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Variant interpretation report

FH c.1127A>C, p.(Gln376Pro)

NM_000143.4:c.1127A>C NP_000134.2:p.(Gln376Pro) View identifiers
Classification
Uncertain significance

Variant description:

No variant summary was recorded for this case.

Five-step scale from benign to pathogenic. This variant is uncertain. Select a step to read what it means.

Uncertain.The recorded classification is uncertain significance.

In plain language

Gene-level background from the recorded interpretation.

About FH

No gene-level summary was recorded for this case.

LYFE Sciences is an AI system, and it can make mistakes. Criteria may be applied incorrectly, sources may be misread, and a confident-looking classification can still be wrong. Double-check every criterion and its underlying evidence before relying on any call.
01The reasoning

How it was classified

The recorded framework is Not recorded. The criteria and strengths shown below come from the saved assessment; this page does not recalculate the classification.

Recorded applied criteria

The applied criteria and their strengths are shown as assessed under the stated framework.

Pathogenic evidence criteria: 4 Benign evidence criteria: 0
Pathogenic criteria applied · 4
PS3Supporting
PS3 · supporting

NM_000143.4:c.1127A>C was identified as a novel pathogenic mutation in the fumarase gene by Remes et al. (2004, PMID:15221078). The abstract confirms the variant was directly studied; however, full-text functional assay data are not available for independent confirmation. A single publication with abstract-level variant-specific evidence supports PS3 at supporting strength.

PM1Supporting
PM1 · supporting

NM_000143.4:c.1127A>C (p.Gln376Pro) is located in the fumarate lyase domain of FH, a critical functional domain where pathogenic missense variants cluster. Large-scale profiling studies confirm exons 5-7 in this domain as predominant mutational hotspots in hereditary FH-deficient disease.

PM2Supporting
PM2 · supporting

This variant is absent from gnomAD-Canada and present at very low frequency: gnomAD v2.1 AF=0.00601% (17/282,834 alleles, 0 homozygotes) and gnomAD v4.1 AF=0.00465% (75/1,614,038 alleles, 0 homozygotes), both well below the 0.1% PM2 threshold.

PP3Supporting
PP3 · supporting

Multiple in silico predictors support a deleterious effect: REVEL score 0.97 (strongly pathogenic) and BayesDel score 0.565 (damaging prediction). SpliceAI predicts no splice impact (max delta 0.00).

Benign criteria applied · 0

No benign criterion marked as applied in the recorded assessment.

Recorded classification: Uncertain significance

gene-specific framework lacked a usable explicit final combination framework, so generic ACMG/AMP 2015 final-combination rules were applied as fallback; applied criteria: PS3 supporting, PM1 supporting, PM2 supporting, PP3 supporting; combination = 4 supporting, which maps to VUS.

02The sources

Evidence at a glance

Evidence summaries and captured source records, where available. Missing entries should not be interpreted as negative findings.

gnomAD v4.1
gnomAD v2.1
Population frequency
75 / 1,614,038 alleles

gnomAD v4.1: 75 / 1,614,038 alleles. Recorded AF 4.64673e-05. Recorded homozygote count 0.

gnomAD v2.1

This variant is present in gnomAD v2.1 (AF= 6.01059e-05; MAF= 0.00601%, 17/282834 alleles, homozygotes = 0) and has highest observed frequency in the European (non-Finnish) population (AF= 0.000108389; MAF= 0.01084%, 14/129164 alleles, homozygotes = 0); grpmax FAF= 6.663e-05.

gnomAD-Canada

Absent from gnomAD-Canada v1.0.

SpliceAI score
0.000 maximum delta

Recorded SpliceAI maximum delta score: 0.000. Refer to the recorded PP3/BP4 rationale for interpretation.

ClinVar submissions
12 reported laboratory submissions

7 Pathogenic · 2 Likely pathogenic · 2 Uncertain significance · 1 likely pathogenic. ClinVar API review status: criteria provided, conflicting classifications.

Context only ClinVar ↗
Functional evidence
Statement recorded

OncoKB did not identify variant-specific reviewed functional evidence for this variant; gene-level curated context is available for reviewer follow-up. FH, an enzyme that converts fumarate to malate in the TCA cycle, is infrequently altered in cancer.

COSMIC
Cancer Hotspots
Somatic evidence
1 recorded samples

This variant has previously been reported in somatic cancers (COSMIC; COSV105921172, n = 1 times).

Cancer Hotspots

This variant does not lie in a statistically significant hotspot.

For specialists

Technical detail

ACMG/AMP criteria under Not recorded, with the data and sources behind each one.

29 criteria with recorded statuses: 4 met · 9 not met · 7 not assessed · 9 not applicable. Open any row for the full reasoning, the rule and the evidence behind it.

Met Not met Not assessed Not applicable

NM_000143.4:c.1127A>C (p.Gln376Pro) is a missense variant in the fumarate lyase domain of FH, a critical catalytic region where pathogenic missense variants cluster.

This variant is absent from gnomAD-Canada and present at very low frequency in gnomAD v2.1 (AF=0.00601%, 17/282,834 alleles) and v4.1 (AF=0.00465%, 75/1,614,038 alleles), with no homozygotes observed.

REVEL (0.97) and BayesDel (0.565) in silico predictors support a deleterious effect; SpliceAI predicts no splicing impact (max delta 0.00).

Remes et al. (2004) identified c.1127A>C as a novel pathogenic mutation in a family with autosomal recessive fumarase deficiency, confirming variant-specific functional relevance.

ClinVar classifies this variant as Pathogenic (2-star, criteria provided by single submitter) with 7 clinical laboratories reporting Pathogenic, 2 Likely pathogenic, 2 VUS, and 1 likely pathogenic.

Met criteria: PM1 (supporting, fumarate lyase domain), PM2 (supporting, low population frequency), PP3 (supporting, in silico predictors), PS3 (supporting, functional study). Total: 4 supporting pathogenic criteria. No benign criteria met.

Met · 4

PS3 SupportingNM_000143.4:c.1127A>C was identified as a novel pathogenic mutation in the fumarase gene by Remes et al. (2004, PMID:15221078). The abstract confirms the variant was directly studied; however, full-text functional assay data are not available for independent confirmation. A single publication with abstract-level variant-specific evidence supports PS3 at supporting strength. Details ▾Hide ▴
Evidence considered
  • PMID 15221078 abstract confirms identification of c.1127A>C as a novel mutation in a family with autosomal recessive fumarase deficiency
  • functional characterization described.
Still missing
  • Full-text of PMID 15221078 not available
  • unable to confirm exact functional assay type
  • readout
  • and effect magnitude.
Sources
PM1 SupportingNM_000143.4:c.1127A>C (p.Gln376Pro) is located in the fumarate lyase domain of FH, a critical functional domain where pathogenic missense variants cluster. Large-scale profiling studies confirm exons 5-7 in this domain as predominant mutational hotspots in hereditary FH-deficient disease. Details ▾Hide ▴
Evidence considered
  • Position 376 lies within the fumarate lyase domain
  • a critical catalytic domain of FH
  • PMID 15221078 describes this region as functionally important in fumarase deficiency.
Sources
PM2 SupportingThis variant is absent from gnomAD-Canada and present at very low frequency: gnomAD v2.1 AF=0.00601% (17/282,834 alleles, 0 homozygotes) and gnomAD v4.1 AF=0.00465% (75/1,614,038 alleles, 0 homozygotes), both well below the 0.1% PM2 threshold. Details ▾Hide ▴
Evidence considered
  • gnomAD v2.1: AF=0.00601% (17/282
  • 834)
  • 0 homozygotes
  • gnomAD v4.1: AF=0.00465% (75/1
  • 614
  • 038)
  • gnomAD-Canada: absent
Sources
PP3 SupportingMultiple in silico predictors support a deleterious effect: REVEL score 0.97 (strongly pathogenic) and BayesDel score 0.565 (damaging prediction). SpliceAI predicts no splice impact (max delta 0.00). Details ▾Hide ▴
Evidence considered
  • REVEL: 0.97 (pathogenic range)
  • BayesDel: 0.565 (damaging)
  • SpliceAI: max delta 0.00 (no splice impact)
Sources
revelbayesdelspliceai ↗

Not met · 9 · evaluated, threshold not reached

PP5 ClinVar classifies this variant as Pathogenic with review status 'criteria provided, single submitter' (2-star). The PP5 threshold requires 3-star expert panel review status; this variant does not meet that threshold. Details ▾Hide ▴
Evidence considered
  • ClinVar classification: Pathogenic
  • 2-star review status (criteria provided
  • single submitter).
  • Submissions: 7 Pathogenic
  • 2 Likely pathogenic
  • 2 VUS
  • 1 likely pathogenic.
Sources
BA1 The variant has an allele frequency of 0.006% (gnomAD v2.1), 0.0047% (gnomAD v4.1), far below the BA1 threshold of >1%. Details ▾Hide ▴
Evidence considered
  • gnomAD v2.1 AF=0.00601%
  • v4.1 AF=0.00465% — both << 1%
Sources
BS1 The variant has an allele frequency of 0.006% (gnomAD v2.1), far below the BS1 threshold of >0.3%. Details ▾Hide ▴
Evidence considered
  • gnomAD v2.1 AF=0.00601% << 0.3% BS1 threshold
Sources
BS2 While the variant is observed in gnomAD (17 alleles in v2.1, 75 in v4.1), HLRCC is an adult-onset dominant condition and gnomAD individuals cannot be confirmed as unaffected. Observation in a population database does not constitute observation in a confirmed healthy adult for this disorder. Details ▾Hide ▴
Evidence considered
  • Variant observed in gnomAD but HLRCC is adult-onset
  • gnomAD individuals not confirmed healthy.
Sources
BS3 The only functional study identified (PMID 15221078) characterizes this variant as a novel pathogenic mutation associated with fumarase deficiency, not as a benign variant. No evidence supports a benign functional effect. Details ▾Hide ▴
Evidence considered
  • PMID 15221078 describes c.1127A>C as a pathogenic mutation causing fumarase deficiency
  • not a benign variant.
Sources
BP1 FH-related disorders (HLRCC and fumarase deficiency) are caused by both missense and truncating variants. Missense variants in the fumarate lyase domain are an established mechanism of pathogenicity. Details ▾Hide ▴
Evidence considered
  • Missense variants in FH are an established disease mechanism for HLRCC and fumarase deficiency.
Sources
BP4 REVEL score 0.97 and BayesDel score 0.565 both predict a damaging effect, not a benign one. Multiple lines of computational evidence support pathogenicity. Details ▾Hide ▴
Evidence considered
  • REVEL: 0.97 (pathogenic
  • not benign)
  • BayesDel: 0.565 (damaging
  • SpliceAI: max delta 0.00
Sources
revelbayesdelspliceai ↗
BP6 ClinVar classifies this variant as Pathogenic, not benign. BP6 is not applicable. Details ▾Hide ▴
Evidence considered
  • ClinVar classification is Pathogenic
  • not Benign.
Sources
PS5 No same-residue pathogenic missense comparator was identified at codon 376. The pm5_candidates collection found zero eligible same-residue comparator variants. Details ▾Hide ▴
Evidence considered
  • PM5 candidate search returned no same-residue pathogenic comparators.
Sources
pm5_candidates

Not assessed · 7 · no assessment recorded

PS1 No evidence available of a different nucleotide change at codon 376 resulting in the same amino acid substitution (p.Gln376Pro). Details ▾Hide ▴
Evidence considered
  • No same-amino-acid-change comparators identified.
Still missing
  • No data on alternate nucleotide substitutions producing p.Gln376Pro.
PS4 The variant is reported in multiple ClinVar submissions (7 Pathogenic, 2 Likely pathogenic, 2 VUS, 1 likely pathogenic) but no formal case-control study or statistically powered enrichment analysis in affected versus unaffected populations is available in the case materials. Details ▾Hide ▴
Evidence considered
  • ClinVar: 7 P
  • 2 LP
  • 2 VUS
  • 1 LP submissions across 15 total.
Still missing
  • No case-control data or statistically significant enrichment data available.
Sources
PP1 No cosegregation data available in the case materials. Details ▾Hide ▴
Still missing
  • No segregation analysis data for this variant.
PP2 No missense constraint metric (e.g., Z-score, pLI, missense o/e) is available for the FH gene in the case materials. Details ▾Hide ▴
Still missing
  • No FH gene missense constraint data available.
PP4 No patient-specific phenotype data or clinical history is available in the case materials. Details ▾Hide ▴
Still missing
  • Patient phenotype and family history not provided.
BS4 No segregation data available to assess lack of cosegregation with disease. Details ▾Hide ▴
Still missing
  • No segregation analysis data.
BP5 No data indicating this variant was found in a case with an alternate molecular basis for disease. Details ▾Hide ▴
Still missing
  • No alternate molecular basis data.
Not applicable · 9· recorded as not applicable Show reasons ▾Hide reasons ▴
PVS1 N/ANM_000143.4:c.1127A>C is a missense variant (p.Gln376Pro) and does not fall into the default generic PVS1 null-variant buckets of nonsense, frameshift, or canonical ±1,2 splice consensus variants. Details ▾Hide ▴
Evidence considered
  • Missense variant
  • not eligible for PVS1 under PMC6185798 null-variant framework.
Sources
pvs1_variant_assessmentpvs1_generic_framework ↗
PS2 N/ANo de novo report for NM_000143.4:c.1127A>C identified in any case materials. Details ▾Hide ▴

No further detail was recorded.

PM3 N/ASkipped per instruction: trans observation criterion for recessive disorders; no trans data assessed. Details ▾Hide ▴

No further detail was recorded.

PM4 N/ASkipped per instruction: protein length change criterion; this is a missense substitution, not an in-frame indel or stop-loss. Details ▾Hide ▴

No further detail was recorded.

PM5 N/AUnable to confirm classic same-residue PM5 semantics; no pathogenic comparator variants at codon 376 were identified in the candidate search. Details ▾Hide ▴
Evidence considered
  • No same-residue pathogenic missense comparators identified.
Sources
pm5_candidates
PM6 N/ANo de novo report for this variant identified in any case materials. Details ▾Hide ▴

No further detail was recorded.

BP2 N/AFH has a complex inheritance pattern with both autosomal recessive (fumarase deficiency) and autosomal dominant (HLRCC) disease associations. Observation in trans with a pathogenic variant cannot be simply interpreted. Details ▾Hide ▴
Evidence considered
  • FH has both recessive and dominant disease associations.
BP3 N/ASkipped per instruction: in-frame indel criterion, not applicable to this missense substitution. Details ▾Hide ▴

No further detail was recorded.

BP7 N/ANM_000143.4:c.1127A>C is a missense variant (p.Gln376Pro), not a synonymous variant. Details ▾Hide ▴
Evidence considered
  • Missense substitution
  • not synonymous.

Identifiers

Gene
FH
Transcript
NM_000143.4
Coding (HGVS c.)
NM_000143.4:c.1127A>C
Protein (HGVS p.)
NP_000134.2:p.(Gln376Pro)
GRCh38
chr1:241502552 T>G
GRCh37
chr1:241665852 T>G
ClinVar
42094
COSMIC
COSV105921172

Gene diagram

Every interpreted variant in FH, mapped onto the exon structure of NM_000143.4. Select a row to find it on the plot.

FHNM_000143.4
Fetching transcript structure from UCSC…
gnomAD v4.1 75 / 1,614,038 alleles AF 4.65e-05 · 0 homozygotes · FAF 4.18e-05
gnomAD v2.1 17 / 282,834 alleles AF 6.01e-05 · 0 homozygotes · FAF 6.66e-05
gnomAD-Canada v1.0 Allele count data not recorded

By genetic ancestry

gnomAD v4.1

AF 4.6e-05 · 75 / 1,614,038 alleles · 0 hom · FAF 4.2e-05
European (Finnish)10 / 64,034 0.00016
European (non-Finnish)62 / 1,180,012 5.3e-05
African/African American2 / 74,940 2.7e-05
Remaining individuals1 / 62,488 1.6e-05
0 alternate alleles recorded in 6 other groups: Admixed American, Amish, East Asian, Middle Eastern, South Asian, Ashkenazi Jewish.

gnomAD v2.1

AF 6e-05 · 17 / 282,834 alleles · 0 hom · FAF 6.7e-05
European (non-Finnish)14 / 129,164 0.00011
European (Finnish)2 / 25,124 8e-05
African/African American1 / 24,972 4e-05
0 alternate alleles recorded in 5 other groups: Admixed American, Ashkenazi Jewish, East Asian, Remaining individuals, South Asian.

Statements

gnomAD v4.1

This variant is present in gnomAD v4.1 (AF= 4.64673e-05; MAF= 0.00465%, 75/1614038 alleles, homozygotes = 0) and has highest observed frequency in the European (Finnish) population (AF= 0.000156167; MAF= 0.01562%, 10/64034 alleles, homozygotes = 0); grpmax FAF= 4.182e-05.

gnomAD v2.1

This variant is present in gnomAD v2.1 (AF= 6.01059e-05; MAF= 0.00601%, 17/282834 alleles, homozygotes = 0) and has highest observed frequency in the European (non-Finnish) population (AF= 0.000108389; MAF= 0.01084%, 14/129164 alleles, homozygotes = 0); grpmax FAF= 6.663e-05.

gnomAD-Canada

Absent from gnomAD-Canada v1.0.

SpliceAI and Pangolin

Pangolin splice lossmagnitude shown
-0.010
Pangolin splice gain
0.010

Other predictors

REVEL
0.970
BayesDel
0.565

How the predictions were used

PP3 SupportingMultiple in silico predictors support a deleterious effect: REVEL score 0.97 (strongly pathogenic) and BayesDel score 0.565 (damaging prediction). SpliceAI predicts no splice impact (max delta 0.00). Details ▾Hide ▴
Evidence considered
  • REVEL: 0.97 (pathogenic range)
  • BayesDel: 0.565 (damaging)
  • SpliceAI: max delta 0.00 (no splice impact)
Sources
revelbayesdelspliceai ↗
BP4 REVEL score 0.97 and BayesDel score 0.565 both predict a damaging effect, not a benign one. Multiple lines of computational evidence support pathogenicity. Details ▾Hide ▴
Evidence considered
  • REVEL: 0.97 (pathogenic
  • not benign)
  • BayesDel: 0.565 (damaging
  • SpliceAI: max delta 0.00
Sources
revelbayesdelspliceai ↗
BP7 N/ANM_000143.4:c.1127A>C is a missense variant (p.Gln376Pro), not a synonymous variant. Details ▾Hide ▴
Evidence considered
  • Missense substitution
  • not synonymous.

Statement

In silico

SpliceAI predicts no significant splice impact for this variant (max delta score = 0.00). REVEL score = 0.97. BayesDel score = 0.565222.

8 paper records listed. 1 cited in the classification.

Cited in the classification

  • A novel mutation of the fumarase gene in a family with autosomal recessive fumarase deficiency.
    Remes AM et al. · 2004 Aug
    Remes et al. describe a novel mutation at nucleotide 1127A>C of the fumarase gene in a family with autosomal recessive fumarase deficiency. The variant was identified as a pathogenic mutation associated with loss of fumarase activity.
    → PS3 → PM1 Names this variant
    PMID 15221078 ↗
    Source detail
    We describe a novel mutation in nucleotide 1127A>C of the fumarase gene

    Location Abstract

Other recorded publications

  • Inhibition of hypoxia-inducible factor (HIF) hydroxylases by citric acid cycle intermediates: possible links between cell metabolism and stabilization of HIF.
    Koivunen P et al. · 2007
    Koivunen et al. studied inhibition of HIF hydroxylases by citric acid cycle intermediates including fumarate. The study examines metabolite-level effects of fumarate accumulation but does not mention NM_000143.4:c.1127A>C or any specific FH variant.
    Does not name this variant
    PMID 17182618 ↗
  • Downregulation of SRF-FOS-JUNB pathway in fumarate hydratase deficiency and in uterine leiomyomas.
    Raimundo N et al. · 2009
    Raimundo et al. studied global expression patterns in FH-deficient fibroblasts and leiomyomas, identifying downregulation of the SRF-FOS-JUNB pathway as a tumorigenic mechanism. The study used FH-deficient cell lines but does not identify or discuss NM_000143.4:c.1127A>C specifically.
    Does not name this variant
    PMID 19151755 ↗
    Quoted passage
    FH-deficient primary diploid fibroblasts from two patients carrying recessive defects of FH ('FH fibroblasts')

    Methods: FH-deficient fibroblast lines from patients with recessive FH defects (line 143-144)

  • Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology.
    Richards et al. published the ACMG/AMP standards and guidelines for interpretation of sequence variants. This foundational guideline document does not discuss or reference NM_000143.4:c.1127A>C.
    Does not name this variant
    PMID 25741868 ↗
  • A Standardized DNA Variant Scoring System for Pathogenicity Assessments in Mendelian Disorders.
    Karbassi et al. describe a standardized DNA variant scoring system for pathogenicity assessments in Mendelian disorders. The paper does not mention NM_000143.4:c.1127A>C or the FH gene specifically.
    Does not name this variant
    PMID 26467025 ↗
  • FH Variant Pathogenicity Promotes Purine Salvage Pathway Dependence in Kidney Cancer.
    This study quantified catalytic efficiencies of 74 FH variants of uncertain significance in kidney cancer context. The abstract does not specify whether NM_000143.4:c.1127A>C (p.Gln376Pro) was among the variants tested.
    Does not name this variant
    PMID 37255402 ↗
  • Abnormalities in succinylpurines in fumarase deficiency: possible role in pathogenesis of CNS impairment.
    Zeman J et al. · 2000
    No paper-specific finding is recorded.
    PMID 10896297 ↗
  • Fumarate hydratase deficiency in monozygotic twins.
    Phillips TM et al. · 2006
    Phillips et al. report monozygotic twins with fumarate hydratase deficiency caused by two different mutations: c.998A>C (p.Q333P) and c.1078C>T (p.H360C). NM_000143.4:c.1127A>C was not identified in this paper.
    Does not name this variant
    PMID 16876016 ↗
    Quoted passage
    Gene testing in both revealed the following two mutations: Mutation #1 998 A to C aa Q333P, which is a glutamine to proline change; and Mutation #2 1078 C to T aa H360C, which is a histidine to cysteine change.

    Case Report, gene testing results (line 118-124)

Screenshots represent source records captured during evidence collection. Select one to view the recorded source content.

All source links

Statements for reports

The evidence statements recorded by the interpretation pipeline. They have not been reinterpreted by the page.

gnomAD v4.1

This variant is present in gnomAD v4.1 (AF= 4.64673e-05; MAF= 0.00465%, 75/1614038 alleles, homozygotes = 0) and has highest observed frequency in the European (Finnish) population (AF= 0.000156167; MAF= 0.01562%, 10/64034 alleles, homozygotes = 0); grpmax FAF= 4.182e-05.

gnomAD v2.1

This variant is present in gnomAD v2.1 (AF= 6.01059e-05; MAF= 0.00601%, 17/282834 alleles, homozygotes = 0) and has highest observed frequency in the European (non-Finnish) population (AF= 0.000108389; MAF= 0.01084%, 14/129164 alleles, homozygotes = 0); grpmax FAF= 6.663e-05.

gnomAD-Canada

Absent from gnomAD-Canada v1.0.

ClinVar

This variant has been reported in ClinVar as Pathogenic (7 clinical laboratories) and as Likely pathogenic (2 clinical laboratories) and as Uncertain significance (2 clinical laboratories) and as likely pathogenic (1 clinical laboratory). (ClinVarID = 42094)

In silico

SpliceAI predicts no significant splice impact for this variant (max delta score = 0.00). REVEL score = 0.97. BayesDel score = 0.565222.

Functional

OncoKB did not identify variant-specific reviewed functional evidence for this variant; gene-level curated context is available for reviewer follow-up. FH, an enzyme that converts fumarate to malate in the TCA cycle, is infrequently altered in cancer.

Somatic

This variant does not lie in a statistically significant hotspot. This variant has previously been reported in somatic cancers (COSMIC; COSV105921172, n = 1 times).

Cancer Hotspots

This variant does not lie in a statistically significant hotspot.