994402, 23769672, 31106297, 31447099, 37443404, 20506408, 29192238, 36769882, 12459547, 2988123, 20089850, 34363016, 34456049, 35480308, 28502495, 37409534, 7489239)
Ambry Genetics	RCV002418071	SCV002726638	likely pathogenic	Cardiovascular phenotype	2024-02-27	criteria provided, single submitter	clinical testing	The p.P699L variant (also known as c.2096C>T), located in coding exon 14 of the LDLR gene, results from a C to T substitution at nucleotide position 2096. The proline at codon 699 is replaced by leucine, an amino acid with similar properties. This variant, also known as p.P678L, has been reported in numerous familial hypercholesterolemia (FH) cohorts, though clinical details were limited in many of the studies (e.g., Thiart R et al. J. Med. Genet., 2000 Jul;37:514-9; Ahmad Z et al, Circ Cardiovasc Genet 2012 Dec; 5(6):666-75; Sharifi M et al. Metab. Clin. Exp., 2016 Mar;65:48-53; Jannes CE et al. Atherosclerosis, 2015 Jan;238:101-7; Wang J et al. Arterioscler. Thromb. Vasc. Biol., 2016 12;36:2439-2445; Gabová D et al. Physiol Res, 2017 Mar;66:75-84; Kawame H et al. J Hum Genet, 2021 Jul;). This alteration has also been described in the compound heterozygous or homozygous state in multiple probands with homozygous FH (Schuster H et al, Arterioscler. Thromb. Vasc. Biol. 1995 Dec; 15(12):2176-80; Santos RD. Atheroscler Suppl, 2014 Sep;15:19-25). This amino acid position is highly conserved in available vertebrate species. In addition, this alteration is predicted to be deleterious by in silico analysis. Based on the majority of available evidence to date, this variant is likely to be pathogenic.
Revvity Omics, Revvity	RCV000237906	SCV003816526	uncertain significance	Hypercholesterolemia, familial, 1	2022-05-27	criteria provided, single submitter	clinical testing
Mayo Clinic Laboratories, Mayo Clinic	RCV001284644	SCV004227683	likely pathogenic	not provided	2023-04-21	criteria provided, single submitter	clinical testing	BS4, PP1, PP3, PM3, PS4
ARUP Laboratories, Molecular Genetics and Genomics, ARUP Laboratories	RCV001284644	SCV004562584	likely pathogenic	not provided	2023-09-29	criteria provided, single submitter	clinical testing	The LDLR c.2096C>T p.Pro699Leu variant, also known as Pro678Leu, (rs201573863) is reported in the literature in several individuals and families with clinically diagnosed familial hypercholesterolemia (selected publications: Ajufo 2021, Brown 2020, Lange 2014, Sun 2018), including a few homozygous or compound heterozygous individuals affected with severe disease (Santos 2014, Schuster 1995). This variant is also reported in ClinVar (Variation ID: 252219), and is found in the general population with an overall allele frequency of 0.0034% (11/282422 alleles) in the Genome Aggregation Database. Computational analyses predict that this variant is deleterious (REVEL: 0.920). Based on available information, this variant is considered to be likely pathogenic. References: Ajufo E et al. A randomized controlled trial of genetic testing and cascade screening in familial hypercholesterolemia. Genet Med. 2021 Sep;23(9):1697-1704. PMID: 34040191. Brown EE et al. Incorporation of genetic testing significantly increases the number of individuals diagnosed with familial hypercholesterolemia. J Clin Lipidol. 2020 May-Jun;14(3):331-338. PMID: 32220565. Lange LA et al. Whole-exome sequencing identifies rare and low-frequency coding variants associated with LDL cholesterol. Am J Hum Genet. 2014 Feb 6;94(2):233-45. PMID: 24507775. Santos RD. What are we able to achieve today for our patients with homozygous familial hypercholesterolaemia, and what are the unmet needs? Atheroscler Suppl. 2014 Sep;15(2):19-25. PMID: 25257073. Schuster H et al. Ten LDL receptor mutants explain one third of familial hypercholesterolemia in a German sample. Arterioscler Thromb Vasc Biol. 1995 Dec;15(12):2176-80. PMID: 7489239. Sun YV et al. Effects of Genetic Variants Associated with Familial Hypercholesterolemia on Low-Density Lipoprotein-Cholesterol Levels and Cardiovascular Outcomes in the Million Veteran Program. Circ Genom Precis Med. 2018 Dec;11(12):e002192. PMID: 31106297.
Center for Genomic Medicine, King Faisal Specialist Hospital and Research Center	RCV000237906	SCV005373905	likely pathogenic	Hypercholesterolemia, familial, 1	2024-09-22	criteria provided, single submitter	clinical testing
Laboratorium voor Moleculaire Diagnostiek Experimentele Vasculaire Geneeskunde, Academisch Medisch Centrum	RCV000237906	SCV000606597	pathogenic	Hypercholesterolemia, familial, 1		no assertion criteria provided	research