The nucleotide substitution c.1898G> A causes an exchange of the amino acid arginine to histidine (p.Arg633His). In addition, the mutation described here has already been described in patients with hypercholesterolemia and is therefore classified as pathogenic. The mutation was observed in a patient with TC up to 270 mg/dl and LDL-C approx 230 mg/dl at the age of 45. PMID: 22390909, 16250003, 16250003
ClinVar Genomic variation as it relates to human health
NM_000527.5(LDLR):c.1898G>A (p.Arg633His)
Germline
Classification
Help
The aggregate germline classification for this variant, typically for a monogenic or Mendelian disorder as in the ACMG/AMP guidelines, or for response to a drug. This value is calculated by NCBI based on data from submitters. Read our rules for calculating the aggregate classification.
(19)
Help
Stars represent the aggregate review status, or the level of review supporting the aggregate germline classification for this VCV record. This value is calculated by NCBI based on data from submitters. Read our rules for calculating the review status. The number of submissions which contribute to this review status is shown in parentheses.
Conflicting classifications of pathogenicity
Pathogenic(5); Likely pathogenic(8); Uncertain significance(3)
Pathogenic(5); Likely pathogenic(8); Uncertain significance(3)
19
criteria provided, conflicting classifications
Somatic
No data submitted for somatic clinical impact
Somatic
No data submitted for oncogenicity
Variant Details
- Identifiers
-
NM_000527.5(LDLR):c.1898G>A (p.Arg633His)
Variation ID: 226380 Accession: VCV000226380.53
- Type and length
-
single nucleotide variant, 1 bp
- Location
-
Cytogenetic: 19p13.2 19: 11120144 (GRCh38) [ NCBI UCSC ] 19: 11230820 (GRCh37) [ NCBI UCSC ]
- Timeline in ClinVar
-
First in ClinVar Help The date this variant first appeared in ClinVar with each type of classification.
Last submission Help The date of the most recent submission for each type of classification for this variant.
Last evaluated Help The most recent date that a submitter evaluated this variant for each type of classification.
Germline May 22, 2016 Nov 24, 2024 Mar 29, 2024 - HGVS
-
... more HGVS ... less HGVSNucleotide Protein Molecular
consequenceNM_000527.5:c.1898G>A MANE Select Help Transcripts from the Matched Annotation from the NCBI and EMBL-EBI (MANE) collaboration.
NP_000518.1:p.Arg633His missense NM_001195798.2:c.1898G>A NP_001182727.1:p.Arg633His missense NM_001195799.2:c.1775G>A NP_001182728.1:p.Arg592His missense NM_001195800.2:c.1394G>A NP_001182729.1:p.Arg465His missense NM_001195803.2:c.1517G>A NP_001182732.1:p.Arg506His missense NC_000019.10:g.11120144G>A NC_000019.9:g.11230820G>A NG_009060.1:g.35764G>A LRG_274:g.35764G>A LRG_274t1:c.1898G>A - Protein change
- R633H, R506H, R592H, R465H
- Other names
- -
- Canonical SPDI
- NC_000019.10:11120143:G:A
-
Functional
consequence HelpThe effect of the variant on RNA or protein function, based on experimental evidence from submitters.
- -
-
Global minor allele
frequency (GMAF) HelpThe global minor allele frequency calculated by the 1000 Genomes Project. The minor allele at this location is indicated in parentheses and may be different from the allele represented by this VCV record.
- -
-
Allele frequency
Help
The frequency of the allele represented by this VCV record.
-
Exome Aggregation Consortium (ExAC) 0.00002
The Genome Aggregation Database (gnomAD), exomes 0.00002
The Genome Aggregation Database (gnomAD) 0.00001
- Links
Genes
| Gene | OMIM | ClinGen Gene Dosage Sensitivity Curation |
Variation Viewer
Help
Links to Variation Viewer, a genome browser to view variation data from NCBI databases. |
Related variants | ||
|---|---|---|---|---|---|---|
| HI score
Help
The haploinsufficiency score for the gene, curated by ClinGen’s Dosage Sensitivity Curation task team. |
TS score
Help
The triplosensitivity score for the gene, curated by ClinGen’s Dosage Sensitivity Curation task team. |
Within gene
Help
The number of variants in ClinVar that are contained within this gene, with a link to view the list of variants. |
All
Help
The number of variants in ClinVar for this gene, including smaller variants within the gene and larger CNVs that overlap or fully contain the gene. |
|||
| LDLR | Sufficient evidence for dosage pathogenicity | No evidence available |
GRCh38 GRCh37 |
4085 | 4361 | |
Conditions - Germline
| Condition
Help
The condition for this variant-condition (RCV) record in ClinVar. |
Classification
Help
The aggregate germline classification for this variant-condition (RCV) record in ClinVar. The number of submissions that contribute to this aggregate classification is shown in parentheses. (# of submissions) |
Review status
Help
The aggregate review status for this variant-condition (RCV) record in ClinVar. This value is calculated by NCBI based on data from submitters. Read our rules for calculating the review status. |
Last evaluated
Help
The most recent date that a submitter evaluated this variant for the condition. |
Variation/condition record
Help
The RCV accession number, with most recent version number, for the variant-condition record, with a link to the RCV web page. |
|---|---|---|---|---|
| Conflicting interpretations of pathogenicity (10) |
criteria provided, conflicting classifications
|
Jun 13, 2022 | RCV000211621.23 | |
| Conflicting interpretations of pathogenicity (4) |
criteria provided, conflicting classifications
|
Mar 29, 2024 | RCV001090454.25 | |
| Likely pathogenic (1) |
criteria provided, single submitter
|
Jul 19, 2023 | RCV002408919.4 | |
| Pathogenic (3) |
criteria provided, multiple submitters, no conflicts
|
Jan 29, 2024 | RCV001188072.11 | |
| Likely pathogenic (1) |
criteria provided, single submitter
|
May 12, 2022 | RCV004017507.1 |
Submissions - Germline
| Classification
Help
The submitted germline classification for each SCV record. (Last evaluated) |
Review status
Help
Stars represent the review status, or the level of review supporting the submitted (SCV) record. This value is calculated by NCBI based on data from the submitter. Read our rules for calculating the review status. This column also includes a link to the submitter’s assertion criteria if provided, and the collection method. (Assertion criteria) |
Condition
Help
The condition for the classification, provided by the submitter for this submitted (SCV) record. This column also includes the affected status and allele origin of individuals observed with this variant. |
Submitter
Help
The submitting organization for this submitted (SCV) record. This column also includes the SCV accession and version number, the date this SCV first appeared in ClinVar, and the date that this SCV was last updated in ClinVar. |
More information
Help
This column includes more information supporting the classification, including citations, the comment on classification, and detailed evidence provided as observations of the variant by the submitter. |
|
|---|---|---|---|---|---|
|
Pathogenic
(May 23, 2018)
|
criteria provided, single submitter
Method: clinical testing
|
Hypercholesterolemia, familial, 1
Affected status: yes
Allele origin:
germline
|
Department of Human Genetics, Laborarztpraxis Dres. Walther, Weindel und Kollegen
Accession: SCV000987029.1
First in ClinVar: Aug 31, 2019 Last updated: Aug 31, 2019 |
Comment:
The nucleotide substitution c.1898G> A causes an exchange of the amino acid arginine to histidine (p.Arg633His). In addition, the mutation described here has already been … (more)
The nucleotide substitution c.1898G> A causes an exchange of the amino acid arginine to histidine (p.Arg633His). In addition, the mutation described here has already been described in patients with hypercholesterolemia and is therefore classified as pathogenic. The mutation was observed in a patient with TC up to 270 mg/dl and LDL-C approx 230 mg/dl at the age of 45. PMID: 22390909, 16250003, 16250003 (less)
|
|
|
Likely Pathogenic
(May 12, 2022)
|
criteria provided, single submitter
Method: clinical testing
|
Homozygous familial hypercholesterolemia
(Autosomal dominant inheritance)
Affected status: unknown
Allele origin:
germline
|
Laboratory for Molecular Medicine, Mass General Brigham Personalized Medicine
Accession: SCV004847737.1
First in ClinVar: Apr 20, 2024 Last updated: Apr 20, 2024 |
Comment:
The p.Arg633His variant in LDLR (also described as p.Arg612His in the literature) has been reported in at least 9 individuals with familial hypercholesterolemia (FH), including … (more)
The p.Arg633His variant in LDLR (also described as p.Arg612His in the literature) has been reported in at least 9 individuals with familial hypercholesterolemia (FH), including 2 compound heterozygotes (Fouchier 2005 PMID: 16250003, Damgaard 2005 PMID: 15823288, Huijgen 2012 PMID: 22390909, Alonso 2016 PMID: 27578128, Alver 2019 PMID: 30270359, Meshkov 2020 PMID: 33418990, Sturm 2021 PMID: 34037665). It has also been reported by other clinical laboratories in ClinVar (Variation ID: 226380) and has been identified in 0.007% (2/30616) of South Asian chromosomes by gnomAD (http://gnomad.broadinstitute.org). This frequency is low enough to be consistent with the frequency of FH in the general population. Computational prediction tools and conservation analyses are consistent with pathogenicity. Another variant involving this codon (p.Arg633Cys) has been identified in individuals with FH and is classified as likely pathogenic by this laboratory. In summary, although additional studies are required to fully establish its clinical significance, this variant meets criteria to be classified as likely pathogenic for autosomal dominant FH. ACMG/AMP Criteria applied: PM2_Supporting, PM5, PP3, PS4_Moderate. (less)
|
|
|
Likely pathogenic
(Oct 01, 2019)
|
criteria provided, single submitter
Method: clinical testing
|
not provided
Affected status: yes
Allele origin:
germline
|
CeGaT Center for Human Genetics Tuebingen
Accession: SCV001246011.26
First in ClinVar: May 12, 2020 Last updated: Oct 20, 2024 |
Number of individuals with the variant: 1
|
|
|
Likely pathogenic
(May 24, 2021)
|
criteria provided, single submitter
Method: clinical testing
|
Hypercholesterolemia, familial, 1
Affected status: yes
Allele origin:
germline
|
Laboratory of molecular diagnosis of dyslipidemias, Università egli studi di Napoli Federico II
Accession: SCV001653653.1
First in ClinVar: Jun 08, 2021 Last updated: Jun 08, 2021 |
Number of individuals with the variant: 1
Ethnicity/Population group: Caucasian
Geographic origin: Italy
|
|
|
Pathogenic
(Mar 29, 2024)
|
criteria provided, single submitter
Method: clinical testing
|
Not provided
Affected status: unknown
Allele origin:
germline
|
Mayo Clinic Laboratories, Mayo Clinic
Accession: SCV005413320.1
First in ClinVar: Nov 24, 2024 Last updated: Nov 24, 2024 |
Comment:
PP3, PM2, PM3_strong, PS4
Number of individuals with the variant: 1
|
|
|
Uncertain significance
(Jan 22, 2020)
|
criteria provided, single submitter
Method: curation
|
Hypercholesterolemia, familial, 1
(Autosomal dominant inheritance)
Affected status: unknown
Allele origin:
germline
|
Broad Center for Mendelian Genomics, Broad Institute of MIT and Harvard
Accession: SCV001423088.2
First in ClinVar: Jul 19, 2020 Last updated: Feb 02, 2022 |
Comment:
The p.Arg633His variant in LDLR has been reported in at least 3 individuals with Familial Hypercholesterolemia (PMID: 16250003, 15823288, 23375686), and has been identified in … (more)
The p.Arg633His variant in LDLR has been reported in at least 3 individuals with Familial Hypercholesterolemia (PMID: 16250003, 15823288, 23375686), and has been identified in 0.009643% (1/10370) of Ashkenazi Jewish chromosomes, 0.006533% (2/30616) of South Asian chromosomes, and 0.002322% (3/129190) of European (non-Finnish) chromosomes by the Genome Aggregation Database (gnomAD, http://gnomad.broadinstitute.org; dbSNP rs754536745). Please note that for diseases with clinical variability, or reduced penetrance, pathogenic variants may be present at a low frequency in the general population. This variant has also been reported as a VUS, likely pathogenic variant, and pathogenic variant in ClinVar (Variation ID: 226380). Computational prediction tools and conservation analyses suggest that this variant may impact the protein, though this information is not predictive enough to determine pathogenicity. In summary, while there is some suspicion for a pathogenic role, the clinical significance of this variant is uncertain. ACMG/AMP Criteria applied: PP3, PS4_Supporting (Richards 2015). (less)
|
|
|
Pathogenic
(Sep 13, 2023)
|
criteria provided, single submitter
Method: clinical testing
|
Familial hypercholesterolemia
Affected status: unknown
Allele origin:
germline
|
Color Diagnostics, LLC DBA Color Health
Accession: SCV001355021.3
First in ClinVar: Jun 22, 2020 Last updated: Feb 14, 2024 |
Comment:
This missense variant replaces arginine with histidine at codon 633 of the LDLR protein. This variant is also known as p.Arg612His in the mature protein. … (more)
This missense variant replaces arginine with histidine at codon 633 of the LDLR protein. This variant is also known as p.Arg612His in the mature protein. This variant alters a conserved arginine residue in the LDLR type B repeat 6 of the EGF precursor homology domain of the LDLR protein (a.a. 616 - 658), where pathogenic missense variants are found enriched (ClinVar-LDLR). 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). To our knowledge, functional studies have not been reported for this variant. This variant has been reported in individuals affected with familial hypercholesterolemia (PMID: 15823288, 16250003, 20506408, 30270359, 33418990, 34297352, 35928446, 37119068), including in the compound heterozygous state with a second pathogenic LDLR variant in individuals affected with severe homozygous familial hypercholesterolemia (PMID: 26228681, 27784735). This variant has been identified in 6/282886 chromosomes in the general population by the Genome Aggregation Database (gnomAD). Different missense variants affecting the same codon, p.Arg633Cys and p.Arg633Leu, are considered to be disease-causing (ClinVar Variation ID: 226379 and 252107), suggesting that arginine at this position is important for LDLR protein function. Based on the available evidence, this variant is classified as Pathogenic. (less)
|
|
|
Pathogenic
(Jan 29, 2024)
|
criteria provided, single submitter
Method: clinical testing
|
Familial hypercholesterolemia
Affected status: unknown
Allele origin:
germline
|
Labcorp Genetics (formerly Invitae), Labcorp
Accession: SCV001575965.4
First in ClinVar: May 10, 2021 Last updated: Feb 20, 2024 |
Comment:
This sequence change replaces arginine, which is basic and polar, with histidine, which is basic and polar, at codon 633 of the LDLR protein (p.Arg633His). … (more)
This sequence change replaces arginine, which is basic and polar, with histidine, which is basic and polar, at codon 633 of the LDLR protein (p.Arg633His). This variant is present in population databases (rs754536745, gnomAD 0.01%). This missense change has been observed in individuals with hypercholesterolemia (PMID: 15823288, 16250003, 19843101; Invitae). This variant is also known as R612H. ClinVar contains an entry for this variant (Variation ID: 226380). 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%. This variant disrupts the p.Arg633 amino acid residue in LDLR. Other variant(s) that disrupt this residue have been determined to be pathogenic (PMID: 9259195, 15241806, 23375686). This suggests that this residue is clinically significant, and that variants that disrupt this residue are likely to be disease-causing. For these reasons, this variant has been classified as Pathogenic. (less)
|
|
|
Likely pathogenic
(Apr 12, 2023)
|
criteria provided, single submitter
Method: clinical testing
|
Not Provided
Affected status: yes
Allele origin:
germline
|
GeneDx
Accession: SCV003918455.1
First in ClinVar: Apr 23, 2023 Last updated: Apr 23, 2023 |
Comment:
Not observed at significant frequency in large population cohorts (gnomAD); In silico analysis supports that this missense variant has a deleterious effect on protein structure/function; … (more)
Not observed at significant frequency in large population cohorts (gnomAD); In silico analysis supports that this missense variant has a deleterious effect on protein structure/function; Also known as p.R612H; This variant is associated with the following publications: (PMID: 22390909, 27578128, 31447099, 16250003, 28235710, 17539906, 9259195, 32719484, 34297352, 33418990, 23375686, 26228681, 20506408, 34037665, 34456049, 19318025, 19843101, 30270359, 15823288, 27784735) (less)
|
|
|
Likely pathogenic
(Jun 13, 2022)
|
criteria provided, single submitter
Method: clinical testing
|
Hypercholesterolemia, familial, 1
Affected status: unknown
Allele origin:
germline
|
Revvity Omics, Revvity
Accession: SCV003830940.2
First in ClinVar: Mar 04, 2023 Last updated: Feb 04, 2024 |
|
|
|
Likely pathogenic
(Jul 19, 2023)
|
criteria provided, single submitter
Method: clinical testing
|
Cardiovascular phenotype
Affected status: unknown
Allele origin:
germline
|
Ambry Genetics
Accession: SCV002719220.3
First in ClinVar: Nov 29, 2022 Last updated: May 01, 2024 |
Comment:
The p.R633H variant (also known as c.1898G>A), located in coding exon 13 of the LDLR gene, results from a G to A substitution at nucleotide … (more)
The p.R633H variant (also known as c.1898G>A), located in coding exon 13 of the LDLR gene, results from a G to A substitution at nucleotide position 1898. The arginine at codon 633 is replaced by histidine, an amino acid with highly similar properties. This alteration (also referred to as p.R612H) has been detected in the heterozygous and compound heterozygous states with other LDLR variants in unrelated individuals reported to have heterozygous or homozygous familial hypercholesterolemia (FH), and in FH cohorts with limited detail (Damgaard D et al. Atherosclerosis, 2005 May;180:155-60; Alonso R et al. Clin. Biochem., 2009 Jun;42:899-903; Roeters van Lennep J et al. J Clin Lipidol. 2015 May;9(4):607-17; Sánchez-Hernández RM et al. Circ Cardiovasc Genet, 2016 Dec;9:504-510; Alver M et al. Genet Med. 2019 May;21(5):1173-1180; Meshkov A et al. Genes (Basel). 2021 Jan;12(1); Cuchel M et al. J Am Heart Assoc. 2023 May;12(9):e029175). 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. (less)
|
|
|
Uncertain significance
(Nov 22, 2022)
|
criteria provided, single submitter
Method: clinical testing
|
not provided
Affected status: unknown
Allele origin:
unknown
|
Quest Diagnostics Nichols Institute San Juan Capistrano
Accession: SCV004219965.1
First in ClinVar: Jan 06, 2024 Last updated: Jan 06, 2024 |
Comment:
The frequency of this variant in the general population, 0.000023 (3/129190 chromosomes, http://gnomad.broadinstitute.org), is uninformative in assessment of its pathogenicity. In the published literature, the … (more)
The frequency of this variant in the general population, 0.000023 (3/129190 chromosomes, http://gnomad.broadinstitute.org), is uninformative in assessment of its pathogenicity. In the published literature, the variant has been reported in patients with familial hypercholesterolemia (PMIDs: 15823288 (2005), 16250003 (2005)). Analysis of this variant using bioinformatics tools for the prediction of the effect of amino acid changes on protein structure and function yielded predictions that this variant is damaging. Based on the available information, we are unable to determine the clinical significance of this variant. (less)
|
|
|
Likely pathogenic
(Mar 25, 2016)
|
criteria provided, single submitter
Method: literature only
|
Familial hypercholesterolemia
(Autosomal dominant inheritance)
Affected status: yes
Allele origin:
germline
|
LDLR-LOVD, British Heart Foundation
Accession: SCV000295746.2
First in ClinVar: Jul 29, 2016 Last updated: Sep 30, 2017 |
Observation 1:
Number of individuals with the variant: 1
Observation 2:
Number of individuals with the variant: 1
Observation 3:
Number of individuals with the variant: 1
|
|
|
Pathogenic
(Mar 30, 2017)
|
criteria provided, single submitter
Method: clinical testing
|
Familial Hypercholesterolemia
Affected status: yes
Allele origin:
germline
|
U4M - Lille University & CHRU Lille, Université de Lille - CHRU de Lille
Accession: SCV000583907.1
First in ClinVar: Jul 29, 2016 Last updated: Jul 29, 2016
Comment:
ACMG Guidelines: Pathogenic (ii)
|
Number of individuals with the variant: 1
Clinical Features:
Hyperbetalipoproteinemia (present) , Hypercholesterolemia (present)
Indication for testing: Familial Hypercholesterolemia
Geographic origin: France
Comment on evidence:
Dutch Lipid Clinic Scoring : Definite FH
Secondary finding: no
|
|
|
Uncertain significance
(Mar 01, 2016)
|
criteria provided, single submitter
Method: research
|
Familial hypercholesterolemia
Affected status: unknown
Allele origin:
germline
|
Fundacion Hipercolesterolemia Familiar
Study: SAFEHEART
Accession: SCV000607654.1 First in ClinVar: Sep 30, 2017 Last updated: Sep 30, 2017 |
Comment on evidence:
%MAF(ExAC):0.001647
|
|
|
Likely pathogenic
(Nov 28, 2017)
|
criteria provided, single submitter
Method: clinical testing
|
Hypercholesterolemia, familial, 1
Affected status: unknown
Allele origin:
germline
|
Human Genome Sequencing Center Clinical Lab, Baylor College of Medicine
Accession: SCV000839996.1
First in ClinVar: Sep 30, 2017 Last updated: Sep 30, 2017 |
Comment:
The c.1898G>A (p.Arg633His) variant is extremely rare in general population (3 in 246014 by gnomad) and observed in multiple familial hypercholesterolaemia (FH) patients (PMID: 15823288,16250003,19318025). … (more)
The c.1898G>A (p.Arg633His) variant is extremely rare in general population (3 in 246014 by gnomad) and observed in multiple familial hypercholesterolaemia (FH) patients (PMID: 15823288,16250003,19318025). It is predicted to be deleterious by multiple in silica prediction software. The Arg633 is well conserved during evolution. It has been also observed in other clinical labs and reported as pathogenic. At the same position, Arg633Cys variant was observed in multiple FH patient cohort. Based on the above evidences, we interpret this variant as ikely pathogenic. (less)
|
|
|
Likely pathogenic
(Sep 16, 2020)
|
no assertion criteria provided
Method: clinical testing
|
Familial hypercholesterolemia
Affected status: unknown
Allele origin:
germline
|
Natera, Inc.
Accession: SCV001461323.1
First in ClinVar: Jan 02, 2021 Last updated: Jan 02, 2021 |
|
|
|
Pathogenic
(Oct 30, 2013)
|
no assertion criteria provided
Method: clinical testing
|
Familial hypercholesterolemia
Affected status: yes
Allele origin:
germline
|
Cardiovascular Genetics Laboratory, PathWest Laboratory Medicine WA - Fiona Stanley Hospital
Accession: SCV000268649.1
First in ClinVar: May 22, 2016 Last updated: May 22, 2016 |
Number of individuals with the variant: 1
|
|
|
Pathogenic
(-)
|
no assertion criteria provided
Method: research
|
Familial hypercholesterolemia
Affected status: unknown
Allele origin:
germline
|
Laboratorium voor Moleculaire Diagnostiek Experimentele Vasculaire Geneeskunde, Academisch Medisch Centrum
Accession: SCV000606553.1
First in ClinVar: Sep 30, 2017 Last updated: Sep 30, 2017 |
|
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Comment:
Comment:
The p.Arg633His variant in LDLR (also described as p.Arg612His in the literature) has been reported in at least 9 individuals with familial hypercholesterolemia (FH), including 2 compound heterozygotes (Fouchier 2005 PMID: 16250003, Damgaard 2005 PMID: 15823288, Huijgen 2012 PMID: 22390909, Alonso 2016 PMID: 27578128, Alver 2019 PMID: 30270359, Meshkov 2020 PMID: 33418990, Sturm 2021 PMID: 34037665). It has also been reported by other clinical laboratories in ClinVar (Variation ID: 226380) and has been identified in 0.007% (2/30616) of South Asian chromosomes by gnomAD (http://gnomad.broadinstitute.org). This frequency is low enough to be consistent with the frequency of FH in the general population. Computational prediction tools and conservation analyses are consistent with pathogenicity. Another variant involving this codon (p.Arg633Cys) has been identified in individuals with FH and is classified as likely pathogenic by this laboratory. In summary, although additional studies are required to fully establish its clinical significance, this variant meets criteria to be classified as likely pathogenic for autosomal dominant FH. ACMG/AMP Criteria applied: PM2_Supporting, PM5, PP3, PS4_Moderate.
Comment:
PP3, PM2, PM3_strong, PS4
Comment:
The p.Arg633His variant in LDLR has been reported in at least 3 individuals with Familial Hypercholesterolemia (PMID: 16250003, 15823288, 23375686), and has been identified in 0.009643% (1/10370) of Ashkenazi Jewish chromosomes, 0.006533% (2/30616) of South Asian chromosomes, and 0.002322% (3/129190) of European (non-Finnish) chromosomes by the Genome Aggregation Database (gnomAD, http://gnomad.broadinstitute.org; dbSNP rs754536745). Please note that for diseases with clinical variability, or reduced penetrance, pathogenic variants may be present at a low frequency in the general population. This variant has also been reported as a VUS, likely pathogenic variant, and pathogenic variant in ClinVar (Variation ID: 226380). Computational prediction tools and conservation analyses suggest that this variant may impact the protein, though this information is not predictive enough to determine pathogenicity. In summary, while there is some suspicion for a pathogenic role, the clinical significance of this variant is uncertain. ACMG/AMP Criteria applied: PP3, PS4_Supporting (Richards 2015).
Comment:
This missense variant replaces arginine with histidine at codon 633 of the LDLR protein. This variant is also known as p.Arg612His in the mature protein. This variant alters a conserved arginine residue in the LDLR type B repeat 6 of the EGF precursor homology domain of the LDLR protein (a.a. 616 - 658), where pathogenic missense variants are found enriched (ClinVar-LDLR). 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). To our knowledge, functional studies have not been reported for this variant. This variant has been reported in individuals affected with familial hypercholesterolemia (PMID: 15823288, 16250003, 20506408, 30270359, 33418990, 34297352, 35928446, 37119068), including in the compound heterozygous state with a second pathogenic LDLR variant in individuals affected with severe homozygous familial hypercholesterolemia (PMID: 26228681, 27784735). This variant has been identified in 6/282886 chromosomes in the general population by the Genome Aggregation Database (gnomAD). Different missense variants affecting the same codon, p.Arg633Cys and p.Arg633Leu, are considered to be disease-causing (ClinVar Variation ID: 226379 and 252107), suggesting that arginine at this position is important for LDLR protein function. Based on the available evidence, this variant is classified as Pathogenic.
Comment:
This sequence change replaces arginine, which is basic and polar, with histidine, which is basic and polar, at codon 633 of the LDLR protein (p.Arg633His). This variant is present in population databases (rs754536745, gnomAD 0.01%). This missense change has been observed in individuals with hypercholesterolemia (PMID: 15823288, 16250003, 19843101; Invitae). This variant is also known as R612H. ClinVar contains an entry for this variant (Variation ID: 226380). 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%. This variant disrupts the p.Arg633 amino acid residue in LDLR. Other variant(s) that disrupt this residue have been determined to be pathogenic (PMID: 9259195, 15241806, 23375686). This suggests that this residue is clinically significant, and that variants that disrupt this residue are likely to be disease-causing. For these reasons, this variant has been classified as Pathogenic.
Comment:
Not observed at significant frequency in large population cohorts (gnomAD); In silico analysis supports that this missense variant has a deleterious effect on protein structure/function; Also known as p.R612H; This variant is associated with the following publications: (PMID: 22390909, 27578128, 31447099, 16250003, 28235710, 17539906, 9259195, 32719484, 34297352, 33418990, 23375686, 26228681, 20506408, 34037665, 34456049, 19318025, 19843101, 30270359, 15823288, 27784735)
Comment:
The p.R633H variant (also known as c.1898G>A), located in coding exon 13 of the LDLR gene, results from a G to A substitution at nucleotide position 1898. The arginine at codon 633 is replaced by histidine, an amino acid with highly similar properties. This alteration (also referred to as p.R612H) has been detected in the heterozygous and compound heterozygous states with other LDLR variants in unrelated individuals reported to have heterozygous or homozygous familial hypercholesterolemia (FH), and in FH cohorts with limited detail (Damgaard D et al. Atherosclerosis, 2005 May;180:155-60; Alonso R et al. Clin. Biochem., 2009 Jun;42:899-903; Roeters van Lennep J et al. J Clin Lipidol. 2015 May;9(4):607-17; Sánchez-Hernández RM et al. Circ Cardiovasc Genet, 2016 Dec;9:504-510; Alver M et al. Genet Med. 2019 May;21(5):1173-1180; Meshkov A et al. Genes (Basel). 2021 Jan;12(1); Cuchel M et al. J Am Heart Assoc. 2023 May;12(9):e029175). 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.
Comment:
The frequency of this variant in the general population, 0.000023 (3/129190 chromosomes, http://gnomad.broadinstitute.org), is uninformative in assessment of its pathogenicity. In the published literature, the variant has been reported in patients with familial hypercholesterolemia (PMIDs: 15823288 (2005), 16250003 (2005)). Analysis of this variant using bioinformatics tools for the prediction of the effect of amino acid changes on protein structure and function yielded predictions that this variant is damaging. Based on the available information, we are unable to determine the clinical significance of this variant.
Comment:
The c.1898G>A (p.Arg633His) variant is extremely rare in general population (3 in 246014 by gnomad) and observed in multiple familial hypercholesterolaemia (FH) patients (PMID: 15823288,16250003,19318025). It is predicted to be deleterious by multiple in silica prediction software. The Arg633 is well conserved during evolution. It has been also observed in other clinical labs and reported as pathogenic. At the same position, Arg633Cys variant was observed in multiple FH patient cohort. Based on the above evidences, we interpret this variant as ikely pathogenic.
Germline Functional Evidence
| There is no functional evidence in ClinVar for this variation. If you have generated functional data for this variation, please consider submitting that data to ClinVar. |
Comment:
The nucleotide substitution c.1898G> A causes an exchange of the amino acid arginine to histidine (p.Arg633His). In addition, the mutation described here has already been described in patients with hypercholesterolemia and is therefore classified as pathogenic. The mutation was observed in a patient with TC up to 270 mg/dl and LDL-C approx 230 mg/dl at the age of 45. PMID: 22390909, 16250003, 16250003
Comment:
The p.Arg633His variant in LDLR (also described as p.Arg612His in the literature) has been reported in at least 9 individuals with familial hypercholesterolemia (FH), including 2 compound heterozygotes (Fouchier 2005 PMID: 16250003, Damgaard 2005 PMID: 15823288, Huijgen 2012 PMID: 22390909, Alonso 2016 PMID: 27578128, Alver 2019 PMID: 30270359, Meshkov 2020 PMID: 33418990, Sturm 2021 PMID: 34037665). It has also been reported by other clinical laboratories in ClinVar (Variation ID: 226380) and has been identified in 0.007% (2/30616) of South Asian chromosomes by gnomAD (http://gnomad.broadinstitute.org). This frequency is low enough to be consistent with the frequency of FH in the general population. Computational prediction tools and conservation analyses are consistent with pathogenicity. Another variant involving this codon (p.Arg633Cys) has been identified in individuals with FH and is classified as likely pathogenic by this laboratory. In summary, although additional studies are required to fully establish its clinical significance, this variant meets criteria to be classified as likely pathogenic for autosomal dominant FH. ACMG/AMP Criteria applied: PM2_Supporting, PM5, PP3, PS4_Moderate.
Comment:
PP3, PM2, PM3_strong, PS4
Comment:
The p.Arg633His variant in LDLR has been reported in at least 3 individuals with Familial Hypercholesterolemia (PMID: 16250003, 15823288, 23375686), and has been identified in 0.009643% (1/10370) of Ashkenazi Jewish chromosomes, 0.006533% (2/30616) of South Asian chromosomes, and 0.002322% (3/129190) of European (non-Finnish) chromosomes by the Genome Aggregation Database (gnomAD, http://gnomad.broadinstitute.org; dbSNP rs754536745). Please note that for diseases with clinical variability, or reduced penetrance, pathogenic variants may be present at a low frequency in the general population. This variant has also been reported as a VUS, likely pathogenic variant, and pathogenic variant in ClinVar (Variation ID: 226380). Computational prediction tools and conservation analyses suggest that this variant may impact the protein, though this information is not predictive enough to determine pathogenicity. In summary, while there is some suspicion for a pathogenic role, the clinical significance of this variant is uncertain. ACMG/AMP Criteria applied: PP3, PS4_Supporting (Richards 2015).
Comment:
This missense variant replaces arginine with histidine at codon 633 of the LDLR protein. This variant is also known as p.Arg612His in the mature protein. This variant alters a conserved arginine residue in the LDLR type B repeat 6 of the EGF precursor homology domain of the LDLR protein (a.a. 616 - 658), where pathogenic missense variants are found enriched (ClinVar-LDLR). 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). To our knowledge, functional studies have not been reported for this variant. This variant has been reported in individuals affected with familial hypercholesterolemia (PMID: 15823288, 16250003, 20506408, 30270359, 33418990, 34297352, 35928446, 37119068), including in the compound heterozygous state with a second pathogenic LDLR variant in individuals affected with severe homozygous familial hypercholesterolemia (PMID: 26228681, 27784735). This variant has been identified in 6/282886 chromosomes in the general population by the Genome Aggregation Database (gnomAD). Different missense variants affecting the same codon, p.Arg633Cys and p.Arg633Leu, are considered to be disease-causing (ClinVar Variation ID: 226379 and 252107), suggesting that arginine at this position is important for LDLR protein function. Based on the available evidence, this variant is classified as Pathogenic.
Comment:
This sequence change replaces arginine, which is basic and polar, with histidine, which is basic and polar, at codon 633 of the LDLR protein (p.Arg633His). This variant is present in population databases (rs754536745, gnomAD 0.01%). This missense change has been observed in individuals with hypercholesterolemia (PMID: 15823288, 16250003, 19843101; Invitae). This variant is also known as R612H. ClinVar contains an entry for this variant (Variation ID: 226380). 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%. This variant disrupts the p.Arg633 amino acid residue in LDLR. Other variant(s) that disrupt this residue have been determined to be pathogenic (PMID: 9259195, 15241806, 23375686). This suggests that this residue is clinically significant, and that variants that disrupt this residue are likely to be disease-causing. For these reasons, this variant has been classified as Pathogenic.
Comment:
Not observed at significant frequency in large population cohorts (gnomAD); In silico analysis supports that this missense variant has a deleterious effect on protein structure/function; Also known as p.R612H; This variant is associated with the following publications: (PMID: 22390909, 27578128, 31447099, 16250003, 28235710, 17539906, 9259195, 32719484, 34297352, 33418990, 23375686, 26228681, 20506408, 34037665, 34456049, 19318025, 19843101, 30270359, 15823288, 27784735)
Comment:
The p.R633H variant (also known as c.1898G>A), located in coding exon 13 of the LDLR gene, results from a G to A substitution at nucleotide position 1898. The arginine at codon 633 is replaced by histidine, an amino acid with highly similar properties. This alteration (also referred to as p.R612H) has been detected in the heterozygous and compound heterozygous states with other LDLR variants in unrelated individuals reported to have heterozygous or homozygous familial hypercholesterolemia (FH), and in FH cohorts with limited detail (Damgaard D et al. Atherosclerosis, 2005 May;180:155-60; Alonso R et al. Clin. Biochem., 2009 Jun;42:899-903; Roeters van Lennep J et al. J Clin Lipidol. 2015 May;9(4):607-17; Sánchez-Hernández RM et al. Circ Cardiovasc Genet, 2016 Dec;9:504-510; Alver M et al. Genet Med. 2019 May;21(5):1173-1180; Meshkov A et al. Genes (Basel). 2021 Jan;12(1); Cuchel M et al. J Am Heart Assoc. 2023 May;12(9):e029175). 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.
Comment:
The frequency of this variant in the general population, 0.000023 (3/129190 chromosomes, http://gnomad.broadinstitute.org), is uninformative in assessment of its pathogenicity. In the published literature, the variant has been reported in patients with familial hypercholesterolemia (PMIDs: 15823288 (2005), 16250003 (2005)). Analysis of this variant using bioinformatics tools for the prediction of the effect of amino acid changes on protein structure and function yielded predictions that this variant is damaging. Based on the available information, we are unable to determine the clinical significance of this variant.
Comment:
The c.1898G>A (p.Arg633His) variant is extremely rare in general population (3 in 246014 by gnomad) and observed in multiple familial hypercholesterolaemia (FH) patients (PMID: 15823288,16250003,19318025). It is predicted to be deleterious by multiple in silica prediction software. The Arg633 is well conserved during evolution. It has been also observed in other clinical labs and reported as pathogenic. At the same position, Arg633Cys variant was observed in multiple FH patient cohort. Based on the above evidences, we interpret this variant as ikely pathogenic.
Citations for germline classification of this variant
Help| Title | Author | Journal | Year | Link |
|---|---|---|---|---|
| Contemporary Homozygous Familial Hypercholesterolemia in the United States: Insights From the CASCADE FH Registry. | Cuchel M | Journal of the American Heart Association | 2023 | PMID: 37119068 |
| Do Biobank Recall Studies Matter? Long-Term Follow-Up of Research Participants With Familial Hypercholesterolemia. | Nurm M | Frontiers in genetics | 2022 | PMID: 35928446 |
| Lipoprotein(a) in hereditary hypercholesterolemia: Influence of the genetic cause, defective gene and type of mutation. | Marco-Benedí V | Atherosclerosis | 2022 | PMID: 34456049 |
| Genetic spectrum of familial hypercholesterolemia and correlations with clinical expression: Implications for diagnosis improvement. | Di Taranto MD | Clinical genetics | 2021 | PMID: 34297352 |
| Limited-Variant Screening vs Comprehensive Genetic Testing for Familial Hypercholesterolemia Diagnosis. | Sturm AC | JAMA cardiology | 2021 | PMID: 34037665 |
| The LDLR, APOB, and PCSK9 Variants of Index Patients with Familial Hypercholesterolemia in Russia. | Meshkov A | Genes | 2021 | PMID: 33418990 |
| Population genetic screening efficiently identifies carriers of autosomal dominant diseases. | Grzymski JJ | Nature medicine | 2020 | PMID: 32719484 |
| Harmonizing Clinical Sequencing and Interpretation for the eMERGE III Network. | eMERGE Consortium. Electronic address: [email protected] | American journal of human genetics | 2019 | PMID: 31447099 |
| Recall by genotype and cascade screening for familial hypercholesterolemia in a population-based biobank from Estonia. | Alver M | Genetics in medicine : official journal of the American College of Medical Genetics | 2019 | PMID: 30270359 |
| Homozygous Familial Hypercholesterolemia in Spain: Prevalence and Phenotype-Genotype Relationship. | Sánchez-Hernández RM | Circulation. Cardiovascular genetics | 2016 | PMID: 27784735 |
| Clinical and molecular characteristics of homozygous familial hypercholesterolemia patients: Insights from SAFEHEART registry. | Alonso R | Journal of clinical lipidology | 2016 | PMID: 27578128 |
| Treating homozygous familial hypercholesterolemia in a real-world setting: Experiences with lomitapide. | Roeters van Lennep J | Journal of clinical lipidology | 2015 | PMID: 26228681 |
| Spectrum of mutations and phenotypic expression in patients with autosomal dominant hypercholesterolemia identified in Italy. | Bertolini S | Atherosclerosis | 2013 | PMID: 23375686 |
| Cardiovascular risk in relation to functionality of sequence variants in the gene coding for the low-density lipoprotein receptor: a study among 29,365 individuals tested for 64 specific low-density lipoprotein-receptor sequence variants. | Huijgen R | European heart journal | 2012 | PMID: 22390909 |
| Functionality of sequence variants in the genes coding for the low-density lipoprotein receptor and apolipoprotein B in individuals with inherited hypercholesterolemia. | Huijgen R | Human mutation | 2010 | PMID: 20506408 |
| Mutation screening in patients for familial hypercholesterolaemia (ADH). | Taylor A | Clinical genetics | 2010 | PMID: 19843101 |
| Genetic diagnosis of familial hypercholesterolemia using a DNA-array based platform. | Alonso R | Clinical biochemistry | 2009 | PMID: 19318025 |
| Update of the molecular basis of familial hypercholesterolemia in The Netherlands. | Fouchier SW | Human mutation | 2005 | PMID: 16250003 |
| The relationship of molecular genetic to clinical diagnosis of familial hypercholesterolemia in a Danish population. | Damgaard D | Atherosclerosis | 2005 | PMID: 15823288 |
| Molecular characterization of familial hypercholesterolemia in Spain: identification of 39 novel and 77 recurrent mutations in LDLR. | Mozas P | Human mutation | 2004 | PMID: 15241806 |
| Spectrum of LDL receptor gene mutations in heterozygous familial hypercholesterolemia. | Day IN | Human mutation | 1997 | PMID: 9259195 |
| https://erepo.clinicalgenome.org/evrepo/ui/interpretation/4115a3d7-c365-4acb-8f0b-856dbeae2147 | - | - | - | - |
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Text-mined citations for rs754536745 ...
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Record last updated Nov 25, 2024
This date represents the last time this VCV record was updated. The update may be due to an update to one of the included submitted records (SCVs), or due to an update that ClinVar made to the variant such as adding HGVS expressions or a rs number. So this date may be different from the date of the “most recent submission” reported at the top of this page.