Submissions for variant NM_000535.7(PMS2):c.736_741delinsTGTGTGTGAAG (p.Pro246_Pro247delinsCysValTer)

dbSNP: rs267608150

Total submissions: 23

Submitter	RCV	SCV	Clinical significance	Condition	Last evaluated	Review status	Method	Comment
International Society for Gastrointestinal Hereditary Tumours (InSiGHT)	RCV000076885	SCV000108380	pathogenic	Lynch syndrome	2013-09-05	reviewed by expert panel	research	Coding sequence variation resulting in a stop codon
GeneDx	RCV000235196	SCV000149612	pathogenic	not provided	2020-12-11	criteria provided, single submitter	clinical testing	Frameshift variant predicted to result in protein truncation or nonsense mediated decay in a gene for which loss-of-function is a known mechanism of disease; Observed in individuals with Lynch syndrome (LS) and LS-related cancers as well as in individuals with constitutional mismatch repair deficiency (CMMR-D) syndrome (Clendenning 2008, Senter 2008, Herkert 2011, Alexander 2016, Rosty 2016, Wang 2020); Truncating variants in this gene are considered pathogenic by a well-established clinical consortium and/or database; Also known as c.736_741del6ins11; Not observed in large population cohorts (Lek 2016); This variant is associated with the following publications: (PMID: 20205264, 22577899, 18602922, 30702970, 16619239, 24323032, 18178629, 21376568, 20487569, 20093870, 26552419, 25856668, 26895986, 27037742, 22081473, 26845104, 26681312, 27601186, 28418444, 29485237, 28466842, 23733757, 16817031, 21204794, 20682701, 29790872, 30322717, 31992580, 31447099, 33193653, 32719484, 32773772)
Ambry Genetics	RCV000115703	SCV000217757	pathogenic	Hereditary cancer-predisposing syndrome	2019-03-08	criteria provided, single submitter	clinical testing	The c.736_741delCCCCCTins11 pathogenic mutation (also known as c.736_741delCCCCCTinsTGTGTGTGAAG and c.736_741del6ins11), located in coding exon 7 of the PMS2 gene, results from the deletion of 6 nucleotides and insertion of 11 nucleotides, causing a translational frameshift with a predicted alternate stop codon (p.P246Cfs*3). Multiple studies have identified this mutation in association with clinical findings consistent with a diagnosis of HNPCC/Lynch syndrome (Clendenning M et al. Hum. Mutat. 2006 May;27:490-5; Clendenning M et al. J. Med. Genet. 2008 Jun;45:340-5; Talseth-Palmer BA et al. Hered. Cancer Clin. Pract. 2010 May;8:5; Herkert JC et al. Eur. J. Cancer. 2011 May;47:965-82; Buchanan DD et al. J. Clin. Oncol. 2014 Jan;32:90-100). Subsequent studies have supported this alteration as a founder mutation that arose approximately 1625 years ago, is enriched in individuals with British and Swedish ancestry, and may be associated with reduced penetrance (Clendenning M et al. J. Med. Genet. 2008 Jun;45:340-5). A more recent study also found this to be a founder mutation in the Icelandic population (Haraldsdottir S et al. Nat. Commun. 2017 May;8:14755). In addition to the clinical data presented in the literature, this alteration is expected to result in loss of function by premature protein truncation or nonsense-mediated mRNA decay. As such, this alteration is interpreted as a disease-causing mutation.
Invitae	RCV001201395	SCV000255296	pathogenic	Hereditary nonpolyposis colorectal neoplasms	2020-01-08	criteria provided, single submitter	clinical testing	This sequence change deletes 6 nucleotides and inserts 11 nucleotides in exon 7 of the PMS2 mRNA (c.736_741delinsTGTGTGTGAAG), causing a frameshift at codon 246. This creates a premature translational stop signal (p.Pro246Cysfs*3) and is expected to result in an absent or disrupted protein product. The frequency data for this variant in the population databases is considered unreliable, as metrics indicate poor data quality at this position in the ExAC database. This variant has been reported in individuals and families affected with Lynch syndrome-associated tumors (PMID: 16619239, 24323032, 18178629, 21376568). This variant has been reported as a common cause of Lynch syndrome in individuals with British and Swedish ancestry (PMID: 18178629). It is also known as c.736_741del6ins11 in the literature. ClinVar contains an entry for this variant (Variation ID: 91366). Loss-of-function variants in PMS2 are known to be pathogenic (PMID: 21376568, 24362816). For these reasons, this variant has been classified as Pathogenic.
HudsonAlpha Institute for Biotechnology, HudsonAlpha Institute for Biotechnology	RCV000009829	SCV000584108	pathogenic	Lynch syndrome 4	2014-12-09	criteria provided, single submitter	research
Color Diagnostics, LLC DBA Color Health	RCV000115703	SCV000686231	pathogenic	Hereditary cancer-predisposing syndrome	2023-12-15	criteria provided, single submitter	clinical testing	This variant causes a frameshift and creates a premature translation stop codon in exon 7 of the PMS2 gene. This variant is expected to result in an absent or non-functional protein product. This variant is also known as c.736_741del6ins11 in the literature. This variant has been reported as a founder mutation in individuals of Northern European ancestry (PMID: 18178629) and has been detected in individuals affected with Lynch syndrome-associated cancers in Europe, North American and Australia (PMID: 16619239, 18178629, 20682701, 23733757, 24323032, 26681312, 27435373, 28466842, 30702970). This variant also has been observed in individuals with compound heterozygous PMS2 mutations who are affected with constitutional mismatch repair deficiency syndrome (PMID: 21376568, 32773772). This variant has not been identified in the general population by the Genome Aggregation Database (gnomAD). Loss of PMS2 function is a known mechanism of disease (clinicalgenome.org). Based on the available evidence, this variant is classified as Pathogenic.
Women's Health and Genetics/Laboratory Corporation of America, LabCorp	RCV000076885	SCV000697382	pathogenic	Lynch syndrome	2017-04-21	criteria provided, single submitter	clinical testing	Variant summary: The PMS2 c.736_741delinsTGTGTGTGAAG (p.Pro246Cysfs) variant results in a premature termination codon, predicted to cause a truncated or absent PMS2 protein due to nonsense mediated decay, which are commonly known mechanisms for disease. Truncations downstream of this position have been classified as pathogenic by our laboratory (e.g. c.823C>T; p.Gln275X, c.861_864delACAG; p.Arg287fs). One in silico tool predicts a damaging outcome for this variant. The variant of interest is absent in a large, broad control population, ExAC in 120338 control chromosomes. The variant of interest has been reported in multiple affected individuals via publications and it was suggested that it might be a founder mutation in Swedish/Scandinavian populations (Clendenning_JMG_2008, van der Klift_Hum Mutat_2016). In addition, IHC performed on tumors showed selective lack of staining of PMS2. Lastly, multiple clinical diagnostic laboratories/reputable databases classified this variant as pathogenic. Taken together, this variant is classified as pathogenic.
Laboratory for Molecular Medicine, Mass General Brigham Personalized Medicine	RCV000076885	SCV000731267	pathogenic	Lynch syndrome	2019-05-08	criteria provided, single submitter	clinical testing	The p.Pro246CysfsX3 variant in PMS2 has been reported in the heterozygous state in more than 13 individuals with Lynch Syndrome-associated cancers (Clendenning 2008, Senter 2008, Ward 2013) and in the compound heterozygous state with another loss-of-function PMS2 variant in at least one individual with constitutional mismatch repair deficiency syndrome (Susswein 2015). Data from large population studies is insufficient to assess the frequency of this variant. The p.Pro246CysfsX3 variant is predicted to cause a frameshift, which alters the protein’s amino acid sequence beginning at position 246 and leads to a premature termination codon 3 amino acids downstream. This alteration is then predicted to lead to a truncated or absent protein. Heterozygous loss of function of the PMS2 gene is an established disease mechanism in individuals with Lynch Syndrome. In addition, this variant was classified as Pathogenic on Sep 5, 2013 by the ClinGen-approved InSiGHT Expert Panel (ClinVar SCV000108380.2). In summary, this variant meets criteria to be classified as pathogenic for Lynch Syndrome in an autosomal dominant manner based upon the predicted impact to the protein and presence in multiple affected individuals. ACMG/AMP criteria applied: PVS1, PS4_Strong.
Human Genome Sequencing Center Clinical Lab, Baylor College of Medicine	RCV000009829	SCV000840049	pathogenic	Lynch syndrome 4	2018-02-14	criteria provided, single submitter	clinical testing	This c.736_741delinsTGTGTGTGAAG (p.Pro246Cysfs*3) variant is predicted to result in a premature stop codon and has been reported in multiple individuals with Lynch syndrome-associated tumors (PMID: 16619239, 24323032, 18178629, 21376568). Therefore, c.736_741delinsTGTGTGTGAAG (p.P246Vfs*3) variant in the PMS2 gene is classified as pathogenic.
St. Jude Molecular Pathology, St. Jude Children's Research Hospital	RCV000722010	SCV000853183	pathogenic	Burkitt lymphoma; Lymphoma	2017-03-07	criteria provided, single submitter	clinical testing	This is a frameshift alteration in which coding nucleotides 736 through 741 are deleted and replaced with 11 nucleotides. This is predicted to change a Proline to a Cysteine at amino acid codon 246 and shift the reading frame. Classification criteria: PVS1, PS3, PM2.
Fulgent Genetics, Fulgent Genetics	RCV000763590	SCV000894429	pathogenic	Mismatch repair cancer syndrome 1; Lynch syndrome 4	2018-10-31	criteria provided, single submitter	clinical testing
Quest Diagnostics Nichols Institute San Juan Capistrano	RCV000235196	SCV001470606	pathogenic	not provided	2022-04-27	criteria provided, single submitter	clinical testing	The PMS2 c.736_741delinsTGTGTGTGAAG (p.Pro246Cysfs*3) variant alters the translational reading frame of the PMS2 mRNA and causes the premature termination of PMS2 protein synthesis. This variant has been reported in the published literature in several individuals and families affected with a Lynch syndrome associated cancer and/or polyps (PMIDs: 18602922 (2008), 27435373 (2016), 28466842 (2017), 30702970 (2019)), as well as in an individual affected with CMMRD (PMID: 21376568 (2011)). Based on the available information, this variant is classified as pathogenic.
Women's Health and Genetics/Laboratory Corporation of America, LabCorp	RCV001804827	SCV002051310	pathogenic	Hereditary nonpolyposis colon cancer	2021-12-21	criteria provided, single submitter	clinical testing	Variant summary: PMS2 c.736_741delinsTGTGTGTGAAG (p.Pro246CysfsX3) results in a premature termination codon, predicted to cause a truncation of the encoded protein or absence of the protein due to nonsense mediated decay, which are commonly known mechanisms for disease. Truncations downstream of this position have been classified as pathogenic by our laboratory. The variant allele was found at a frequency of 1.8e-05 in 279974 control chromosomes. c.736_741delins11 has been reported in the literature in multiple individuals affected with Hereditary Nonpolyposis Colorectal Cancer (e.g. Clendenning_2008, vanderKlift_2016) or Endometrial cancer (Buchanan_2014). These data indicate that the variant is very likely to be associated with disease. Ten 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. Based on the evidence outlined above, the variant was classified as pathogenic.
CeGaT Center for Human Genetics Tuebingen	RCV000235196	SCV002586166	pathogenic	not provided	2023-12-01	criteria provided, single submitter	clinical testing	PMS2: PVS1, PS4:Moderate
CHEO Genetics Diagnostic Laboratory, Children's Hospital of Eastern Ontario	RCV003149759	SCV003838391	pathogenic	Breast and/or ovarian cancer	2022-02-09	criteria provided, single submitter	clinical testing
St. Jude Molecular Pathology, St. Jude Children's Research Hospital	RCV000009829	SCV004171476	pathogenic	Lynch syndrome 4	2023-10-16	criteria provided, single submitter	clinical testing	The PMS2 c.736_741delinsTGTGTGTGAAG (p.Pro246CysfsTer3) change deletes six nucleotides and inserts 11 nucleotides to cause a frameshift and the creation of a premature stop codon. This change is predicted to cause protein truncation or absence of protein due to nonsense-mediated decay. This variant has been reported in individuals with Lynch-syndrome associated cancers, some of which have demonstrated loss of PMS2 by IHC (PMID: 16619239, 24323032, 26681312, 30322717, 33193653). This variant has also been reported in individuals with constitutional mismatch repair deficiency (PMID: 21376568, internal data). This variant is absent in gnomAD v2.1.1 (https://gnomad.broadinstitute.org/). In summary, this variant meets criteria to be classified as pathogenic.
Myriad Genetics, Inc.	RCV000009829	SCV004187685	pathogenic	Lynch syndrome 4	2023-09-19	criteria provided, single submitter	clinical testing	This variant is considered pathogenic. This variant creates a frameshift predicted to result in premature protein truncation.
Mayo Clinic Laboratories, Mayo Clinic	RCV000235196	SCV004227262	pathogenic	not provided	2022-07-27	criteria provided, single submitter	clinical testing	PP4, PP5, PM2, PM3, PS4_moderate, PVS1
PreventionGenetics, part of Exact Sciences	RCV003915043	SCV004735444	pathogenic	PMS2-related condition	2023-12-21	criteria provided, single submitter	clinical testing	The PMS2 c.736_741delinsTGTGTGTGAAG variant is predicted to result in a frameshift and premature protein termination (p.Pro246Cysfs*3). This variant, also known as c.736_741del6ins11, has been reported to be causative for Lynch syndrome (Clendenning et al. 2006, PubMed ID: 16619239; Clendenning et al. 2008. PubMed ID: 18178629), endometrial cancer (Buchanan et al. 2014, PubMed ID: 24323032), and colon, glioblastoma, and ovarian cancer (Susswein et al. 2016. PubMed ID: 26681312). This variant has not been reported in a large population database, indicating this variant is rare. This variant has been interpreted as pathogenic in ClinVar (https://www.ncbi.nlm.nih.gov/clinvar/variation/91366/). Frameshift variants in PMS2 are expected to be pathogenic. This variant is interpreted as pathogenic.
OMIM	RCV000009829	SCV000030050	pathogenic	Lynch syndrome 4	2008-06-01	no assertion criteria provided	literature only
Department of Pathology and Laboratory Medicine, Sinai Health System	RCV001353497	SCV000592929	pathogenic	Carcinoma of colon		no assertion criteria provided	clinical testing	The PMS2 p.Pro246CysfsX3 variant was identified in 34 of 2806 proband chromosomes (frequency: 0.012) from individuals or families with endometrial cancer, colorectal cancer, intestinal cancer, cerebral angiosarcoma, (Buchanan 2014, Clendenning 2006, Clendenning 2008, Halvarsson 2006, Herkert 2011, Lagerstedt-Robinson 2007, Senter 2008). The variant was also identified in the following databases: dbSNP (ID: rs267608150) as With Pathogenic allele, ClinVar (classified as pathogenic by InSight, GeneDx, Ambry Genetics, Invitae, OMIM), Clinvitae (as pathogenic), COGR, Insight Colon Cancer Gene Variant Database (32X class5), and the Insight Hereditary Tumors Database (32X class5). The variant was not identifies in Zhejiang Colon Cancer Database or the Mismatch Repair Genes Variant Database. The variant was identified in control databases in 5 of 275066 chromosomes at a frequency of 0.00002 (Genome Aggregation Consortium Feb 27, 2017). The c.736_741delinsTGTGTGTGAAG variant is predicted to cause a frameshift, which alters the protein's amino acid sequence beginning at codon 246 and leads to a premature stop codon at position 248. This alteration is then predicted to result in a truncated or absent protein and loss of function. Loss of function variants of the PMS2 gene are an established mechanism of disease in colorectal cancer and is the type of variant expected to cause the disorder. In summary, based on the above information, this variant meets our laboratory’s criteria to be classified as pathogenic.
GenomeConnect, ClinGen	RCV000076885	SCV000986945	not provided	Lynch syndrome		no assertion provided	phenotyping only	Variant interpretted as pathogenic and reported on 10/17/2018 by GTR ID 500068. GenomeConnect assertions are reported exactly as they appear on the patient-provided report from the testing laboratory. GenomeConnect staff make no attempt to reinterpret the clinical significance of the variant.
Institute of Human Genetics, Medical University Innsbruck	RCV001254933	SCV001431023	pathogenic	Mismatch repair cancer syndrome 1	2020-05-06	no assertion criteria provided	research	This variant, NM_000535.6:c.736_741delinsTGTGTGTGAAG, was found in compound heterozygosity with the pathogenic variant NM_000535.6:c.2404C>T. Sample UAB332 in Perez J et al, Genet Med (PMID: 32773772).