The HEXA NM_000520.6:c.1421+1G>C (NP_000511.2:p.?) splicing variant has not previously been reported in somatic cancers (COSMIC). This variant is predicted to disrupt normal RNA processing, resulting in either an aberrant protein product or nonsense-mediated RNA decay. Experimental evidence: Patient-fibroblast cDNA studies showed intron 12 retention and abnormal HEXA mRNA for the exact c.1421+1G>C splice variant. Based on available guidelines, this variant is considered to be Likely Pathogenic.
Five-step scale from benign to pathogenic. This variant is likely pathogenic. Select a step to read what it means.
This variantScenario
BenignPathogenic
Likely pathogenic.A likely pathogenic classification under the recorded framework.
In plain language
Gene-level background from the recorded interpretation.
Words with a dotted underline have a short definition. Hover or tap them.
About HEXA
HEXA encodes the alpha subunit of beta-hexosaminidase, a lysosomal enzyme that helps break down GM2 ganglioside and other molecules containing terminal N-acetyl hexosamines. Harmful changes in HEXA can cause GM2 gangliosidoses, including Tay-Sachs disease, in which GM2 accumulates in nerve cells and leads to progressive neurodegeneration. HEXA is not established as a cancer-related gene.
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01The reasoning
How it was classified
The recorded framework is Generic ACMG/AMP 2015 with ClinGen SVI recommendations. 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.
Met at very strong: the canonical +1 splice variant in exon 12 of 14 is predicted to skip 91 coding nucleotides, shifting the reading frame in LOF-sensitive HEXA.
PS3Moderate
PS3 · moderate
Met at moderate strength: patient-fibroblast cDNA studies showed intron 12 retention and abnormal HEXA mRNA for the exact c.1421+1G>C splice variant.
Benign criteria applied · 1
BP4Supporting
BP4 · supporting
Met at supporting: SpliceAI max delta 0.00 meets the <=0.1 BP4 threshold for intronic or splice-region variants.
Recorded classification: Likely pathogenic
Likely Pathogenic: PVS1 (very strong) plus PS3 (moderate) satisfy the generic ACMG/AMP combination rule; BP4 does not satisfy a benign rule.
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
109 / 1,612,550 alleles
gnomAD v4.1: 109 / 1,612,550 alleles. Recorded AF 6.75948e-05. Recorded homozygote count 0.
gnomAD v2.1
This variant is present in gnomAD v2.1 (AF= 0.000115725; MAF= 0.01157%, 29/250594 alleles, homozygotes = 0) and has highest observed frequency in the Ashkenazi Jewish population (AF= 0.00249203; MAF= 0.24920%, 25/10032 alleles, homozygotes = 0); grpmax FAF= 7.03e-06.
ACMG/AMP criteria under Generic ACMG/AMP 2015 with ClinGen SVI recommendations, with the data and sources behind each one.
28 criteria with recorded statuses: 3 met · 8 not met · 9 not assessed · 8 not applicable. Open any row for the full reasoning, the rule and the evidence behind it.
No criterion among PS2, PM6, PP1, and BS4 can be assigned from the available evidence because parental testing, family structure, informative meioses, and segregation or non-segregation results are not documented.
No functional evidence demonstrates preserved splicing or protein function, so BS3 is not met.
No VCEP covers HEXA in this case, so generic ACMG/AMP 2015 rules govern.
The exact variant is documented in affected Tay-Sachs patients, but the available literature does not provide PS4 case-control data, current-patient phenotype data for PP4, an alternate molecular basis for BP5, or a qualifying ClinVar expert-panel assertion for PP5/BP6.
The variant is an intronic canonical splice-site change, so PP3 and BP4 were adjudicated only through SpliceAI; REVEL and BayesDel were not used.
SpliceAI max delta 0.00 does not meet PP3 >= 0.2 but meets BP4 <= 0.1 at supporting strength.
Population evidence supports none of the four requested criteria: the variant is rare, has no observed homozygotes, is far below BA1/BS1 frequency thresholds, and narrowly exceeds the explicit PM2 threshold in gnomAD v2.1 despite qualifying in gnomAD v4.1.
No criteria match.
Met · 3
PVS1Very strongACMG_2015Met at very strong: the canonical +1 splice variant in exon 12 of 14 is predicted to skip 91 coding nucleotides, shifting the reading frame in LOF-sensitive HEXA.
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Reasoning
PVS1 is met at very strong strength. NM_000520.6:c.1421+1G>C is a canonical donor-site (+1) splice variant in the MANE Select transcript NM_000520.6, satisfying the ACMG/AMP null-variant definition. HEXA loss of function is supported as a germline disease mechanism in the gene-level assessment. The affected exon is exon 12 of 14, is neither the first, penultimate, nor last exon, and contains 91 coding nucleotides; exon skipping would remove 91 nucleotides (91 % 3 = 1) and shift the reading frame, predicting a premature truncating consequence rather than an in-frame change. The exact variant has been shown to produce abnormal HEXA mRNAs with retained or truncated intron 12, and the extracted finding describes the abnormal transcripts as unstable, supporting loss of transcript function. No named downgrade rule is triggered: the transcript is clinically relevant, the affected exon is internal rather than a non-critical distal terminal exon, and the predicted consequence does not escape the expected NMD-sensitive region. No repeat-region context or population LoF-enrichment evidence is present in the supplied case evidence. The ClinGen SVI generic PVS1 framework is therefore applied without downgrade.
Rule
PVS1: Null variant (nonsense, frameshift, canonical +/−1 or 2 splice sites, initiation codon, single or multi-exon deletion) in a gene where loss of function (LOF) is a known mechanism of disease.
Evidence considered
Variant assessment: NM_000520.6:c.1421+1G>C is a canonical donor (+1) splice variant in exon 12 of 14 on transcript NM_000520.6, with NP_000511.2:p.?.
Variant assessment: exon 12 is 91 coding nucleotides; skipping it would remove 91 nucleotides (91 % 3 = 1) and shift the reading frame.
Gene-level PVS1 context: HEXA loss of function is supported as a germline disease mechanism and the generic PVS1 gene gate is eligible.
The exact variant study reports abnormal HEXA alpha-chain mRNAs, including retained or truncated intron 12 transcripts, and describes the abnormal mRNAs as unstable.
The transcript is the MANE Select/refseq-select transcript, and the affected exon is internal rather than the first, penultimate, or last exon; no supplied evidence indicates a non-critical distal exon or repeat-region exception.
The generic ClinGen SVI PVS1 framework is applied without a named downgrade because the canonical splice-site change predicts a frameshifting loss-of-function consequence in an internal exon and does not indicate NMD escape.
PS3ModerateACMG_2015Met at moderate strength: patient-fibroblast cDNA studies showed intron 12 retention and abnormal HEXA mRNA for the exact c.1421+1G>C splice variant.
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Reasoning
PS3 is met at moderate strength. PMID:2837213 directly evaluated the exact HEXA splice-site change corresponding to NM_000520.6:c.1421+1G>C using cDNA cloning and sequencing from patient fibroblasts, with genomic hybridization controls across multiple patient cell lines. The study found retention of intact or truncated intron 12 in abnormal HEXA mRNAs and documented the donor-site G-to-C substitution; its direct result states, "However, the first nucleotide at the 5' donor site of intron 12 was consistently C, instead of the normal G." PMID:2973464 independently reports cDNA analysis from fibroblasts showing abnormal clones with intron 12 retention for the same G-to-C donor-site mutation. These concordant variant-specific RNA studies demonstrate abnormal splicing and support a damaging effect on the HEXA gene product. The evidence does not justify strong strength because the available material does not establish validated clinical-laboratory reproducibility or a fully quantified assay calibration.
Rule
Well-established in vitro or in vivo functional studies supportive of a damaging effect on the gene or gene product.
Evidence considered
PMID:2837213, Results, Structure of cDNAs, p. 466: cDNA cloning and Sanger sequencing from fibroblasts of patient cell line GM0502B showed abnormal HEXA transcripts retaining intact or truncated intron 12.
PMID:2837213, Results, Genomic DNA Analysis for the Junctional Transversion, pp. 466-467: genomic hybridization with normal and mutant 21-mer oligonucleotide probes in GM0502B, GM2968, and GM0515A confirmed the donor-site G-to-C substitution and included normal-sequence comparison.
PMID:2837213: the exact donor-site change was associated with abnormal, unstable HEXA alpha-chain mRNAs.
PMID:2973464, abstract: cDNA clones from fibroblasts of a compound-heterozygous Ashkenazi Jewish patient included abnormal transcripts retaining intron 12 with the G-to-C mutation at the 5' donor site.
Still missing
No evidence was provided that the assay was validated and reproducible in a clinical diagnostic laboratory setting.
Quantitative normal and known-damaging splice controls were not available in the extracted evidence.
BP4SupportingACMG_2015Met at supporting: SpliceAI max delta 0.00 meets the <=0.1 BP4 threshold for intronic or splice-region variants.
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Reasoning
NM_000520.6:c.1421+1G>C is an intronic canonical donor-site variant, so the governing generic rule selects the SpliceAI path only; REVEL and BayesDel are not applicable to BP4 in this situation. SpliceAI maximum delta is 0.00, meeting the generic BP4 supporting threshold of <= 0.1 from the supplied Jaganathan et al. 2019 calibration (PMID:30661751). BP4 is therefore met at supporting strength.
Rule
Multiple lines of computational evidence suggest no impact on gene or gene product (conservation, evolutionary, splicing impact, etc) ... BP4 (supporting): <= 0.1 — SpliceAI recommended cutoff (Jaganathan et al. 2019, Cell) (PMID:30661751)
Evidence considered
NM_000520.6:c.1421+1G>C is an intronic canonical donor-site variant (c.1421+1), so the generic intronic/splice-region path requires SpliceAI only.
SpliceAI max delta score = 0.00; this meets the generic BP4 supporting cutoff <= 0.1 from the supplied SpliceAI calibration by Jaganathan et al. 2019 (PMID:30661751).
REVEL 0.928 and BayesDel 0.66 were excluded because the governing rule selects the SpliceAI path for this intronic variant; the SpliceAI result was not double-counted across PP3, BP4, or BP7.
PM2ACMGNot met: gnomAD v2.1 total AF is 0.000115725, exceeding the recessive PM2 threshold of 0.0001 despite v4.1 being lower.
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Reasoning
PM2 is not met under the supplied generic threshold. The variant is present in both default all-comers datasets: gnomAD v2.1 total AF is 0.000115725 (29/250594), which is above the recessive PM2 threshold of 0.0001, while gnomAD v4.1 total AF is 6.75948e-05 (109/1612550), which is below it. The newer v4.1 value alone would qualify as extremely low frequency, but the v2.1 value exceeds the explicit threshold; therefore the combined population evidence does not satisfy PM2 consistently.
Rule
PM2 (supporting): <= 0.0001 — SVI recommendation to downgrade PM2 to Supporting (ClinGen SVI 2020) (PMID:25741868) ... PM2: Absent from controls (or at extremely low frequency if recessive) in Exome Sequencing Project, 1000 Genomes or Exome Aggregation Consortium.
Evidence considered
gnomAD v2.1 (exome): total AF=0.000115725 (29/250594 alleles), homozygotes=0; this exceeds the supplied PM2 threshold of <=0.0001.
gnomAD v4.1: total AF=6.75948e-05 (109/1612550 alleles), homozygotes=0; this is below the supplied PM2 threshold of <=0.0001.
No governing VCEP specifies a non-cancer or exome-only source for this gene, so the default all-comers gnomAD v2.1 and v4.1 entries were used.
PP3ACMG_2015Not met: SpliceAI max delta 0.00 is below the >=0.2 PP3 supporting threshold for intronic or splice-region variants.
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Reasoning
NM_000520.6:c.1421+1G>C is an intronic canonical donor-site variant, so the governing generic rule selects the SpliceAI path only; REVEL and BayesDel are not applicable to PP3 in this situation. SpliceAI maximum delta is 0.00, below the generic PP3 supporting threshold of >= 0.2 and moderate threshold of >= 0.5, using the supplied Jaganathan et al. 2019 calibration (PMID:30661751). PP3 is therefore not met.
Rule
Multiple lines of computational evidence support a deleterious effect on the gene or gene product (conservation, evolutionary, splicing impact, etc.). ... PP3 (supporting): >= 0.2 — SpliceAI recommended cutoff (Jaganathan et al. 2019, Cell) (PMID:30661751)
Evidence considered
NM_000520.6:c.1421+1G>C is an intronic canonical donor-site variant (c.1421+1), so the generic intronic/splice-region path requires SpliceAI only.
SpliceAI max delta score = 0.00; this is below the generic PP3 supporting cutoff >= 0.2 and moderate cutoff >= 0.5 from the supplied SpliceAI calibration by Jaganathan et al. 2019 (PMID:30661751).
REVEL 0.928 and BayesDel 0.66 were excluded because the governing rule selects the SpliceAI path for this intronic variant.
PP5ACMG_2015Not met: ClinVar is Pathogenic without an expert-panel classification, consisting of ordinary laboratory submissions rather than a qualifying reputable expert assertion.
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Reasoning
ClinVar reports Pathogenic for the exact variant, but the record has no expert-panel classification and is labeled criteria provided, multiple submitters, no conflicts, with clinical-laboratory submissions. Under the required generic rule, ordinary laboratory submissions, aggregate labels, and non-expert assertions do not trigger PP5; therefore this evidence does not meet PP5.
Rule
Reputable source recently reports variant as pathogenic, but the evidence is not available to the laboratory to perform an independent evaluation.
Evidence considered
ClinVar variation 3890 lists the exact variant as Pathogenic with review status criteria provided, multiple submitters, no conflicts; the audit reports no expert-panel submission and clinical-laboratory submissions.
The ClinVar record is therefore not an exact-variant ClinVar expert-panel classification and cannot trigger PP5 under the specified generic rule.
BA1ACMGNot met: gnomAD grpmax FAF is 2.47e-06 in v4.1, far below the generic BA1 threshold of 0.05.
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Reasoning
BA1 is not met. The relevant filtering allele-frequency measure is the gnomAD grpmax FAF, not the Ashkenazi Jewish popmax point estimate: gnomAD v2.1 reports grpmax FAF 7.03e-06 and gnomAD v4.1 reports grpmax FAF 2.47e-06, both below the generic BA1 stand-alone threshold of 0.05. The Ashkenazi Jewish observed frequencies (25/10032 alleles in v2.1 and 89/29568 in v4.1) are not substituted for grpmax FAF; both populations have more than 2000 observed alleles, but neither filtering FAF supports BA1.
Rule
BA1 (stand-alone): >= 0.05 — ACMG/AMP 2015 stand-alone benign allele frequency (PMID:25741868) ... BA1: Allele frequency is above 5% in Exome Sequencing Project, 1000 Genomes or Exome Aggregation Consortium.
Evidence considered
gnomAD v2.1 (exome): grpmax FAF=7.03e-06; total AF=0.000115725 (29/250594 alleles), with Ashkenazi Jewish AF=0.00249203 (25/10032 alleles).
gnomAD v4.1: grpmax FAF=2.47e-06; total AF=6.75948e-05 (109/1612550 alleles), with Ashkenazi Jewish AF=0.00301001 (89/29568 alleles).
The generic BA1 threshold supplied for this interpretation is >=0.05; both filtering FAF values are below that threshold.
BS1ACMGNot met: the highest filtering FAF is 7.03e-06, below the generic BS1 default threshold of 0.01.
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Reasoning
BS1 is not met. Using the required filtering allele-frequency measure, gnomAD v2.1 grpmax FAF is 7.03e-06 and gnomAD v4.1 grpmax FAF is 2.47e-06, both far below the generic 0.01 default. The variant is observed at low frequency in the Ashkenazi Jewish population, but the point estimates are not used for this decision. These data do not show an allele frequency greater than expected for the rare autosomal-recessive Tay-Sachs disorder; a maximum-credible-frequency calculation is not necessary to reject BS1 because both filtering FAF values are already well below the default threshold.
Rule
BS1 (strong): >= 0.01 — Generic SVI default; per-gene derivation preferred (Whiffin et al. 2017) (PMID:28518168) ... BS1: Allele frequency is greater than expected for the disorder.
Evidence considered
gnomAD v2.1 (exome) reports grpmax FAF=7.03e-06 and total AF=0.000115725 (29/250594 alleles).
gnomAD v4.1 reports grpmax FAF=2.47e-06 and total AF=6.75948e-05 (109/1612550 alleles).
The generic BS1 default supplied for this interpretation is >=0.01; both required filtering FAF values are substantially below it, and no frequency greater than expected for this autosomal-recessive disorder is demonstrated.
BS2ACMG_2015Not met: gnomAD v2.1 and v4.1 each report zero homozygotes, so no healthy adult homozygote is observed.
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Reasoning
BS2 is not met. gnomAD v2.1 reports zero homozygotes among 250594 alleles and gnomAD v4.1 reports zero homozygotes among 1612550 alleles. No healthy adult homozygote for this recessive disorder is documented in the supplied population data, so the required observation supporting BS2 is absent.
Rule
BS2: Observed in a healthy adult individual for a recessive (homozygous), dominant (heterozygous), or X-linked (hemizygous) disorder, with full penetrance expected at an early age.
Evidence considered
gnomAD v2.1 (exome) reports homozygotes=0 with 29/250594 observed alleles.
gnomAD v4.1 reports homozygotes=0 with 109/1612550 observed alleles.
BS3ACMG_2015Not met: available patient-fibroblast assays showed abnormal intron 12 retention, not normal HEXA splicing or preserved function.
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Reasoning
BS3 is not met. The available functional studies evaluate the exact variant and report abnormal HEXA RNA processing with intron 12 retention; they do not show no damaging effect on protein function or splicing. No benign functional assay result was identified.
Rule
Well-established in vitro or in vivo functional studies show no damaging effect on protein function or splicing.
Evidence considered
PMID:2837213: variant-specific cDNA analysis showed abnormal HEXA transcripts with intact or truncated intron 12 retained.
BP6ACMG_2015Not met: no exact-variant ClinVar expert-panel benign or likely benign classification is present, and ClinVar instead reports Pathogenic laboratory submissions.
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Reasoning
No qualifying benign or likely benign exact-variant ClinVar expert-panel classification is present. ClinVar instead reports Pathogenic from clinical-laboratory submissions without an expert panel, and the reviewed literature contains no reputable benign assertion that meets the specified PP5/BP6 restriction; therefore BP6 is not met.
Rule
Reputable source recently reports variant as benign, but the evidence is not available to the laboratory to perform an independent evaluation.
Evidence considered
ClinVar variation 3890 reports Pathogenic with criteria provided, multiple submitters, no conflicts and no expert-panel classification.
No exact-variant ClinVar expert-panel benign or likely benign assertion was identified; ordinary laboratory submissions and aggregate labels do not trigger BP6 under the specified generic rule.
PS2ACMG_2015Not assessed: affected patients were reported, but parental genotypes and confirmed maternity and paternity were not provided.
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Reasoning
The available report describes the variant in affected Tay-Sachs patients, including compound heterozygous patients, but provides no maternity confirmation, paternity confirmation, parental genotypes, or explicit de novo determination. Therefore the PS2 requirements cannot be assessed.
Rule
De novo (both maternity and paternity confirmed) in a patient with the disease and no family history.
Evidence considered
PMID:2837213 reports the c.1421+1G>C-equivalent donor-site change in affected infantile Tay-Sachs patients and identifies compound heterozygosity, but does not report parental genotypes or a de novo finding.
Still missing
Parental testing for the variant with confirmed maternity and paternity.
Documentation that the patient has the disease and has no family history.
PS4ACMG_2015Not assessed: affected-patient reports exist, but no exact-variant case-control counts or odds ratio with a 95% confidence interval are available.
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Reasoning
No reviewed source provides a case-control comparison for the exact NM_000520.6:c.1421+1G>C variant. PMID:2837213 reports the variant in affected Ashkenazi Jewish Tay-Sachs patients, but it is a functional/case report without unaffected or population control counts; therefore an OR and 95% CI cannot be computed. The governing ACMG/AMP threshold is not reached because the required comparative estimate is unavailable.
Rule
The prevalence of the variant in affected individuals is significantly increased compared to the prevalence in controls. ... Relative risk (RR) or odds ratio (OR), as obtained from case-control studies, is >5.0 and the confidence interval around the estimate of RR or OR does not include 1.0.
Evidence considered
PMID:2837213 reports the exact splice-site change in Ashkenazi Jewish infantile Tay-Sachs patients and describes compound heterozygous patients, but provides no unaffected or population control comparison for this variant.
PMID:2973464 reports the exact G>C donor-site mutation in a compound-heterozygous Ashkenazi Jewish Tay-Sachs patient, but provides no case-control counts.
No OR or 95% CI was computed because the reviewed sources do not provide the required case and control counts or a case frequency paired with a matched-ancestry control frequency.
Still missing
A case-control study or matched-ancestry control comparison reporting exact-variant counts is needed to calculate OR and its 95% CI.
PM3ACMG_2015Not assessed: affected patients had a normal sequence on the other allele, but no pathogenic variant in trans was documented for the PM3 requirement.
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Reasoning
HEXA-related Tay-Sachs disease is recessive, and PMID:2837213 reports the exact donor-site variant in affected patients GM0502B and GM2968 as compound heterozygous with a normal sequence on the other allele. However, the available evidence does not identify a pathogenic variant in trans, and it does not establish parental testing or phase with a pathogenic allele as required for PM3. The report therefore cannot support application of PM3, but the criterion is not assessed rather than called absent because the pathogenicity of any second allele is not fully documented in the available evidence.
Rule
PM3: For recessive disorders, detected in trans with a pathogenic variant ... Note: This requires testing of parents (or offspring) to determine phase.
Evidence considered
A splicing defect due to an exon-intron junctional mutation results in abnormal beta-hexosaminidase alpha chain mRNAs in Ashkenazi Jewish patients with Tay-Sachs disease, Results, pp. 466-467: the exact c.1421+1G>C donor-site change was found in affected patients GM0502B and GM2968, who were compound heterozygotes with the mutation on one allele and a normal sequence on the other allele; the report does not document a pathogenic variant in trans or parental phase testing.
Still missing
Identify and classify the second HEXA allele in an affected proband.
Confirm phase by parental testing or equivalent segregation evidence.
PM6ACMG_2015Not assessed: the report lacks an assumed-de-novo statement and provides no parental testing or inheritance information.
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Reasoning
The available report documents the variant in affected patients but does not state that it was assumed de novo and does not provide parental testing or inheritance information. The PM6 requirement therefore cannot be assessed.
Rule
Assumed de novo, but without confirmation of paternity and maternity.
Evidence considered
PMID:2837213 describes affected patients carrying the variant but gives no parental testing results and does not characterize the variant as assumed de novo.
Still missing
An explicit assumption or clinical documentation that the variant is de novo.
Available parental testing information, even if maternity or paternity is unconfirmed.
PP1ACMG_2015Not assessed: multiple affected patients were reported, but no shared family, pedigree, informative meioses, or co-segregation data were provided.
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Reasoning
The available report includes more than one affected patient with the variant, but it does not establish that they are affected members of the same family, does not provide family pedigrees or informative meioses, and does not report variant co-segregation with disease. PP1 cannot be assessed.
Rule
Co-segregation with disease in multiple affected family members in a gene definitively known to cause the disease.
Evidence considered
PMID:2837213 reports the variant in affected Tay-Sachs patients from separate cell lines and describes compound heterozygosity, but supplies no family-level segregation analysis or informative meioses.
Still missing
A pedigree linking multiple affected family members.
Genotypes and phenotypes for affected and unaffected relatives sufficient to evaluate co-segregation.
Confirmation that HEXA is definitively responsible for the segregating disease in the reported family.
PP4ACMG_2015Not assessed: literature reports classical infantile Tay-Sachs, but this case lacks the evaluated patient's phenotype or family-history details required for PP4.
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Reasoning
The reviewed literature describes infantile Tay-Sachs disease in patients carrying the exact variant, including the classical infantile phenotype in PMID:2837213. However, the case materials do not provide the phenotype or family history of the individual being adjudicated, so the requirement concerning the patient's phenotype cannot be evaluated for this case.
Rule
Patient’s phenotype or family history is highly specific for a disease with a single genetic etiology.
Evidence considered
PMID:2837213 states that the exact donor-site mutation was identified in an Ashkenazi Jewish patient with classical infantile Tay-Sachs disease, but this is published-patient information rather than the current patient's phenotype.
The case evidence does not document the current patient's clinical findings, diagnostic biochemical phenotype, or family history.
Still missing
The evaluated patient's clinical phenotype and family history must be supplied to assess disease specificity.
BS4ACMG_2015Not assessed: no pedigree or affected relative lacking the variant was reported to demonstrate lack of segregation.
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Reasoning
No affected family members with documented absence of the variant are reported, and no pedigree or non-segregation analysis is available. The evidence does not establish lack of segregation and is insufficient to assess BS4.
Rule
Lack of segregation in affected members of a family.
Evidence considered
PMID:2837213 reports affected patients carrying the variant but does not report affected relatives who lack it or any family-level non-segregation analysis.
Still missing
Genotypes and disease phenotypes for affected relatives in an informative family.
A documented affected relative who lacks the variant, with phenocopy and multiple-pathogenic-variant explanations considered.
BP2ACMG_2015Not assessed: no qualifying cis or dominant-disorder trans observation with a pathogenic variant was documented for BP2.
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Reasoning
No available case evidence documents this variant in cis with a pathogenic variant, or in trans with a pathogenic variant in a fully penetrant dominant gene or disorder. The affected HEXA reports concern a recessive disorder and do not establish a qualifying BP2 allelic observation; therefore BP2 is not assessed.
Rule
BP2: Observed in trans with a pathogenic variant for a fully penetrant dominant gene/disorder or observed in cis with a pathogenic variant in any inheritance pattern.
Still missing
Determine whether the variant was observed in cis with a pathogenic variant or in trans in a fully penetrant dominant disorder.
BP5ACMG_2015Not assessed: no evidence identifies an alternate molecular basis for disease in a case carrying this variant.
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Reasoning
No reviewed evidence shows that this variant was found in a case with an alternate molecular basis for disease. The literature reports Tay-Sachs patients carrying the variant and functional splice effects, but does not establish an alternate molecular cause for the disease in the adjudicated case.
Rule
Variant found in a case with an alternate molecular basis for disease.
Evidence considered
PMID:2837213 describes compound heterozygous Tay-Sachs patients and the variant's abnormal splicing, not an alternate molecular basis for disease.
PMID:2973464 describes a compound-heterozygous Tay-Sachs patient and abnormal HEXA transcripts, not an alternate molecular diagnosis.
Still missing
A case report with an independently established alternate molecular diagnosis in the same affected individual is needed.
Not applicable · 8· recorded as not applicableShow reasons ▾Hide reasons ▴PS1N/ANot applicable: PS1 requires a missense variant, and this is a canonical splice-site variant.
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Reasoning
PS1 (Richards et al. 2015, PMID:25741868) requires the same amino acid change as a previously established pathogenic variant, evaluated regardless of the underlying nucleotide change. NM_000520.6:c.1421+1G>C in HEXA is a variant at a canonical ±1/2 splice-consensus position predicted to produce NP_000511.2:p.?. As a result, no altered amino acid exists at this position to compare against any previously established pathogenic missense variant, so PS1's structural prerequisite is not met by this variant class. No VCEP criteria specification covers PS1 for HEXA, so the generic ACMG/AMP 2015 definition applies. This determination was made deterministically from the variant's consequence class, prior to LLM adjudication.
Rule
deterministic_prefilter: requires_missense
Evidence considered
Deterministic consequence classification: canonical_splice (prefetch.json normalized protein consequence)
VCEP criterion policy: absent
Sources
generic_acmg_combination_rules
PM1N/ANot applicable: PM1 requires a missense variant, and this is a canonical splice-site variant.
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Reasoning
PM1 (Richards et al. 2015, PMID:25741868) applies to a missense variant located in a mutational hot spot and/or a critical, well-established functional domain without benign variation. NM_000520.6:c.1421+1G>C in HEXA is a variant at a canonical ±1/2 splice-consensus position predicted to produce NP_000511.2:p.?. As a result, no altered residue exists to evaluate for mutational hot-spot or critical-domain membership, so PM1's structural prerequisite is not met by this variant class. No VCEP criteria specification covers PM1 for HEXA, so the generic ACMG/AMP 2015 definition applies. This determination was made deterministically from the variant's consequence class, prior to LLM adjudication.
Rule
deterministic_prefilter: requires_missense
Evidence considered
Deterministic consequence classification: canonical_splice (prefetch.json normalized protein consequence)
VCEP criterion policy: absent
Sources
generic_acmg_combination_rules
PM4N/ANot applicable: PM4 requires a protein-length change, and this is a canonical splice-site variant.
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Reasoning
PM4 (Richards et al. 2015, PMID:25741868) applies to protein length changes: in-frame insertions/deletions in a non-repetitive region, or stop-loss variants that extend the protein past the reference stop codon. NM_000520.6:c.1421+1G>C in HEXA is a variant at a canonical ±1/2 splice-consensus position predicted to produce NP_000511.2:p.?. As a result, no change in protein length occurs, so there is nothing for this criterion to evaluate, so PM4's structural prerequisite is not met by this variant class. No VCEP criteria specification covers PM4 for HEXA, so the generic ACMG/AMP 2015 definition applies. This determination was made deterministically from the variant's consequence class, prior to LLM adjudication.
PM5N/ANot applicable: PM5 requires a missense variant, and this is a canonical splice-site variant.
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Reasoning
PM5 (Richards et al. 2015, PMID:25741868) requires a novel missense change at an amino acid residue where a different missense change has previously been determined to be pathogenic. NM_000520.6:c.1421+1G>C in HEXA is a variant at a canonical ±1/2 splice-consensus position predicted to produce NP_000511.2:p.?. As a result, no missense change exists at this residue to compare against a different pathogenic missense change at the same position, so PM5's structural prerequisite is not met by this variant class. No VCEP criteria specification covers PM5 for HEXA, so the generic ACMG/AMP 2015 definition applies. This determination was made deterministically from the variant's consequence class, prior to LLM adjudication.
Rule
deterministic_prefilter: requires_missense
Evidence considered
Deterministic consequence classification: canonical_splice (prefetch.json normalized protein consequence)
VCEP criterion policy: absent
Sources
generic_acmg_combination_rules
PP2N/ANot applicable: PP2 requires a missense variant, and this is a canonical splice-site variant.
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Reasoning
PP2 (Richards et al. 2015, PMID:25741868) applies to a missense variant in a gene with a low rate of benign missense variation, where missense variants are a common mechanism of disease. NM_000520.6:c.1421+1G>C in HEXA is a variant at a canonical ±1/2 splice-consensus position predicted to produce NP_000511.2:p.?. As a result, the gene's missense-constraint properties are irrelevant because no missense change is present to evaluate, so PP2's structural prerequisite is not met by this variant class. No VCEP criteria specification covers PP2 for HEXA, so the generic ACMG/AMP 2015 definition applies. This determination was made deterministically from the variant's consequence class, prior to LLM adjudication.
Rule
deterministic_prefilter: requires_missense
Evidence considered
Deterministic consequence classification: canonical_splice (prefetch.json normalized protein consequence)
VCEP criterion policy: absent
Sources
generic_acmg_combination_rules
BP1N/ANot applicable: BP1 requires a missense variant, and this is a canonical splice-site variant.
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Reasoning
BP1 (Richards et al. 2015, PMID:25741868) applies to a missense variant in a gene for which primarily truncating variants are known to cause disease. NM_000520.6:c.1421+1G>C in HEXA is a variant at a canonical ±1/2 splice-consensus position predicted to produce NP_000511.2:p.?. As a result, the gene's truncating-variant mechanism is irrelevant because no missense change is present to evaluate, so BP1's structural prerequisite is not met by this variant class. No VCEP criteria specification covers BP1 for HEXA, so the generic ACMG/AMP 2015 definition applies. This determination was made deterministically from the variant's consequence class, prior to LLM adjudication.
Rule
deterministic_prefilter: requires_missense
Evidence considered
Deterministic consequence classification: canonical_splice (prefetch.json normalized protein consequence)
VCEP criterion policy: absent
Sources
generic_acmg_combination_rules
BP3N/ANot applicable: BP3 requires an in-frame indel in a repeat region, and this is a canonical splice-site variant.
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Reasoning
BP3 (Richards et al. 2015, PMID:25741868) applies to in-frame insertions/deletions located in a repetitive region without a known function. NM_000520.6:c.1421+1G>C in HEXA is a variant at a canonical ±1/2 splice-consensus position predicted to produce NP_000511.2:p.?. As a result, the variant does not alter protein length within a repeat region, so there is nothing for this criterion to evaluate, so BP3's structural prerequisite is not met by this variant class. No VCEP criteria specification covers BP3 for HEXA, so the generic ACMG/AMP 2015 definition applies. This determination was made deterministically from the variant's consequence class, prior to LLM adjudication.
BP7N/ANot applicable: BP7 requires a synonymous variant, and this is a canonical splice-site variant.
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Reasoning
BP7 (Richards et al. 2015, PMID:25741868) is defined for a synonymous (silent) variant for which splicing prediction algorithms predict no impact to the splice consensus sequence and the nucleotide is not highly conserved. NM_000520.6:c.1421+1G>C in HEXA is a variant at a canonical ±1/2 splice-consensus position predicted to produce NP_000511.2:p.?. As a result, the encoded protein sequence is altered, so the criterion's silent-variant premise does not hold regardless of any splicing prediction, so BP7's structural prerequisite is not met by this variant class. No VCEP criteria specification covers BP7 for HEXA, so the generic ACMG/AMP 2015 definition applies. This determination was made deterministically from the variant's consequence class, prior to LLM adjudication.
Rule
deterministic_prefilter: requires_synonymous
Evidence considered
Deterministic consequence classification: canonical_splice (prefetch.json normalized protein consequence)
VCEP criterion policy: absent
Sources
generic_acmg_combination_rules
Identifiers
Gene
HEXA
Transcript
NM_000520.6
Coding (HGVS c.)
NM_000520.6:c.1421+1G>C
Protein (HGVS p.)
NP_000511.2:p.?
GRCh38
chr15:72346234 C>G
GRCh37
chr15:72638575 C>G
Location and type
Intron 12 · canonical splice
Gene diagram
Every interpreted variant in HEXA, mapped onto the exon structure of NM_000520.6. Select a row to find it on the plot.
HEXANM_000520.6
Fetching transcript structure from UCSC…
Exons
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Transcript span
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Strand
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Variants mapped
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Source
UCSC ncbiRefSeqCurated
All variants in HEXA—Select a row to find it on the plot; use the link to open its page.
AF 6.8e-05 · 109 / 1,612,550 alleles · 0 hom · FAF 2.5e-06
Ashkenazi Jewish89 / 29,568
0.003
Remaining individuals13 / 62,420
0.00021
European (non-Finnish)7 / 1,178,898
5.9e-06
0 alternate alleles recorded in 7 other groups: Admixed American, European (Finnish), Amish, East Asian, Middle Eastern, South Asian, African/African American.
gnomAD v2.1
AF 0.00012 · 29 / 250,594 alleles · 0 hom · FAF 7e-06
Ashkenazi Jewish25 / 10,032
0.0025
Remaining individuals1 / 6,120
0.00016
European (non-Finnish)3 / 113,462
2.6e-05
0 alternate alleles recorded in 5 other groups: African/African American, Admixed American, East Asian, European (Finnish), South Asian.
Statements
gnomAD v4.1
This variant is present in gnomAD v4.1 (AF= 6.75948e-05; MAF= 0.00676%, 109/1612550 alleles, homozygotes = 0) and has highest observed frequency in the Ashkenazi Jewish population (AF= 0.00301001; MAF= 0.30100%, 89/29568 alleles, homozygotes = 0); grpmax FAF= 2.47e-06.
gnomAD v2.1
This variant is present in gnomAD v2.1 (AF= 0.000115725; MAF= 0.01157%, 29/250594 alleles, homozygotes = 0) and has highest observed frequency in the Ashkenazi Jewish population (AF= 0.00249203; MAF= 0.24920%, 25/10032 alleles, homozygotes = 0); grpmax FAF= 7.03e-06.
gnomAD-Canada
Not available in gnomAD-Canada v1.0.
SpliceAI and Pangolin
SpliceAI acceptor lossat -450 bp
0.000
SpliceAI acceptor gainat +1 bp
0.000
SpliceAI donor lossat -486 bp
0.000
SpliceAI donor gainat +125 bp
0.000
Other predictors
REVEL
0.928
BayesDel
0.660
How the predictions were used
BP4SupportingACMG_2015Met at supporting: SpliceAI max delta 0.00 meets the <=0.1 BP4 threshold for intronic or splice-region variants.
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Reasoning
NM_000520.6:c.1421+1G>C is an intronic canonical donor-site variant, so the governing generic rule selects the SpliceAI path only; REVEL and BayesDel are not applicable to BP4 in this situation. SpliceAI maximum delta is 0.00, meeting the generic BP4 supporting threshold of <= 0.1 from the supplied Jaganathan et al. 2019 calibration (PMID:30661751). BP4 is therefore met at supporting strength.
Rule
Multiple lines of computational evidence suggest no impact on gene or gene product (conservation, evolutionary, splicing impact, etc) ... BP4 (supporting): <= 0.1 — SpliceAI recommended cutoff (Jaganathan et al. 2019, Cell) (PMID:30661751)
Evidence considered
NM_000520.6:c.1421+1G>C is an intronic canonical donor-site variant (c.1421+1), so the generic intronic/splice-region path requires SpliceAI only.
SpliceAI max delta score = 0.00; this meets the generic BP4 supporting cutoff <= 0.1 from the supplied SpliceAI calibration by Jaganathan et al. 2019 (PMID:30661751).
REVEL 0.928 and BayesDel 0.66 were excluded because the governing rule selects the SpliceAI path for this intronic variant; the SpliceAI result was not double-counted across PP3, BP4, or BP7.
PP3ACMG_2015Not met: SpliceAI max delta 0.00 is below the >=0.2 PP3 supporting threshold for intronic or splice-region variants.
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Reasoning
NM_000520.6:c.1421+1G>C is an intronic canonical donor-site variant, so the governing generic rule selects the SpliceAI path only; REVEL and BayesDel are not applicable to PP3 in this situation. SpliceAI maximum delta is 0.00, below the generic PP3 supporting threshold of >= 0.2 and moderate threshold of >= 0.5, using the supplied Jaganathan et al. 2019 calibration (PMID:30661751). PP3 is therefore not met.
Rule
Multiple lines of computational evidence support a deleterious effect on the gene or gene product (conservation, evolutionary, splicing impact, etc.). ... PP3 (supporting): >= 0.2 — SpliceAI recommended cutoff (Jaganathan et al. 2019, Cell) (PMID:30661751)
Evidence considered
NM_000520.6:c.1421+1G>C is an intronic canonical donor-site variant (c.1421+1), so the generic intronic/splice-region path requires SpliceAI only.
SpliceAI max delta score = 0.00; this is below the generic PP3 supporting cutoff >= 0.2 and moderate cutoff >= 0.5 from the supplied SpliceAI calibration by Jaganathan et al. 2019 (PMID:30661751).
REVEL 0.928 and BayesDel 0.66 were excluded because the governing rule selects the SpliceAI path for this intronic variant.
BP7N/ANot applicable: BP7 requires a synonymous variant, and this is a canonical splice-site variant.
Details ▾Hide ▴
Reasoning
BP7 (Richards et al. 2015, PMID:25741868) is defined for a synonymous (silent) variant for which splicing prediction algorithms predict no impact to the splice consensus sequence and the nucleotide is not highly conserved. NM_000520.6:c.1421+1G>C in HEXA is a variant at a canonical ±1/2 splice-consensus position predicted to produce NP_000511.2:p.?. As a result, the encoded protein sequence is altered, so the criterion's silent-variant premise does not hold regardless of any splicing prediction, so BP7's structural prerequisite is not met by this variant class. No VCEP criteria specification covers BP7 for HEXA, so the generic ACMG/AMP 2015 definition applies. This determination was made deterministically from the variant's consequence class, prior to LLM adjudication.
Rule
deterministic_prefilter: requires_synonymous
Evidence considered
Deterministic consequence classification: canonical_splice (prefetch.json normalized protein consequence)
VCEP criterion policy: absent
Sources
generic_acmg_combination_rules
Statement
In silico
SpliceAI predicts no significant splice impact for this variant (max delta score = 0.00). REVEL score = 0.928. BayesDel score = 0.66.
5 paper records listed. 2 cited in the classification.
Cited in the classification
A splicing defect due to an exon-intron junctional mutation results in abnormal beta-hexosaminidase alpha chain mRNAs in Ashkenazi Jewish patients with Tay-Sachs disease.
The paper explicitly describes the HEXA exon 12–intron 12 5′ donor-site mutation corresponding to c.1421+1G>C. Sequencing of abnormal cDNA clones from an Ashkenazi Jewish infantile Tay-Sachs patient showed the donor-site G replaced by C, with intact or truncated intron 12 retained in the mRNA; the abnormal HEXA alpha-chain mRNAs were described as unstable.
→ PVS1 · very strong→ PS3 · moderateNames this variant
However, the first nucleotide at the 5' donor site of intron 12 was consistently C, instead of the normal G.
Location Results, “Structure of cDNAs,” p. 466; “Genomic DNA Analysis for the Junctional Transversion,” pp. 466–467
Context HEXA cDNA cloning and Sanger sequencing from fibroblasts of patient cell line GM0502B; genomic DNA hybridization with normal and mutant 21-mer oligonucleotide probes in GM0502B, GM2968, and GM0515A.
Multiple abnormal beta-hexosaminidase alpha chain mRNAs in a compound-heterozygous Ashkenazi Jewish patient with Tay-Sachs disease.
The abstract reports that abnormal HEXA alpha-chain cDNA clones were isolated from fibroblasts of a compound-heterozygous Ashkenazi Jewish patient with Tay-Sachs disease. Three abnormal mRNAs retained intron 12 containing the G-to-C mutation at the 5' donor site, supporting abnormal processing of the exact splice-site variant.
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= 6.75948e-05; MAF= 0.00676%, 109/1612550 alleles, homozygotes = 0) and has highest observed frequency in the Ashkenazi Jewish population (AF= 0.00301001; MAF= 0.30100%, 89/29568 alleles, homozygotes = 0); grpmax FAF= 2.47e-06.
gnomAD v2.1
This variant is present in gnomAD v2.1 (AF= 0.000115725; MAF= 0.01157%, 29/250594 alleles, homozygotes = 0) and has highest observed frequency in the Ashkenazi Jewish population (AF= 0.00249203; MAF= 0.24920%, 25/10032 alleles, homozygotes = 0); grpmax FAF= 7.03e-06.
gnomAD-Canada
Not available in gnomAD-Canada v1.0.
ClinVar
This variant has been reported in ClinVar as Pathogenic (10 clinical laboratories). (ClinVarID = 3890)
In silico
SpliceAI predicts no significant splice impact for this variant (max delta score = 0.00). REVEL score = 0.928. BayesDel score = 0.66.
Somatic
This variant has not previously been reported in somatic cancers (COSMIC).