Submissions for variant NM_001370658.1(BTD):c.451G>A (p.Ala151Thr)

gnomAD frequency: 0.00039  dbSNP: rs13073139

Total submissions: 21

Submitter	RCV	SCV	Clinical significance	Condition	Last evaluated	Review status	Method	Comment
GeneDx	RCV000078073	SCV000238743	pathogenic	not provided	2018-09-13	criteria provided, single submitter	clinical testing	The A171T variant has only been reported on the same allele as D444H comprising what has been described as a double mutation allele, denoted A171T;D444H. A171T;D444H has been observed in approximately 17% of alleles in children with profound biotinidase deficiency ascertained by newborn screening in the United States (Norrgard et al., 1999). The A171T variant was seen with the D444H variant at GeneDx.
Center for Pediatric Genomic Medicine, Children's Mercy Hospital and Clinics	RCV000078073	SCV000281607	pathogenic	not provided	2014-08-13	criteria provided, single submitter	clinical testing
Fulgent Genetics, Fulgent Genetics	RCV000031859	SCV000611183	pathogenic	Biotinidase deficiency	2017-05-18	criteria provided, single submitter	clinical testing
Invitae	RCV000031859	SCV000630334	uncertain significance	Biotinidase deficiency	2018-07-05	criteria provided, single submitter	clinical testing	This sequence change replaces alanine with threonine at codon 171 of the BTD protein (p.Ala171Thr). The alanine residue is highly conserved and there is a small physicochemical difference between alanine and threonine. This variant is present in population databases (rs13073139, ExAC 0.07%). This variant has been reported in the literature in multiple individuals affected with biotinidase (BTD) deficiency co-occurring on the same chromosome with the common pathogenic p.Asp444His BTD variant (PMID: 10206677, 21752405, 9654207, 20556795, 12227467, 25174816, 20549359, 27329734, 9375914). ClinVar contains an entry for this variant (Variation ID: 25016, 38298). Algorithms developed to predict the effect of missense changes on protein structure and function do not agree on the potential impact of this missense change (SIFT: "Tolerated"; PolyPhen-2: "Probably Damaging"; Align-GVGD: "Class C0"). In summary, this variant is a rare missense change with uncertain impact on protein function. Therefore, it has been classified as a Variant of Uncertain Significance.
Quest Diagnostics Nichols Institute San Juan Capistrano	RCV000078073	SCV000888019	pathogenic	not provided	2021-01-07	criteria provided, single submitter	clinical testing
Illumina Laboratory Services, Illumina	RCV000031859	SCV000915026	pathogenic	Biotinidase deficiency	2018-03-30	criteria provided, single submitter	clinical testing	Across a selection of the available literature, the BTD c.511G>A (p.Ala171Thr) variant has been found as part of a complex allele [p.Ala171Thr;p.Asp444His] in a majority of cases including 25 individuals, a majority of whom were newborns, with the variant in a compound heterozygous state, 20 with profound biotinidase deficiency, four with partial biotinidase deficiency, and one individual who did not have information on biotinidase activity (Norrgard et al. 1998; Norrgard et al. 1999; Borsatto et al. 2014; Borsatto et al. 2017). The second variant identified in the compound heterozygous individuals was most often a missense variant. The complex allele has also been reported in a homozygous state in three individuals with profound biotinidase deficiency including a father-daughter pair from a consanguineous family where one parent and two grandparents were all heterozygous carriers of the variant and were unaffected (Wolf et al. 1997). A study by Lindau-Shepart et al. (2012) also identified the p.Ala171Thr variant in at least ten patients without the p.Asp444His variant, including five with a different second variant, but in whom zygosity was not specified. In addition, since a limited number of variants were evaluated in this study, the authors suggest that a less common variant may also be present with the p.Ala171Thr variant in the five individuals with a single variant detected. The p.Ala171Thr variant was absent from 376 normal blood spots and is reported at a frequency of 0.00066 in the European (non-Finnish) population of the Exome Aggregation Consortium. Based on the collective evidence, the p.Ala171Thr variant is classified as pathogenic for biotinidase deficiency.
Mendelics	RCV000031859	SCV001136341	pathogenic	Biotinidase deficiency	2019-05-28	criteria provided, single submitter	clinical testing
Myriad Genetics, Inc.	RCV000031859	SCV001193777	pathogenic	Biotinidase deficiency	2019-12-26	criteria provided, single submitter	clinical testing	NM_000060.2(BTD):c.511G>A(A171T) is classified as pathogenic in the context of biotinidase deficiency. Please note that this variant is frequently observed in combination with D444H in the literature, which suggests they are likely to be on the same chromosome. When A171T and D444H are present on the same chromosome, this combination of variants is associated with profound biotinidase deficiency. Sources cited for classification include the following: PMID 27625817, 29995633, 28971021, 21752405 and 18845537. Classification of NM_000060.2(BTD):c.511G>A(A171T) is based on the following criteria: This is a well-established pathogenic variant in the literature that has been observed more frequently in patients with clinical diagnoses than in healthy populations. Please note: this variant was assessed in the context of healthy population screening.
CeGaT Center for Human Genetics Tuebingen	RCV000078073	SCV001246039	pathogenic	not provided	2018-12-01	criteria provided, single submitter	clinical testing
Knight Diagnostic Laboratories, Oregon Health and Sciences University	RCV000031859	SCV001448938	pathogenic	Biotinidase deficiency	2018-09-13	criteria provided, single submitter	clinical testing
Institute for Clinical Genetics, University Hospital TU Dresden, University Hospital TU Dresden	RCV000078073	SCV002010531	pathogenic	not provided	2021-11-03	criteria provided, single submitter	clinical testing
Revvity Omics, Revvity	RCV000031859	SCV002017997	pathogenic	Biotinidase deficiency	2023-03-02	criteria provided, single submitter	clinical testing
DASA	RCV000031859	SCV002097263	pathogenic	Biotinidase deficiency	2022-02-14	criteria provided, single submitter	clinical testing	The c.451G>A;p.(Ala151Thr) missense variant has been observed in affected individual(s) (PMID: 29995633; 28971021; 28498829; 27329734; 25174816) - PS4. The variant is located in a mutational hot spot and/or critical and well-established functional domain (CN_hydrolase) - PM1. The variant is present at low allele frequencies population databases (rs13073139 - gnomAD 0.003485%; ABraOM no frequency - http://abraom.ib.usp.br/) - PM2_supporting. The p.(Ala151Thr) was detected in trans with a pathogenic variant (PMID: 29995633; 28971021; 28498829; 27329734; 25174816) - PM3_very strong. Multiple lines of computational evidence support a deleterious effect on the gene or gene product - PP3. The variant was observed in trans with a pathogenic variant for a fully penetrant dominant gene/disorder or observed in cis with a pathogenic variant in any inheritance pattern - BP2. In summary, the currently available evidence indicates that the variant is pathogenic.
Women's Health and Genetics/Laboratory Corporation of America, LabCorp	RCV000031859	SCV002572407	pathogenic	Biotinidase deficiency	2022-08-29	criteria provided, single submitter	clinical testing	Variant summary: BTD c.451G>A (p.Ala151Thr) results in a non-conservative amino acid change located in the Carbon-nitrogen hydrolase (IPR003010) 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 0.00033 in 251332 control chromosomes (gnomAD), predominantly at a frequency of 0.00065 within the Non-Finnish European subpopulation in the gnomAD database. This frequency is not significantly higher than expected for a pathogenic variant in BTD causing Biotinidase Deficiency (0.00033 vs 0.0046), allowing no conclusion about variant significance. c.451G>A (often reported as c.511G>A) frequently occurs in cis with c.1270G>C [p.Asp424His] (often reported as c.1330G>C, p.Asp444His) as a complex allele. This allele has been reported in the literature in multiple individuals affected with Biotinidase Deficiency (e.g.Pomponio_2000, Borsatto_2019, Sarafoglou_2009, Tangeraas_2020). These data indicate that the variant is very likely to be associated with disease. Although the variant has not been examined in vitro in isolation, the complex allele is expected to have 0-10% enzymatic activity based on plasma biotinidase activity levels from patients whose other allele has a quantified variant (Borsatto_2019). Twelve ClinVar submitters have assessed the variant since 2014: eleven have classified the variant as pathogenic and one as uncertain significance. Based on the evidence outlined above, the variant was classified as pathogenic.
Ambry Genetics	RCV002514126	SCV003756359	pathogenic	Inborn genetic diseases	2021-09-29	criteria provided, single submitter	clinical testing	The c.511G>A (p.A171T) alteration is located in exon 4 (coding exon 4) of the BTD gene. This alteration results from a G to A substitution at nucleotide position 511, causing the alanine (A) at amino acid position 171 to be replaced by a threonine (T). Manual RD edits for complex allele_x000D_ _x000D_ _x000D_ The c.1330G>C (p.D444H) alteration is located in exon 4 (coding exon 4) of the BTD gene. This alteration results from a G to C substitution at nucleotide position 1330, causing the aspartic acid (D) at amino acid position 444 to be replaced by a histidine (H). The c.511G>A (p.A171T) alteration is located in exon 4 (coding exon 4) of the BTD gene. This alteration results from a G to A substitution at nucleotide position 511, causing the alanine (A) at amino acid position 171 to be replaced by a threonine (T)._x000D_ _x000D_ The [c.1330G>C (p.D444H); c.511G>A (p.A171T)] complex allele results in a profound deficiency allele with <10% of residual enzyme activity. This complex allele has been reported in patients with profound biotinidase deficiency when in trans with another profound allele or in the homozygous state (Swango, 1998; Norrgard, 1998; Mil&aacute;nkovics, 2010; Cowan, 2010)._x000D_ _x000D_ Based on the available evidence, the BTD [c.1330G>C (p.D444H); c.511G>A (p.A171T)] complex allele is classified as pathogenic. Based on the available evidence, this alteration is classified as pathogenic.
Baylor Genetics	RCV000031859	SCV003836470	pathogenic	Biotinidase deficiency	2022-03-25	criteria provided, single submitter	clinical testing
Laboratory for Molecular Medicine, Mass General Brigham Personalized Medicine	RCV000031859	SCV004847508	pathogenic	Biotinidase deficiency	2017-01-31	criteria provided, single submitter	clinical testing	The p.Ala171Thr (NM_000060.2 c.511G>A) variant in BTD has previously been reported in several compound heterozygous individuals with biotinidase deficiency (Norrgard 1998 and Borsatto 2014). These reports identify the variant in cis with p.Asp444His (c.1330G>C), a partial deficiency allele on its own. The p.Ala171Thr variant has been identified in 0.04% (47/120,592) of chromosomes by the Exome Aggregation Consortium (ExAC, http://exac.broadinstitute.org; dbSNP rs13073139), which is assumed to represent the combined p.[Ala171Thr;Asp444His] allele. In summary, the p.Ala171Thr variant, when found as p.[Ala171Thr;Asp444His], meets our criteria to be classified as pathogenic for biotinidase deficiency in an autosomal recessive manner primarily based upon its occurrence in trans with other pathogenic variants in affected individuals.
GeneReviews	RCV000031859	SCV000054465	not provided	Biotinidase deficiency		no assertion provided	literature only
GenomeConnect, ClinGen	RCV000031859	SCV001423159	not provided	Biotinidase deficiency		no assertion provided	phenotyping only	Variant interpretted as Pathogenic and reported on 12-12-2018 by Lab or GTR ID 26957. 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.
Joint Genome Diagnostic Labs from Nijmegen and Maastricht, Radboudumc and MUMC+	RCV000078073	SCV001953022	pathogenic	not provided		no assertion criteria provided	clinical testing
Clinical Genetics DNA and cytogenetics Diagnostics Lab, Erasmus MC, Erasmus Medical Center	RCV000078073	SCV001967056	pathogenic	not provided		no assertion criteria provided	clinical testing