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NM_000179.3:c.2017C>G
p.Pro673Ala · MSH6
0%
complete
Final classification
Uncertain Significance - Conflicting Evidence
PM2BP4
MSH6
c.2017C>G
p.Pro673Ala
missense · exon 4

MSH6 encodes a protein in the DNA mismatch repair system, which fixes errors made during DNA replication. Partnering with MSH2, it forms a complex that recognizes and helps correct mismatched DNA bases, keeping the genetic code stable. Inherited mutations in MSH6 cause Lynch syndrome (hereditary nonpolyposis colorectal cancer), raising the risk of colorectal, endometrial, ovarian, and other cancers, while mutations in both copies lead to constitutional mismatch repair deficiency. Because faulty mismatch repair drives tumor development and produces microsatellite instability, MSH6 acts as a tumor suppressor, and cancers with such repair defects often respond well to immune checkpoint inhibitor therapy.

This variant

All three consequence/LoF criteria resolve from the variant's own consequence class: NM_000179.3:c.2017C>G is a missense substitution (NP_000170.1:p.(Pro673Ala)) with no protein-length change (mutalyzer start 672 / end 673 unchanged) and no predicted splice effect (SpliceAI max delta 0.014), so the allele is neither a null variant nor an in-frame length-altering variant.

Transcript
NM_000179.3
HGVS · transcript:coding
NM_000179.3:c.2017C>G
GRCh38
chr2:47800000 C>G
GRCh37
chr2:48027139 C>G
ClinGen InSiGHT Hereditary Colorectal Cancer/Polyposis Expert Panel Specifications to the ACMG/AMP Variant Interpretation Guidelines for MSH6 Version 2.0 v2.0 criteria-combination framework: matched Rule31 (Benign.Supporting >=1 + Pathogenic.Supporting >=1) with applied criteria: PM2 supporting, BP4 supporting; maps to Uncertain Significance - Conflicting Evidence.
Classification rationale
PM2 BP4 Uncertain Significance - Conflicting Evidence
MSH6 c.2017C>G missense · exon 4

All three consequence/LoF criteria resolve from the variant's own consequence class: NM_000179.3:c.2017C>G is a missense substitution (NP_000170.1:p.(Pro673Ala)) with no protein-length change (mutalyzer start 672 / end 673 unchanged) and no predicted splice effect (SpliceAI max delta 0.014), so the allele is neither a null variant nor an in-frame length-altering variant. PVS1 is therefore not met - no PTC, no frameshift, no large genomic alteration, no IVS+/-1 or +/-2 change, and no mRNA assay evidence of a splicing aberration - and no PVS1 strength tier is assigned (the 'very strong' tier would require a met, un-downgraded null call, which this is not). PM4 and BP3 are not applicable: the governing ClinGen InSiGHT MSH6 VCEP v2.0 explicitly designates both criteria as Not Applicable (protein length change from an in-frame variant not used; in-frame indels in a repetitive region of unknown function not used). This group contributes no pathogenic and no benign evidence; classification of this variant rests entirely on the other evidence groups. None of the five codon/residue/domain criteria contributes pathogenic or benign evidence for NM_000179.3:c.2017C>G (p.Pro673Ala): PS1 and PM5 are not met, and PM1, PP2 and BP1 are designated Not Applicable by the governing InSiGHT MSH6 VCEP specification v2.0. PS1 fails because c.2017C>G is the only codon-673 substitution that encodes alanine (codon 673 is CCG), so no alternate-nucleotide p.Pro673Ala comparator exists, and no codon-673 variant carries a VCEP Pathogenic/Likely Pathogenic classification. PM5 fails on two independent limbs: no VCEP-classified different missense change exists at residue 673, and the VCEP's mandatory PP3 gate is unsatisfied because this variant's HCI prior of 0.0159 falls in the BP4_supporting range (<0.11) rather than above the PP3_supporting threshold (>0.68). The benign direction carried by this group is limited to the observation, relevant only to the VCEP in-silico rules, that the HCI prior of 0.0159 (and REVEL 0.447) sit in the BP4_supporting range; no criterion in this group is met. The segregation/de novo group contributes no scoring evidence for NM_000179.3:c.2017C>G (p.Pro673Ala): PS2 scores 0 de novo points, PP1 is unmet (no pedigree or family genotypes, so no co-segregation Bayes likelihood ratio exists), BS4 is unmet (no informative family, so non-segregation cannot be shown), and PM6 is not applicable in the governing specification. Governing framework is the InSiGHT Hereditary Colorectal Cancer/Polyposis Expert Panel specification for MSH6 v2.0 (CSPEC doc 1578294885): PS2 is a proband-point rule (2 points de novo with confirmed maternity/paternity and MMR-deficient LS-spectrum tumour; 1 point with confirmed maternity/paternity and LS-spectrum tumour; 0.5 points assumed de novo with unconfirmed parentage; >=4 Very Strong, 2-3.5 Strong, 1-1.5 Moderate, 0.5 Supporting), PP1 and BS4 are graded from a combined pedigree Bayes likelihood ratio (PP1 Supporting >2.08, Moderate >4.3, Strong >18.7 in >=2 families; BS4 Strong <0.05, Supporting >0.05-0.48), and PM6 is explicitly not applicable. The absence of evidence is documented rather than assumed: ClinVar variation 410451 contains 8 single-submitter germline submissions (7 Uncertain significance, 1 Likely benign, no expert panel) with no de novo, parental-testing, pedigree or segregation statement, the submission criterion signals are limited to PP3, PS3 and PP4, and none of the seven fetched full texts mentions the variant. This case carries no proband-level clinical record of any kind - no pedigree, no trio or parental genotypes, no family history, no tumour phenotype - so the group's criteria cannot be satisfied by any in-record observation, and the de novo point total (0) and both likelihood-ratio-based criteria (PP1, BS4) remain at their unmet/not-calculable defaults. PM6 non-applicability is a specification decision (MSH6 v2.0 marks PM6 and all of its strength tiers not applicable, folding assumed-de-novo evidence into the PS2 point scale) and must not be carried into the final classification as benign or pathogenic evidence. Framework applied: ClinGen InSiGHT Hereditary Colorectal Cancer/Polyposis Expert Panel specification for MSH6 v2.0 (case framework_mode = vcep; doc_id 1578294885), which is gene-specific and therefore takes precedence over generic ACMG/AMP. Both PS3 and BS3 in that specification are driven exclusively by functional assay data: calibrated functional assays reported as functional odds for pathogenicity, or variant-specific protein/mRNA assay results evaluated through the MMR functional assay flowchart. PS3 is not met and BS3 is not met, for the same reason: no functional assay of any kind has been performed on NM_000179.3:c.2017C>G, p.(Pro673Ala). No calibrated assay result (cell-free or mammalian MMR repair activity, MSH6 protein expression/stability, subcellular localisation, cDNA full-length transcript with and without NMD inhibition) appears anywhere in the case evidence; the VCEP's approved-assay documentation contains no entry for this variant, and the VCEP pilot-variant table does not list it. Independent corroboration of the absence of functional data: two clinical-laboratory ClinVar submissions (All of Us Research Program SCV004838292 and Color Diagnostics SCV000685248) state that functional studies have not been reported for this variant; OncoKB reports no variant-specific reviewed functional evidence; and none of the seven full-text papers retrieved for this case mentions the variant or reports an MSH6 functional assay. SpliceAI max delta 0.014 (no significant splice impact) means the variant cannot be routed into a splicing-based functional path either; the flowchart's missense-without-splice-impact branch requires a calibrated functional assay or two independent concordant assays, and neither was performed. The BS3_Strong synonymous/intronic branch is inapplicable to a missense variant. Deliberate non-use of a superficially attractive number: the local HCI prior for p.P673A is 0.0159 (MAPP/PP2 prior column; Custom_PP2_score 0.409, MAPP 4.34). Numerically this sits below the BS3 functional-odds threshold of <=0.05, but it is an in-silico prior that this VCEP assigns to PP3/BP4 (<0.11 = BP4_Supporting), not a measurement from a calibrated functional assay. Using it for BS3 would double-count a computational prior as functional evidence; the PP3/BP4 consequences are left to the in-silico group. Net functional contribution to this case: zero points in either direction. No other source's final classification was used to reach this conclusion. Three of this group's five criteria (PS4, PP5, BP6) are not applicable: the governing InSiGHT Hereditary Colorectal Cancer/Polyposis MSH6 specification v2.0 disallows them for this gene, and PP5/BP6 additionally have no exact-variant ClinVar expert-panel classification to act on (expert-panel submissions = 0). PP4 (MSI-H tumour phenotype) is applicable but not met: qualifying tumour count 0 versus the Supporting threshold of at least 1 (0 >= 1? No). BP5 (MSS / no-MMR-loss tumour phenotype) is applicable but not met: qualifying tumour count 0 versus the Supporting threshold of 2 or 3 (0 >= 2? No). Net contribution of this group to the final classification is zero: no tumour MSI/IHC, BRAF V600E or MLH1 methylation data exist for MSH6 c.2017C>G (p.Pro673Ala), so neither the pathogenic (PS4/PP4) nor the benign (BP5/BP6) side of this group supplies evidence. This group contributes no scoring evidence: PM3 scores 0 points because the InSiGHT MSH6 v2.0 co-occurrence rule (second pathogenic MSH6 variant in a CMMRD-consistent patient, 1.0 point in trans or 0.5 points phase-unknown) has no qualifying observation for c.2017C>G, and BP2 is not applicable in this gene-disease specification, which uses BS2 instead. Allelic evidence is uniformly absent rather than merely unreported: the variant is reported only as a heterozygous germline finding in Lynch-syndrome-spectrum testing (7 ClinVar submissions Uncertain significance, 1 Likely benign, no expert panel), no submitter or publication describes a second MSH6 variant, phase, or a biallelic/CMMRD case, and gnomAD v4.1 shows 7/1,613,704 alleles with zero homozygotes. Because the variant's known clinical use is heterozygous in a dominant cancer-predisposition context, this group cannot supply pathogenic or benign weight from trans/cis configuration; any such weight would have to come from a CMMRD-setting co-occurrence observation that does not currently exist. Consequence type fixed the single predictor path: c.2017C>G is a missense substitution (NP_000170.1:p.(Pro673Ala), MSH6 exon 4), so PP3/BP4 were evaluated on the protein-impact path only; the SpliceAI splice path and BP7 were excluded upstream by scope, not because evidence was missing or unresolved. The governing ClinGen InSiGHT MSH6 VCEP specification (v2.0) replaces generic REVEL calibration for missense variants with the HCI prior probability of pathogenicity: >0.81 = PP3_Moderate, >0.68-0.81 = PP3_Supporting, <0.11 = BP4_Supporting. The declared local VCEP lookup HCI-PRIORS-MSH6.txt was searched under all three notations of this variant (c.2017C>G, p.Pro673Ala, p.P673A) and contains the exact row at line 4413 (dbid MSH6_04411) with prior probability 0.0159; this yields PP3 not_met and BP4 met at supporting strength, the strength the VCEP assigns to BP4 by default. The single HCI prior value (0.0159) supports exactly one criterion: it falls below 0.11 (BP4) and below 0.68 (PP3), so no prediction is double-counted across PP3/BP4, and BP7 is not applicable to a missense variant. Generic calibration was used only as a non-governing cross-check: REVEL 0.447 is in the indeterminate zone (0.29-0.644, PMID:36413997) and would give neither PP3 nor BP4 on its own; the SpliceAI delta of 0.014 was not used for either missense criterion, and no other source's final classification (ClinVar Uncertain significance, OncoKB unknown) was inferred into any criterion. Population group result under the governing ClinGen InSiGHT MSH6 v2.0 specification: BA1 not met, BS1 not met, BS2 not met, PM2 met at Supporting. The variant is genuinely rare rather than absent: gnomAD v4.1 records 7 alleles in 1,613,704 (total AF 4.337846e-06; Grpmax filtering AF 1.83e-06) with 0 homozygotes, which clears the VCEP's PM2 cutoff of <0.00002 but falls three orders of magnitude short of the VCEP's BS1 (0.00022) and BA1 (0.0022) thresholds, so no benign population-frequency evidence is generated. No gnomAD iteration or ancestry group approaches a benign threshold: maxima available are Grpmax filtering AF 2.849e-05 (v3.1 non-cancer genomes, European non-Finnish driven) and subpopulation AF 7.725110e-05 (European non-Finnish, v3.1 non-cancer genomes), both far below the VCEP BS1 floor of 0.00022; gnomAD v2.1, gnomAD v2.1 non-cancer exomes and gnomAD-Canada provide nothing higher (gnomAD-Canada: absent). Zero homozygotes were observed in every population dataset for this variant, so there is no population observation supporting BS2 (no healthy homozygous adult) or, conversely, any biallelic/CMMRD-type signal. Net contribution of this group to the final classification: one pathogenic criterion at Supporting strength (PM2_Supporting) and no benign criteria; the founder-pathogenic-variant exclusion clause attached to BA1/BS1 is moot because neither frequency threshold is approached. Source-selection sensitivity is limited and does not change any verdict: whether the VCEP-specified gnomAD v4 all-comers figures, the v2.1 (all-comers or non-cancer exome) figures, or the v3.1 non-cancer genome figures are used, BA1 and BS1 are not met; only PM2 is sensitive to source choice, and the VCEP explicitly names the gnomAD v4 dataset, which yields 1.83e-06 and therefore meets it.

PM2 + BP4 → Uncertain Significance - Conflicting Evidence
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.
Gene diagram · NM_000179.3 · variants mapped to exon structure
MSH6 NM_000179.3
Fetching transcript structure from UCSC…
Applied criteria · 2 applied · 15 assessed
MetEvidence satisfies this criterion.
Not metEvaluated against available evidence; threshold not reached.
Not assessedApplies in principle, but no evidence was found to evaluate it.
N/ADoesn't apply to this variant type.
Applied · 2
Strength Supporting Moderate Strong Very strong
PM2 supporting Pathogenic
Met at supporting: gnomAD v4.1 Grpmax filtering AF 1.83e-06 (7/1,613,704 alleles) versus the InSiGHT MSH6 v2.0 PM2 cutoff of <0.00002.
ClinGen InSiGHT MSH6 v2.0 (cspec, doc 1578294885) PM2 rule at Supporting strength: 'Absent/extremely rare allele frequency <0.00002 (<1 in 50,000 alleles) in gnomAD v4 dataset'. The CSPEC release notes state: 'Amendment: Minor change to PM2 allele frequency format (1/50000 = 0.00002)'.The same specification's PS1 moderate rule requires that 'PM2_supporting is met', confirming that the VCEP intends PM2 to be applied at Supporting strength only.gnomAD v4.1 (chr2-47800000-C-G, GRCh38): total AF 4.337846e-06 (7/1,613,704 alleles, ~1 in 230,529 alleles), Grpmax filtering AF 1.83e-06, 0 homozygotes; exome-only 2/1,461,876 (1.368105e-06) and genome-only 5/151,828 (3.29320e-05).
BP4 supporting Benign
Met at supporting: HCI prior probability 0.0159 for c.2017C>G (p.P673A) is below the VCEP's <0.11 BP4 threshold.
Scope check: c.2017C>G is a missense variant (NP_000170.1:p.(Pro673Ala)), the consequence type BP4's missense clause covers; the intronic/synonymous SpliceAI clause of the VCEP BP4 rule does not apply.MSH6 VCEP v2.0 BP4 rule (default strength Benign Supporting, cspec doc 1578294885): missense variant with HCI-prior probability of pathogenicity <0.11; alternatively, for intronic and synonymous variants, SpliceAI predicts no splicing impact with delta score <=0.1.Exact lookup: HCI-PRIORS-MSH6.txt line 4413, exon 4, c.2017C>G, p.P673A, dbid MSH6_04411, prior probability 0.0159 (MAPP 4.34, custom PP2 0.409), reference {PMID22949387:Thompson et al., 2013}. 0.0159 < 0.11, so the VCEP's missense BP4 clause is satisfied by its own pre-assigned prior value.
Assessed · not applied · 15 not met · 0 not assessed
Pathogenic
PVS1 Not met: c.2017C>G encodes p.Pro673Ala, a missense substitution with no protein-length change, not a null variant (SpliceAI max delta 0.014).
PS1 Not met: c.2017C>G is the only codon-673 substitution encoding alanine, so no alternate-nucleotide p.Pro673Ala comparator exists.
PS2 Not met: 0 of the minimum 0.5 de novo points, as no de novo occurrence or parental testing is reported for this variant.
PS3 Not met: no calibrated MMR functional assay or functional odds exists for p.(Pro673Ala), and submitters report functional studies have not been reported.
PM3 Not met: InSiGHT MSH6 v2.0 PM3 requires a second pathogenic MSH6 variant in trans in a CMMRD-consistent patient; no such co-occurrence is reported, scoring 0 points.
PM5 Not met: the VCEP requires PP3 supporting, but this variant's HCI prior of 0.0159 falls in the BP4 range, and no VCEP-classified residue-673 comparator exists.
PP1 Not met: no pedigree or family genotypes exist, so no co-segregation Bayes likelihood ratio can be computed against the >2.08 Supporting threshold.
PP3 Not met: HCI prior probability 0.0159 for p.Pro673Ala is below the >0.68 threshold the MSH6 VCEP sets for PP3_Supporting.
PP4 Not met: zero qualifying MSI-H or MSH6-consistent MMR-IHC-loss tumors reported, against the PP4 Supporting threshold of at least 1 tumor.
Benign
BA1 Not met: gnomAD v4.1 Grpmax filtering AF 1.83e-06 versus the InSiGHT MSH6 v2.0 BA1 threshold of >=0.0022 (0.22%).
BS1 Not met: gnomAD v4.1 Grpmax filtering AF 1.83e-06 versus the InSiGHT MSH6 v2.0 BS1 threshold of >=0.00022 (0.022%).
BS2 Not met: no in-trans pathogenic MSH6 co-occurrence with confirmed phase was found, and gnomAD v4.1 reports 0 homozygotes (7/1,613,704 alleles).
BS3 Not met: no calibrated functional assay or protein/mRNA assay reports proficient function for this variant, and the low in-silico MAPP/PP2 prior is not a functional odds.
BS4 Not met: no family or meiosis data exist, so no Bayes likelihood ratio below the <0.05 Strong (or <=0.48 Supporting) non-segregation threshold can be established.
BP5 Not met: zero MSS/no-MMR-loss tumors reported versus the BP5 Supporting threshold of 2 or 3 tumors.
N/A · 11 PS4 · PM1 · PM4 · PM6 · PP2 · PP5 · BP1 · BP2 · BP3 · BP6 · BP7
Research & evidence
Population frequency
gnomAD v4.1 screenshot
gnomAD v4.1
gnomAD v2.1 screenshot
gnomAD v2.1
v4.1
This variant is present in gnomAD v4.1 (AF= 4.33785e-06; MAF= 0.00043%, 7/1613704 alleles, homozygotes = 0) and has highest observed frequency in the Admixed American population (AF= 1.66783e-05; MAF= 0.00167%, 1/59958 alleles, homozygotes = 0); grpmax FAF= 1.83e-06.
v2.1
This variant is present in gnomAD v2.1 (AF= 1.41683e-05; MAF= 0.00142%, 4/282320 alleles, homozygotes = 0) and has highest observed frequency in the Admixed American population (AF= 2.82279e-05; MAF= 0.00282%, 1/35426 alleles, homozygotes = 0); grpmax FAF= 2.241e-05.
🇨🇦 CA
Absent from gnomAD-Canada v1.0.
Allele frequency by ancestry
three datasets · side by side
gnomAD v4.1
0.00043% · 7 / 1,613,704
0 hom · FAF 0.00018%
Admixed American
1 / 59,958
0.0017%
European (non-Finnish)
6 / 1,179,950
0.00051%
+ 8 not observed (Remaining individuals, European (Finnish), Amish, East Asian, Middle Eastern, South Asian, Ashkenazi Jewish, African/African American)
gnomAD v2.1
0.0014% · 4 / 282,320
0 hom · FAF 0.0022%
Admixed American
1 / 35,426
0.0028%
European (non-Finnish)
3 / 128,714
0.0023%
+ 6 not observed (African/African American, Ashkenazi Jewish, East Asian, European (Finnish), Remaining individuals, South Asian)
gnomAD Canada 🇨🇦
Absent · 0 / ?
0 hom
Not observed in any ancestry group.
ClinVar screenshot
ClinVar
This variant has been reported in ClinVar as Uncertain significance (5 clinical laboratories) and as Uncertain Significance (1 clinical laboratory) and as Likely benign (1 clinical laboratory). (ClinVarID = 410451)
SpliceAI screenshot
In silico
SpliceAI predicts no significant splice impact for this variant (max delta score = 0.01). REVEL score = 0.447. BayesDel score = -0.0894312. HCI prior probability for pathogenicity = 0.0159. MAPP score = 4.34. Custom PP2 score = 0.409.
Functional / OncoKB screenshot
Functional Unknown Oncogenic Effect
OncoKB did not identify variant-specific reviewed functional evidence for this variant; gene-level curated context is available for reviewer follow-up. MSH6, a DNA mismatch repair protein, is frequently mutated in colorectal, small bowel, and endometrial cancers.
OncoKB ↗
COSMIC screenshot
COSMIC
Cancer hotspots screenshot
Cancer hotspots
Somatic evidence Not in COSMIC / hotspots
COSMIC
This variant does not lie in a statistically significant hotspot. This variant has not previously been reported in somatic cancers (COSMIC).
Hotspots
This variant does not lie in a statistically significant hotspot.
Literature · how each cited paper was used
7papers cited
Each card is an audit: what was searched, what was found, whether it names the variant, which criteria it fed, and why. 1 further PMID triaged but not cited — see Sources & references.
Rule & framework references · cited for criterion definitions, not variant evidence
25394175 ↗ A practice guideline from the American College of Medical Genetics and Genomics
25711197 ↗ Lynch Syndrome: A Primer for Urologists and Panel Recommendations.
25741868 ↗ Standards and guidelines for the interpretation of sequence variants: a joint co
26324357 ↗ American Society of Clinical Oncology Policy Statement Update: Genetic and Genom
27854360 ↗ Recommendations for reporting of secondary findings in clinical exome and genome
28492532 ↗ Sherloc: a comprehensive refinement of the ACMG-AMP variant classification crite
30267214 ↗ Rare loss of function variants in candidate genes and risk of colorectal cancer.
Sources & reference links
9Sources
CSpec VCEP
ClinVar
gnomAD v2.1
gnomAD v4.1
gnomAD-Canada
SpliceAI
OncoKB
COSMIC
Cancer hotspots
Triaged references · 1 PMID not cited in assessment
33451724 ↗ Endometrial cancer: A society of gynecologic oncology evidence-based review and CLINVAR