Reasoning
No NF2-specific ClinGen VCEP PVS1 specification is available for this case (cspec.found=false, gene_vcep_dir=null), so the generic ACMG/AMP PVS1 decision tree (ClinGen SVI recommendations, PMC6185798) was applied. NM_000268.3:c.778G>T produces NP_000259.1:p.(Glu260Ter), a nonsense variant in the NF2 transcript (consequence_class='nonsense'). Gene-level LoF mechanism was confirmed eligible for germline NF2 disease (pvs1_gene_context: lof_mechanism_supported=true, pvs1_gene_gate='eligible'), consistent with NF2-related schwannomatosis arising from biallelic/functional loss of merlin. Transcript relevance: NM_000268.3 is the reference/CCDS-linked transcript (CCDS13861.1) used for annotation, and the stop is predicted from the canonical CDS (c.1-1788, 596 aa protein). NMD prediction: exon boundaries from the transcript model place c.778 within an internal coding exon (c.676-810, well upstream of the terminal exon-exon junction at approximately c.1737/1738), i.e. more than 50 nt upstream of the last exon-exon junction, so the premature termination codon is predicted to trigger nonsense-mediated decay, consistent with a null allele. Protein length change: even absent NMD, the truncation would remove residues 260-596 (337 of 596 aa, ~57% of the protein), eliminating the C-terminal FERM-associated/tail region required for merlin function -- a substantial truncation, not a distal/non-critical loss. Exon importance/repeat-region context: exon 8 (c.676-810) is a constitutively included internal coding exon with no evidence in the gathered materials of being alternatively spliced, minimally conserved, or enriched for benign population-observed LoF variation; the variant is absent from gnomAD v2.1, v4.1, and gnomAD-Canada, arguing against this exon tolerating LoF variation in the general population. SpliceAI predicts no meaningful splice disruption (max delta 0.149, below typical actionable thresholds), so this is assessed purely as a canonical nonsense/NMD-predicted LoF variant, not a splice-altering event, avoiding double counting with splice-based evidence. No exon-skipping rescue or reinitiation evidence was identified. Taken together, this meets the ClinGen SVI generic PVS1 criteria at full (Very Strong) strength for NF2.
Rule
PVS1_generic_ClinGen_SVI_PMC6185798
Evidence considered
- case_summary.json cspec.found=false and vcep_materials.final_classification_framework.found=false confirm no NF2-specific VCEP PVS1 specification is available, mandating generic ACMG/AMP PVS1 fallback per PMC6185798 (pvs1_variant_assessment.framework_source).
- pvs1_gene_context.json: lof_mechanism_supported=true and pvs1_gene_gate='eligible', with mechanism_rationale stating that targeted germline literature review identified disease-focused publications supporting NF2 loss of function as a germline disease mechanism.
- pvs1_variant_assessment.json: consequence_class='nonsense', variant_bucket='nonsense', protein_1l='NP_000259.1:p.(E260*)', suggested_default_strength='PVS1', with rationale that nonsense variants are evaluated with the generic PVS1 framework once germline LOF is established.
- prefetch.json mutalyzer selector_short exon/CDS coordinate table shows c.778 falls in the exon spanning c.676-810 (an internal exon), and the CDS terminal exon-exon junction is at approximately c.1737/1738, placing the premature stop far (>50 nt) upstream of the last junction, consistent with NMD.
- prefetch.json mutalyzer protein prediction: predicted truncated protein 'MAGAIASRMSFSSLKRKQPKTFTVRIVTMDAEMEFNCEMKWKGKDLFDLVCRTLGLRETWFFGLQYTIKDTVAWLKMDKKVLDHDVSKEEPVTFHFLAKFYPENAEEELVQEITQHLFFLQVKKQILDEKIYCPPEASVLLASYAVQAKYGDYDPSVHKRGFLAQEELLPKRVINLYQMTPEMWEERITAWYAEHRGRARDEAEMEYLKIAQDLEMYGVNYFAIRNKKGTELLLGVDALGLHIYDPENRLTPKISFPWN*' ends at position 260 versus wild-type length 596 (position_last_original=596, position_last_predicted=260), confirming loss of 337 residues (~57% of the protein).
- case_summary.json compact_evidence.spliceai: SpliceAI max delta score 0.149 (DS_AL=0.149, all other deltas <=0.035), interpreted as no significant splice impact, so this variant is treated as a straightforward nonsense/NMD event rather than a splice-disruption event, avoiding evidence overlap with splice-based criteria.
- case_summary.json compact_evidence.gnomad: variant absent from gnomAD v2.1, v4.1, and gnomAD-Canada v1.0, providing no population evidence that this exon or codon position tolerates LoF variation.
Still missing
- No NF2/schwannomatosis-specific ClinGen VCEP PVS1 specification exists yet for this case; assessment relies on the generic ClinGen SVI PVS1 decision tree (PMC6185798).
- Exact exon number and precise last-exon-junction distance were derived from transcript coordinate ranges in the prefetch normalization data rather than a curated NF2 exon map; no evidence was found that exon 8 is a recognized non-critical or LoF-tolerant region.
- No direct experimental NMD confirmation (e.g., patient RNA/transcript-level study) for this specific variant was located; NMD status is a rule-based prediction from position relative to the terminal exon junction.
Sources