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Variant interpretation report

G6PD c.563C>T, p.Ser188Phe

NM_001360016.2:c.563C>T NP_001346945.1:p.(Ser188Phe) Missense · exon 6 View identifiers
Classification
Uncertain significance

Variant description:

The G6PD NM_001360016.2:c.563C>T (NP_001346945.1:p.(Ser188Phe)) missense variant has not previously been reported in somatic cancers (COSMIC). Experimental evidence: G6PD Mediterranean activity was 0.64–1.1 IU/g Hb, with a separate infant showing 8% residual activity, but direct controlled variant-versus-wild-type assays were unavailable. Based on available guidelines, this variant is considered to be a Variant of Uncertain Significance (VUS).

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 G6PD

G6PD encodes an enzyme that helps cells produce NADPH, which protects against oxidative damage and supports important biosynthetic reactions. Changes that reduce G6PD activity can cause G6PD deficiency, leading to neonatal jaundice, episodes of red blood cell breakdown, or chronic hemolytic anemia. G6PD is not known to have a primary role in cancer.

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 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.

Pathogenic evidence criteria: 1 Benign evidence criteria: 0
Pathogenic criteria applied · 1
PS3Supporting
PS3 · supporting

Met at supporting: G6PD Mediterranean activity was 0.64–1.1 IU/g Hb, with a separate infant showing 8% residual activity, but direct controlled variant-versus-wild-type assays were unavailable.

Benign criteria applied · 0

No benign criterion marked as applied in the recorded assessment.

Recorded classification: Uncertain significance

VUS: PS3 supporting is the only applied criterion, and one supporting criterion does not satisfy a generic ACMG pathogenic or benign combination 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
1,705 / 1,209,752 alleles

gnomAD v4.1: 1,705 / 1,209,752 alleles. Recorded AF 0.00140938. Recorded homozygote count 23.

gnomAD v2.1

This variant is present in gnomAD v2.1 (AF= 0.00230096; MAF= 0.23010%, 471/204697 alleles, homozygotes = 6) and has highest observed frequency in the South Asian population (AF= 0.0173498; MAF= 1.73498%, 331/19078 alleles, homozygotes = 4); grpmax FAF= 0.0158107.

gnomAD-Canada

This variant is present in gnomAD-Canada v1.0 (AF= 0.0021542738012508686, 31/14390 alleles, homozygotes = 0).

SpliceAI score
0.024 maximum delta

Recorded SpliceAI maximum delta score: 0.024. Refer to the recorded PP3/BP4 rationale for interpretation.

No listed criterion applied SpliceAI ↗
ClinVar submissions
61 reported laboratory submissions

55 Pathogenic · 6 Likely pathogenic. ClinVar API review status: criteria provided, multiple submitters, no conflicts.

Context only ClinVar ↗
No screenshot for this evidence
Functional evidence
Not recorded

No standalone functional evidence summary is recorded in evidence_summary.functional.

COSMIC
Cancer Hotspots
Somatic evidence
No matching record reported

This variant has not previously been reported in somatic cancers (COSMIC).

Cancer Hotspots

This variant does not lie in a statistically significant hotspot.

For specialists

Technical detail

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: 1 met · 6 not met · 17 not assessed · 4 not applicable. Open any row for the full reasoning, the rule and the evidence behind it.

Met Not met Not assessed Not applicable

The G6PD CSPEC is listed but has no released criteria, so generic ACMG/AMP rules govern.

No criterion in this group is met from the supplied evidence: affected-cohort observations do not establish PS4 without an appropriate control comparison, the index phenotype is not supplied for PP4, no alternate molecular basis is supplied for BP5, and ClinVar has no exact-variant expert-panel classification for PP5 or BP6.

Population evidence does not support BA1 because the maximum observed ancestry frequency is 4.204%, below the supplied 5% threshold.

PM2 is not met because the variant is present in multiple control datasets at frequencies well above the supplied 0.0001 threshold.

BS1 is not assessed because the ancestry-enriched founder frequency cannot be compared with a disorder-specific maximum credible frequency without explicit prevalence, penetrance, and allelic-heterogeneity inputs.

BS2 is not assessed because population databases report aggregate genotype counts without establishing a healthy adult hemizygote.

Met · 1

PS3 SupportingACMG_2015Met at supporting: G6PD Mediterranean activity was 0.64–1.1 IU/g Hb, with a separate infant showing 8% residual activity, but direct controlled variant-versus-wild-type assays were unavailable. Details ▾Hide ▴
Reasoning

PS3 is met at supporting strength. The exact variant NM_001360016.2:c.563C>T (p.Ser188Phe), also called G6PD Mediterranean, was evaluated through quantitative erythrocyte G6PD activity assays in multiple clinical/population studies. In an Indian cohort, the G6PD Mediterranean type was specifically associated with 0.64–1.1 IU/g Hb enzyme activity (PMID:18568599). In a Swedish newborn-screening study, the exact variant was found on 16 alleles; one compound-heterozygous infant had 8% residual G6PD activity, and 14 of 16 individuals with activity <=10% of normal carried c.563C>T (PMID:33072997). A Hellenic study identified the same 188 Ser>Phe variant in 231 of 299 deficient males, with the deficient cohort showing 0.1–5% of normal activity, although no variant-specific activity value was reported (PMID:10782016). A Saudi study also identified p.Ser188Phe as the Mediterranean haplotype in a cohort assessed by quantitative spectrophotometry, but did not provide a variant-specific activity value in the extracted evidence (PMID:23006493). These are clinically relevant quantitative enzyme-function measurements and are concordant with reduced G6PD function, but the evidence lacks a direct purified-protein or engineered-cell comparison with matched wild-type and assay controls and does not establish reproducibility at the highest functional-evidence level; therefore strong PS3 is not justified.

Rule
Well-established in vitro or in vivo functional studies supportive of a damaging effect on the gene or gene product.
Evidence considered
  • PMID:18568599, Results and discussion: the G6PD Mediterranean variant is described as 188 Ser>Phe, and its enzyme activity was 0.64–1.1 IU/g Hb in the studied populations.
  • PMID:33072997, Results/Table 2/Discussion: c.563C>T (p.Ser188Phe) was found on 16 alleles; one compound-heterozygous infant had 8% residual activity, and 14/16 infants with activity <=10% of normal carried c.563C>T.
  • PMID:10782016, Results/Tables 1–2: 231/299 G6PD-deficient Hellenic males carried G6PD Mediterranean (188 Ser>Phe); deficient-cohort activity ranged from 0.1% to 5% of normal, without a variant-specific value.
  • PMID:23006493, Results: p.Ser188Phe defined the Mediterranean haplotype (29/164, 17.79%); the cohort underwent quantitative G6PD enzyme activity measurement, but the extracted evidence did not provide a variant-specific activity value.
Still missing
  • No direct recombinant-protein or engineered-cell assay with matched wild-type, positive-damaging, and negative controls was identified.
  • Several studies reported cohort-level or compound-genotype activity rather than an isolated c.563C>T effect with a matched reference.
  • The governing prompt supplied no validated quantitative strength-escalation threshold beyond the generic PS3 definition.
Sources

Not met · 6 · evaluated, threshold not reached

PM2 ACMG_2015Not met: gnomAD v4.1 reports AF 0.0014094 with 23 homozygotes, exceeding the PM2 threshold of 0.0001. Details ▾Hide ▴
Reasoning

PM2 is not met. The variant is present in gnomAD v4.1 at AF 0.0014093798 (1705/1209752 alleles; 23 homozygotes) and in gnomAD v2.1 at AF 0.0023009619 (471/204697 alleles; 6 homozygotes), with substantially higher ancestry-specific frequencies. These observations are far above the supplied generic PM2 supporting threshold of <=0.0001 and are incompatible with absence or extremely low frequency in controls.

Rule
Absent from controls (or at extremely low frequency if recessive) in Exome Sequencing Project, 1000 Genomes or Exome Aggregation Consortium.
Evidence considered
  • gnomAD v4.1 all-comers: AF 0.0014093798 (1705/1209752 alleles) with 23 homozygotes; Middle Eastern AF 0.0420399724 and South Asian AF 0.0186749745.
  • gnomAD v2.1 all-comers: AF 0.0023009619 (471/204697 alleles) with 6 homozygotes; South Asian AF 0.0173498270 with 4 homozygotes.
  • The available gnomAD v2.1 non-cancer exome record also shows the variant (AF 0.0026785818; 461/172106 exome alleles; 6 homozygotes), and the v3.1 non-cancer genome-only record shows AF 0.0007261096 (79/108799 alleles; 2 homozygotes); these reinforce presence in controls but do not alter the generic all-comers default.
  • The supplied generic PM2 calibration threshold is <=0.0001.
Sources
PP3 ACMG_2015Not met: this missense variant requires REVEL, but no REVEL score is available for comparison with the generic PP3 thresholds. Details ▾Hide ▴
Reasoning

PP3 is evaluated on the single path matching the variant consequence. NM_001360016.2:c.563C>T is a missense variant producing p.(Ser188Phe), so REVEL is the applicable predictor and SpliceAI is excluded. No REVEL score is available for this variant; therefore the applicable computational result is indeterminate and PP3 is not met. The available BayesDel score (0.453964) is not usable because no generic ACMG-strength calibration is established, and the SpliceAI max delta of 0.024 cannot support PP3 for a missense variant.

Rule
Multiple lines of computational evidence support a deleterious effect on the gene or gene product (conservation, evolutionary, splicing impact, etc.).
Evidence considered
  • Variant consequence: missense, NM_001360016.2:c.563C>T, predicted protein change NP_001346945.1:p.(Ser188Phe).
  • Generic path selection: missense variants use REVEL only; SpliceAI is not evidence for PP3 on a missense path.
  • REVEL result: unavailable; the available record reports no REVEL score for chrX:154534419.
  • SpliceAI lookup reports max delta 0.024, but this splice-path result is excluded for the missense variant.
  • BayesDel score 0.453964 is not used because no generic ACMG-strength calibration is established for BayesDel.
Still missing
  • A validated REVEL score for NM_001360016.2:c.563C>T is unavailable.
Sources
spliceai ↗generic_acmg_combination_rules
BA1 ACMG_2015Not met: the highest gnomAD v4.1 ancestry frequency is 4.204%, below the 5% BA1 threshold. Details ▾Hide ▴
Reasoning

BA1 is not met. The highest reported gnomAD v4.1 ancestry frequency is 0.0420399724 in the Middle Eastern population (183/4353 alleles), below the supplied generic stand-alone threshold of 0.05; the all-comers frequency is 0.0014093798 (1705/1209752 alleles). The generic rule therefore is not satisfied, and the variant is an SNV rather than an indel subject to the stated calling caveat.

Rule
Allele frequency is above 5% in Exome Sequencing Project, 1000 Genomes or Exome Aggregation Consortium.
Evidence considered
  • gnomAD v4.1 all-comers: AF 0.0014093798 (1705/1209752 alleles), with 23 homozygotes.
  • gnomAD v4.1 highest ancestry frequency: Middle Eastern AF 0.0420399724 (183/4353 alleles), with 4 homozygotes; this is below the supplied BA1 threshold of >=0.05.
  • The governing CSPEC is listed without released criteria, so generic ACMG/AMP rules apply; no VCEP-specific population source overrides the all-comers default.
Sources
BS3 ACMG_2015Not met: available studies report reduced G6PD activity, including 0.64–1.1 IU/g Hb and 8% residual activity, rather than normal function or splicing. Details ▾Hide ▴
Reasoning

BS3 is not met. No study in the reviewed evidence demonstrates that NM_001360016.2:c.563C>T (p.Ser188Phe) has normal G6PD function or normal splicing. The available quantitative enzyme-activity observations instead report markedly reduced activity for G6PD Mediterranean or for individuals carrying the exact variant, including 0.64–1.1 IU/g Hb in one cohort and 8% residual activity in a compound-heterozygous infant. The studies do not provide a well-established benign functional result or adequate matched controls that could support BS3.

Rule
Well-established in vitro or in vivo functional studies show no damaging effect on protein function or splicing.
Evidence considered
  • PMID:18568599: G6PD Mediterranean (188 Ser>Phe) was associated with enzyme activity of 0.64–1.1 IU/g Hb, which does not support normal function.
  • PMID:33072997: an infant carrying c.563C>T in trans with another pathogenic splice variant had 8% residual G6PD activity; the study reported no normal-function result for p.Ser188Phe.
  • PMID:10782016: G6PD Mediterranean (188 Ser>Phe) was found among G6PD-deficient males; no benign functional result was reported.
  • PMID:23006493: p.Ser188Phe was identified as the Mediterranean haplotype in a quantitatively assayed deficiency cohort; no normal-function result was reported.
Still missing
  • No validated normal-function or normal-splicing assay for p.Ser188Phe was identified.
  • No matched wild-type and benign-control functional experiment was identified.
Sources
BP1 ACMG_2015Not met: most G6PD disease-causing variants are reported as missense or nonsense, not primarily truncating. Details ▾Hide ▴
Reasoning

NM_001360016.2:c.563C>T is a missense variant producing p.Ser188Phe. BP1 applies to a gene for which primarily truncating variants are known to cause disease. PMID:33072997 states that most G6PD disease-causing variants are either missense or nonsense and gives c.563C>T (p.Ser188Phe) as a disease-associated missense example. The available evidence does not support a primarily truncating disease mechanism for G6PD, so BP1 is not met.

Rule
Missense variant in a gene for which primarily truncating variants are known to cause disease.
Evidence considered
  • PMID:33072997, Section 1.2 'The G6PD Gene': 'Most disease-causing variants are either missense or nonsense,' and the paper gives c.563C>T (p.(Ser188Phe)) as the Mediterranean example.
Sources
BP4 ACMG_2015Not met: this missense variant requires REVEL, but no REVEL score is available for comparison with the generic BP4 thresholds. Details ▾Hide ▴
Reasoning

BP4 is evaluated on the single path matching the variant consequence. NM_001360016.2:c.563C>T is a missense variant producing p.(Ser188Phe), so REVEL is the applicable predictor and SpliceAI is excluded. No REVEL score is available for this variant; therefore the applicable computational result is indeterminate and BP4 is not met. The available BayesDel score (0.453964) is not usable because no generic ACMG-strength calibration is established, and the SpliceAI max delta of 0.024 cannot support BP4 for a missense variant despite being below the splice-path cutoff.

Rule
Multiple lines of computational evidence suggest no impact on gene or gene product (conservation, evolutionary, splicing impact, etc)
Evidence considered
  • Variant consequence: missense, NM_001360016.2:c.563C>T, predicted protein change NP_001346945.1:p.(Ser188Phe).
  • Generic path selection: missense variants use REVEL only; SpliceAI is not evidence for BP4 on a missense path.
  • REVEL result: unavailable; the available record reports no REVEL score for chrX:154534419.
  • SpliceAI lookup reports max delta 0.024, but this splice-path result is excluded for the missense variant and cannot substitute for a missing REVEL result.
  • BayesDel score 0.453964 is not used because no generic ACMG-strength calibration is established for BayesDel.
Still missing
  • A validated REVEL score for NM_001360016.2:c.563C>T is unavailable.
Sources
spliceai ↗generic_acmg_combination_rules

Not assessed · 17 · no assessment recorded

PS1 ACMG_2015Not assessed: the reviewed evidence establishes p.Ser188Phe but documents no distinct nucleotide substitution producing the same amino-acid change. Details ▾Hide ▴
Reasoning

The variant is G6PD p.Ser188Phe (c.563C>T), and the reviewed studies establish this exact pathogenic disease-associated variant. However, no reviewed source documents a distinct nucleotide substitution that produces the same p.Ser188Phe amino-acid change. Because PS1 requires the same amino-acid change from a previously established pathogenic variant regardless of nucleotide change, the available evidence is insufficient to apply PS1.

Rule
Same amino acid change as a previously established pathogenic variant regardless of nucleotide change.
Evidence considered
  • PMID:10782016 reports the G6PD Mediterranean 188 Ser→Phe variant in 231 of 299 G6PD-deficient Hellenic male subjects.
  • PMID:23006493 identifies p.Ser188Phe as the mutation defining the Mediterranean haplotype, but does not report a different nucleotide substitution producing the same amino-acid change.
  • PMID:33072997 identifies c.563C>T (p.Ser188Phe) as the Mediterranean variant; the reviewed evidence does not document an alternate nucleotide change at the same codon with the same protein consequence.
Still missing
  • A verified pathogenic alternate nucleotide substitution producing G6PD p.Ser188Phe is needed.
Sources
PS2 ACMG_2015Not assessed: 0 documented proband-parent trios have confirmed maternity and paternity plus the required disease and family-history context. Details ▾Hide ▴
Reasoning

No case-level evidence documents a proband with the disease, absence of family history, or confirmed maternity and paternity for a de novo occurrence of NM_001360016.2:c.563C>T. Without both parental confirmations and the required clinical context, PS2 cannot be assessed.

Rule
De novo (both maternity and paternity confirmed) in a patient with the disease and no family history.
Evidence considered
  • No documented proband-level de novo case includes confirmed maternity and paternity, disease phenotype, and absence of family history for NM_001360016.2:c.563C>T.
Still missing
  • Proband-level disease phenotype and diagnostic details are not documented.
  • Family history is not documented.
  • Maternity and paternity confirmation are not documented.
  • Parental variant testing results are not documented.
PS4 ACMG_2015Not assessed: affected-cohort reports (29/164, 16 alleles, and 231/299) lack matched unaffected controls, so the required OR/RR >5.0 with CI excluding 1.0 cannot be calculated. Details ▾Hide ▴
Reasoning

The governing rule requires a significantly increased prevalence in affected individuals compared with controls and, under its stated note, an odds ratio or relative risk >5.0 with a confidence interval excluding 1.0. The reviewed exact-variant papers report affected cohorts but do not provide an unaffected or population-control comparison for c.563C>T/p.Ser188Phe: Dallol et al. report 29/164 haplotypes (17.79%) in a Saudi suspected-deficiency cohort; the Swedish newborn-screening study reports 16 alleles in 10,098 screened infants and 14/16 among infants with activity <=10% of normal; and Rinaldi et al. report 231/299 deficient Hellenic males. These are not sufficient to calculate the required case-control OR/RR and 95% CI. The literature_pass.json PS4 index entries (PMID:22876374 and PMID:35753512) have no corresponding paper_extracts entries or ai_classified_papers verification, so they cannot establish PS4. No numeric inequality can be evaluated because no case-control effect estimate and confidence interval are available.

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:23006493, Results, 6-locus haplotyping paragraph: p.Ser188Phe was observed in 29/164 reported haplotypes (17.79%) in a Saudi cohort of 249 individuals with suspected G6PD deficiency; no unaffected-control comparison is reported.
  • PMID:33072997, Results paragraph 2 and Table 2: c.563C>T was found on 16 alleles in a Swedish newborn-screening cohort of 10,098 samples; 14/16 infants with activity <=10% of normal carried the variant, but no unaffected-control comparison is reported.
  • PMID:10782016, Results paragraphs 1-2 and Tables 1-2: 231/299 G6PD-deficient Hellenic male subjects were hemizygous for G6PD Mediterranean; the study does not report variant prevalence in unaffected controls.
  • PMID:18568599, Results and discussion paragraph 2: 83/223 deficient males were classified as G6PD Mediterranean; this is a deficient cohort without a control comparison and the extraction does not explicitly identify c.563C>T.
  • The literature_pass.json PS4 index lists PMID:22876374 and PMID:35753512, but ai_classified_papers is empty and no paper_extracts entry verifies either paper for this variant.
Still missing
  • A case-control or matched-ancestry comparison providing affected-case and unaffected/control counts or an OR/RR with its 95% CI is required.
  • The literature_pass PS4 index entries PMID:22876374 and PMID:35753512 lack extracted full-text or abstract verification in this case.
Sources
PM1 ACMG_2015Not assessed: residue 188 has no approved G6PD domain entry, and the hotspot query returned no statistically significant hotspot. Details ▾Hide ▴
Reasoning

The variant is G6PD p.Ser188Phe. The governing G6PD CSPEC record has no released criterion specifications, and vcep_materials.json reports an empty domain_tables object, so there is no authoritative approved G6PD critical-domain entry to assess at residue 188. The Cancer Hotspots result for G6PD S188 is negative, and no reviewed evidence establishes residue 188 as a mutational hotspot or critical, well-established functional domain without benign variation. The generic PM1 requirement therefore cannot be assessed from the available evidence.

Rule
Located in a mutational hot spot and/or critical and well-established functional domain (e.g. active site of an enzyme) without benign variation.
Evidence considered
  • The G6PD CSPEC record is listed but has no released criteria, and vcep_materials.json reports domain_tables as an empty object.
  • The Cancer Hotspots result for G6PD S188 reports no result and states that the variant does not lie in a statistically significant hotspot.
Still missing
  • A verified G6PD critical-domain or qualifying mutational-hotspot source meeting the generic PM1 definition is needed.
Sources
PM3 ACMG_2015Not assessed: one compound-heterozygous patient had 8% residual activity, but the trans c.267+5G>A variant was only described as possibly splice-altering, not confirmed pathogenic. Details ▾Hide ▴
Reasoning

The Swedish newborn-screening study reports one patient compound heterozygous for c.[267+5G>A];[563C>T] with 8% residual G6PD activity, which establishes an allelic pairing but does not establish that c.267+5G>A is pathogenic; it is described only as an intronic variant possibly causing aberrant splicing and not described before. The available report therefore does not provide a confirmed pathogenic variant in trans, so PM3 cannot be applied. Parent or offspring testing is not reported as an independent phase confirmation.

Rule
For recessive disorders, detected in trans with a pathogenic variant ... Note: This requires testing of parents (or offspring) to determine phase.
Evidence considered
  • Incidence of Glucose-6-Phosphate Dehydrogenase Deficiency among Swedish Newborn Infants, Results paragraph 2: c.267+5G>A was described as an intronic variant possibly causing aberrant splicing and not described before; it occurred in a patient compound heterozygous for c.[267+5G>A];[563C>T] with 8% of normal residual activity.
  • The report shows an allelic pairing but does not establish the partner variant as pathogenic under the PM3 definition, and no parental or offspring phase testing is reported.
Still missing
  • A confirmed pathogenic classification or adequate disease-causing evidence for the trans c.267+5G>A allele is missing.
  • Independent parental or offspring testing to confirm phase is not reported.
Sources
PM5 ACMG_2015Not assessed: the PM5 collection contains 0 same-residue candidates, and no different pathogenic missense change at residue 188 is documented. Details ▾Hide ▴
Reasoning

The variant changes G6PD Ser188 to Phe. The PM5 candidate collection contains zero total candidates and zero same-residue candidates, and the reviewed papers report p.Ser188Phe itself rather than a different missense substitution at residue 188. No different missense change at residue 188 has therefore been established as pathogenic in the available evidence.

Rule
Novel missense change at an amino acid residue where a different missense change determined to be pathogenic has been seen before.
Evidence considered
  • The PM5 candidate collection reports 0 total candidates and 0 same-residue candidates for NP_001346945.1:p.(S188F).
  • PMID:10782016, PMID:23006493, and PMID:33072997 report p.Ser188Phe/c.563C>T itself, not a different missense substitution at residue 188.
Still missing
  • A verified pathogenic different missense variant at G6PD residue 188 is needed.
Sources
PM6 ACMG_2015Not assessed: 0 documented affected probands are described as assumed de novo without confirmed maternity and paternity. Details ▾Hide ▴
Reasoning

No case-level evidence documents an assumed de novo occurrence of NM_001360016.2:c.563C>T. The available information does not establish a proband with the disease or indicate whether maternity or paternity was unconfirmed, so PM6 cannot be assessed.

Rule
Assumed de novo, but without confirmation of paternity and maternity.
Evidence considered
  • No documented affected proband is described as having an assumed de novo NM_001360016.2:c.563C>T variant with incomplete parental confirmation.
Still missing
  • A proband with the relevant disease phenotype is not documented.
  • An assumed de novo occurrence is not documented.
  • Parental testing and the specific unconfirmed parentage status are not documented.
PP1 ACMG_2015Not assessed: 0 affected relatives and 0 informative meioses are documented for phenotype-consistent cosegregation. Details ▾Hide ▴
Reasoning

No family-level evidence documents multiple affected relatives carrying NM_001360016.2:c.563C>T, the number of informative meioses, or phenotype-consistent cosegregation. PP1 therefore cannot be assessed.

Rule
Co-segregation with disease in multiple affected family members in a gene definitively known to cause the disease.
Evidence considered
  • No documented pedigree provides multiple affected family members, genotype results, phenotype consistency, or informative meioses for NM_001360016.2:c.563C>T.
Still missing
  • Affected relatives are not documented.
  • Variant status in relatives is not documented.
  • Phenotype consistency among relatives is not documented.
  • Informative meioses and segregation counts are not documented.
PP2 ACMG_2015Not assessed: missense disease mechanism is supported, but no qualifying low benign-missense-rate metric is available. Details ▾Hide ▴
Reasoning

The reviewed G6PD literature supports a missense disease mechanism, but it does not provide a validated gene-level rate or threshold showing low benign missense variation. Because PP2 requires both low benign missense variation and missense variants as a common disease mechanism, the available evidence is insufficient to apply PP2.

Rule
Missense variant in a gene that has a low rate of benign missense variation and where missense variants are a common mechanism of disease.
Evidence considered
  • PMID:33072997 states that most G6PD disease-causing variants are either missense or nonsense, supporting a missense disease mechanism but not the required low benign-missense-rate component.
Still missing
  • A validated gene-level measure demonstrating a low rate of benign G6PD missense variation is needed.
Sources
PP4 ACMG_2015Not assessed: no index-patient phenotype or family history is documented that is highly specific for G6PD deficiency with a single genetic etiology. Details ▾Hide ▴
Reasoning

The governing rule requires a patient's phenotype or family history that is highly specific for a disease with a single genetic etiology. The case evidence supplied for this variant does not provide an index-patient phenotype or family history sufficiently specific for G6PD deficiency, and the reviewed literature reports cohort-level deficiency ascertainment rather than a documented phenotype for this case. Therefore PP4 cannot be assessed.

Rule
Patient’s phenotype or family history is highly specific for a disease with a single genetic etiology.
Evidence considered
  • The supplied case evidence identifies G6PD deficiency-related conditions and population cohorts but does not document a specific index-patient phenotype or family history for this interpretation.
  • PMID:10782016, PMID:18568599, PMID:23006493, and PMID:33072997 describe deficient or screened cohorts rather than the phenotype of the index patient.
Still missing
  • Document the patient's clinical phenotype and family history, including whether findings are highly specific for G6PD deficiency and exclude relevant alternative etiologies.
Sources
PP5 ACMG_2015Not assessed: ClinVar has no exact-variant expert-panel classification, so ordinary laboratory and aggregate Pathogenic/Likely pathogenic labels cannot trigger PP5. Details ▾Hide ▴
Reasoning

The governing rule concerns a reputable recent pathogenic report whose underlying evidence is unavailable for independent evaluation. Under the specified generic rule for this interpretation, PP5 may be applied only for an exact-variant ClinVar expert-panel classification. ClinVar reports this variant as Pathogenic/Likely pathogenic with no expert-panel submission, and the available submissions are ordinary laboratory or aggregate assertions. Therefore PP5 is not triggered; an expert-panel classification is the missing requirement.

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 100057 reports Pathogenic/Likely pathogenic classifications with review status criteria provided, multiple submitters, no conflicts; the case summary records 0 expert-panel submissions.
  • The available ClinVar record therefore does not meet the required exact-variant expert-panel condition for PP5.
Still missing
  • An exact-variant ClinVar expert-panel Pathogenic or Likely pathogenic classification would be required under the specified generic PP5 rule.
Sources
BS1 ACMG_2015Not assessed: ancestry frequency reaches 4.204%, but disorder-specific prevalence, penetrance, and allelic-heterogeneity inputs for a credible BS1 threshold are unavailable. Details ▾Hide ▴
Reasoning

BS1 is not assessed. gnomAD v4.1 shows an overall AF of 0.0014093798 and a Middle Eastern AF of 0.0420399724 (183/4353 alleles; 4 homozygotes), while gnomAD v2.1 shows a South Asian AF of 0.0173498270 (331/19078 alleles; 4 homozygotes). The ancestry-enriched frequency is consistent with the reported Mediterranean founder context, but the generic BS1 question is whether the frequency is greater than expected for this disorder. The supplied 1% value is only a default, and no maximum-credible-frequency calculation with explicit prevalence, penetrance, and allelic-heterogeneity inputs is available; applying the default alone would be inappropriate for this X-linked, ancestry-enriched G6PD variant.

Rule
Allele frequency is greater than expected for the disorder.
Evidence considered
  • gnomAD v4.1 all-comers: overall AF 0.0014093798; Middle Eastern AF 0.0420399724 (183/4353 alleles) with 4 homozygotes; South Asian AF 0.0186749745 (1061/56814 alleles) with 14 homozygotes.
  • gnomAD v2.1 all-comers: overall AF 0.0023009619 (471/204697 alleles); South Asian AF 0.0173498270 (331/19078 alleles) with 4 homozygotes.
  • The available gnomAD v2.1 non-cancer exome record reports AF 0.0026785818 (461/172106 exome alleles) and 6 homozygotes; because no VCEP rule specifies this source, the all-comers gnomAD v2.1 entry remains the governing default. The v3.1 non-cancer record is genome-only and reports AF 0.0007261096 (79/108799 alleles) with 2 homozygotes; no VCEP rule specifies it.
  • PMID:23006493, Results, 6-locus haplotyping paragraph: the Mediterranean haplotype is characterised by p.Ser188Phe and was reported in 29/164 haplotypes (17.79%) in a Saudi cohort of individuals with suspected G6PD deficiency.
  • PMID:10782016, Results, paragraphs 1-2: 231 of 299 G6PD-deficient Hellenic male subjects were hemizygous for the G6PD Mediterranean 188 Ser->Phe variant (77% of deficient samples).
  • The supplied generic guidance identifies 0.01 as only a default and requires consideration of maximum credible allele frequency using prevalence, penetrance, and allelic heterogeneity; Whiffin et al. 2017 is PMID:28518168.
Still missing
  • A disorder- and ancestry-specific maximum credible allele-frequency calculation with explicit prevalence, penetrance, and allelic-heterogeneity inputs is needed.
Sources
BS2 ACMG_2015Not assessed: gnomAD reports 23 homozygotes, but it does not establish a healthy adult hemizygote for this X-linked disorder. Details ▾Hide ▴
Reasoning

BS2 is not assessed. gnomAD v4.1 reports 23 homozygotes overall, including 4 in the Middle Eastern population and 14 in the South Asian population; gnomAD v2.1 reports 6 homozygotes overall. These aggregate counts do not identify healthy adults, and the X-linked rule requires an observed healthy adult hemizygote. The available population records provide no individual phenotype, age, or clinical follow-up establishing that requirement.

Rule
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 v4.1 reports 23 homozygotes overall, including 4 Middle Eastern homozygotes and 14 South Asian homozygotes; the database record does not provide healthy-adult status or phenotype for those individuals.
  • gnomAD v2.1 reports 6 homozygotes overall, including 4 South Asian homozygotes; the database record does not provide healthy-adult status or phenotype for those individuals.
  • For this X-linked gene, aggregate homozygote counts, predominantly reflecting female genotypes, do not by themselves establish an observed healthy adult hemizygote.
Still missing
  • Individual-level phenotype and age information for a hemizygous adult carrier is needed to establish the required healthy-adult observation.
Sources
BS4 ACMG_2015Not assessed: 0 affected family members have documented genotype and phenotype results demonstrating lack of segregation. Details ▾Hide ▴
Reasoning

No family-level evidence identifies affected family members who lack NM_001360016.2:c.563C>T or establishes that the variant fails to segregate with disease. BS4 cannot be assessed without affected relatives, their phenotypes, and their variant results.

Rule
Lack of segregation in affected members of a family.
Evidence considered
  • No documented affected relatives have genotype and phenotype results showing non-segregation of NM_001360016.2:c.563C>T.
Still missing
  • Affected family members are not documented.
  • Genotypes of affected family members are not documented.
  • Phenotypes and diagnostic certainty of affected family members are not documented.
  • Potential phenocopies or additional pathogenic variants cannot be evaluated.
BP2 ACMG_2015Not assessed: no cis pathogenic-variant observation is documented, and the reported compound-heterozygous pairing does not meet the dominant-disorder BP2 branch. Details ▾Hide ▴
Reasoning

No observation of c.563C>T in cis with a pathogenic variant is documented. The available compound-heterozygous observation is not evidence for the BP2 dominant-disorder branch because G6PD deficiency is being evaluated as a recessive/X-linked disorder, and it does not establish cis phase. Therefore the BP2 evidence requirement is not assessable from the available data.

Rule
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.
Evidence considered
  • The available literature reports a compound-heterozygous c.[267+5G>A];[563C>T] pairing, not a cis pairing, and provides no fully penetrant dominant G6PD disorder context for applying the trans branch of BP2.
Still missing
  • No confirmed cis pairing of c.563C>T with a pathogenic variant is documented.
BP5 ACMG_2015Not assessed: no alternate molecular basis for the disease is documented in the case or reviewed exact-variant literature. Details ▾Hide ▴
Reasoning

The governing rule requires the variant to be found in a case with an alternate molecular basis for disease. The supplied case evidence does not document an alternate pathogenic molecular diagnosis in the case, and none of the reviewed variant papers establishes such an alternate molecular basis for this patient. BP5 therefore cannot be assessed.

Rule
Variant found in a case with an alternate molecular basis for disease.
Evidence considered
  • The supplied case evidence contains no documented alternate molecular diagnosis for the index case.
  • The reviewed exact-variant publications report G6PD deficiency cohorts and do not establish an alternate molecular basis for the index case.
Still missing
  • Document an independently established alternate molecular diagnosis in the same case, with the relevant variant or molecular finding and source.
Sources
BP6 ACMG_2015Not assessed: ClinVar has no exact-variant expert-panel Benign or Likely benign classification required to trigger BP6. Details ▾Hide ▴
Reasoning

The governing rule concerns a reputable recent benign report whose underlying evidence is unavailable for independent evaluation. Under the specified generic rule for this interpretation, BP6 may be applied only for an exact-variant ClinVar expert-panel classification of Benign or Likely benign. ClinVar has no expert-panel submission for this variant and reports Pathogenic/Likely pathogenic aggregate classifications, not an expert-panel benign classification. Therefore BP6 is not triggered; an exact-variant expert-panel benign classification is the missing requirement.

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 100057 reports Pathogenic/Likely pathogenic classifications with no expert-panel submission; no exact-variant expert-panel Benign or Likely benign classification is present.
  • Ordinary laboratory submissions and aggregate ClinVar labels are excluded from BP6 under the specified generic rule.
Still missing
  • An exact-variant ClinVar expert-panel Benign or Likely benign classification would be required under the specified generic BP6 rule.
Sources
Not applicable · 4· recorded as not applicable Show reasons ▾Hide reasons ▴
PVS1 N/ANot applicable: PVS1 requires a null variant (nonsense, frameshift, canonical splice, start-loss or stop-loss), and this is a missense variant. Details ▾Hide ▴
Reasoning

PVS1 (ClinGen SVI PVS1 recommendations, PMC6185798, pvs1_generic_framework) applies only to null variant classes — nonsense, frameshift, canonical ±1/2 splice-consensus, translation-initiation-codon loss, and stop-loss variants — each expected to trigger nonsense-mediated decay or otherwise abolish normal protein function. NM_001360016.2:c.563C>T in G6PD is a missense substitution predicted to produce NP_001346945.1:p.(Ser188Phe). As a result, no null-variant mechanism (nonsense-mediated decay, truncation, or canonical splice disruption) is triggered by this variant class, so PVS1's structural prerequisite is not met by this variant class. No VCEP criteria specification covers PVS1 for G6PD, 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_null_variant_class
Evidence considered
  • Deterministic consequence classification: missense (prefetch.json normalized protein consequence)
  • VCEP criterion policy: absent
Sources
pvs1_generic_framework ↗generic_acmg_combination_rules
PM4 N/ANot applicable: PM4 requires a protein-length change, and this is a missense variant. Details ▾Hide ▴
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_001360016.2:c.563C>T in G6PD is a missense substitution predicted to produce NP_001346945.1:p.(Ser188Phe). 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 G6PD, 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_stop_loss_or_nonrepeat_indel
Evidence considered
  • Deterministic consequence classification: missense (prefetch.json normalized protein consequence)
  • VCEP criterion policy: absent
Sources
pvs1_generic_framework ↗generic_acmg_combination_rules
BP3 N/ANot applicable: BP3 requires an in-frame indel in a repeat region, and this is a missense variant. Details ▾Hide ▴
Reasoning

BP3 (Richards et al. 2015, PMID:25741868) applies to in-frame insertions/deletions located in a repetitive region without a known function. NM_001360016.2:c.563C>T in G6PD is a missense substitution predicted to produce NP_001346945.1:p.(Ser188Phe). 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 G6PD, 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_repeat_region_indel
Evidence considered
  • Deterministic consequence classification: missense (prefetch.json normalized protein consequence)
  • VCEP criterion policy: absent
Sources
pvs1_generic_framework ↗generic_acmg_combination_rules
BP7 N/ANot applicable: BP7 requires a synonymous variant, and this is a missense 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_001360016.2:c.563C>T in G6PD is a missense substitution predicted to produce NP_001346945.1:p.(Ser188Phe). 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 G6PD, 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: missense (prefetch.json normalized protein consequence)
  • VCEP criterion policy: absent
Sources
generic_acmg_combination_rules

Identifiers

Gene
G6PD
Transcript
NM_001360016.2
Coding (HGVS c.)
NM_001360016.2:c.563C>T
Protein (HGVS p.)
NP_001346945.1:p.(Ser188Phe)
GRCh38
chrX:154534419 G>A
GRCh37
chrX:153762634 G>A
Location and type
Exon 6 · missense
ClinVar
1722739, 1722698, 1722697, 1722696, 100057

Gene diagram

Every interpreted variant in G6PD, mapped onto the exon structure of NM_001360016.2. Select a row to find it on the plot.

G6PDNM_001360016.2
Fetching transcript structure from UCSC…
gnomAD v4.1 1,705 / 1,209,752 alleles AF 0.00141 · 23 homozygotes · FAF 0.0371
gnomAD v2.1 471 / 204,697 alleles AF 0.0023 · 6 homozygotes · FAF 0.0158
gnomAD-Canada v1.0 Allele count data not recorded

By genetic ancestry

gnomAD v4.1

AF 0.0014 · 1705 / 1,209,752 alleles · 23 hom · FAF 0.037
Middle Eastern183 / 4,353 0.0424 hom
South Asian1061 / 56,814 0.01914 hom
Ashkenazi Jewish122 / 22,030 0.00551 hom
Remaining individuals156 / 47,600 0.00333 hom
African/African American12 / 57,216 0.00021
European (non-Finnish)170 / 894,832 0.000191 hom
Admixed American1 / 45,850 2.2e-05
0 alternate alleles recorded in 3 other groups: European (Finnish), Amish, East Asian.

gnomAD v2.1

AF 0.0023 · 471 / 204,697 alleles · 6 hom · FAF 0.016
South Asian331 / 19,078 0.0174 hom
Ashkenazi Jewish45 / 7,653 0.0059
Remaining individuals26 / 5,322 0.00491 hom
European (non-Finnish)65 / 92,279 0.00071 hom
African/African American4 / 18,967 0.00021
0 alternate alleles recorded in 3 other groups: Admixed American, East Asian, European (Finnish).

gnomAD-Canada

AF not recorded · ? / ? alleles

Statements

gnomAD v4.1

This variant is present in gnomAD v4.1 (AF= 0.00140938; MAF= 0.14094%, 1705/1209752 alleles, homozygotes = 23) and has highest observed frequency in the Middle Eastern population (AF= 0.04204; MAF= 4.20400%, 183/4353 alleles, homozygotes = 4); grpmax FAF= 0.0370614.

gnomAD v2.1

This variant is present in gnomAD v2.1 (AF= 0.00230096; MAF= 0.23010%, 471/204697 alleles, homozygotes = 6) and has highest observed frequency in the South Asian population (AF= 0.0173498; MAF= 1.73498%, 331/19078 alleles, homozygotes = 4); grpmax FAF= 0.0158107.

gnomAD-Canada

This variant is present in gnomAD-Canada v1.0 (AF= 0.0021542738012508686, 31/14390 alleles, homozygotes = 0).

Open the gnomAD-Canada detail page →

SpliceAI and Pangolin

SpliceAI acceptor lossat +117 bp
0.006
SpliceAI acceptor gainat -23 bp
0.024
SpliceAI donor lossat -73 bp
0.000
SpliceAI donor gainat -11 bp
0.001
Pangolin splice lossmagnitude shown
-0.004
Pangolin splice gain
0.006

Other predictors

REVEL
Not available
BayesDel
0.454

How the predictions were used

PP3 ACMG_2015Not met: this missense variant requires REVEL, but no REVEL score is available for comparison with the generic PP3 thresholds. Details ▾Hide ▴
Reasoning

PP3 is evaluated on the single path matching the variant consequence. NM_001360016.2:c.563C>T is a missense variant producing p.(Ser188Phe), so REVEL is the applicable predictor and SpliceAI is excluded. No REVEL score is available for this variant; therefore the applicable computational result is indeterminate and PP3 is not met. The available BayesDel score (0.453964) is not usable because no generic ACMG-strength calibration is established, and the SpliceAI max delta of 0.024 cannot support PP3 for a missense variant.

Rule
Multiple lines of computational evidence support a deleterious effect on the gene or gene product (conservation, evolutionary, splicing impact, etc.).
Evidence considered
  • Variant consequence: missense, NM_001360016.2:c.563C>T, predicted protein change NP_001346945.1:p.(Ser188Phe).
  • Generic path selection: missense variants use REVEL only; SpliceAI is not evidence for PP3 on a missense path.
  • REVEL result: unavailable; the available record reports no REVEL score for chrX:154534419.
  • SpliceAI lookup reports max delta 0.024, but this splice-path result is excluded for the missense variant.
  • BayesDel score 0.453964 is not used because no generic ACMG-strength calibration is established for BayesDel.
Still missing
  • A validated REVEL score for NM_001360016.2:c.563C>T is unavailable.
Sources
spliceai ↗generic_acmg_combination_rules
BP4 ACMG_2015Not met: this missense variant requires REVEL, but no REVEL score is available for comparison with the generic BP4 thresholds. Details ▾Hide ▴
Reasoning

BP4 is evaluated on the single path matching the variant consequence. NM_001360016.2:c.563C>T is a missense variant producing p.(Ser188Phe), so REVEL is the applicable predictor and SpliceAI is excluded. No REVEL score is available for this variant; therefore the applicable computational result is indeterminate and BP4 is not met. The available BayesDel score (0.453964) is not usable because no generic ACMG-strength calibration is established, and the SpliceAI max delta of 0.024 cannot support BP4 for a missense variant despite being below the splice-path cutoff.

Rule
Multiple lines of computational evidence suggest no impact on gene or gene product (conservation, evolutionary, splicing impact, etc)
Evidence considered
  • Variant consequence: missense, NM_001360016.2:c.563C>T, predicted protein change NP_001346945.1:p.(Ser188Phe).
  • Generic path selection: missense variants use REVEL only; SpliceAI is not evidence for BP4 on a missense path.
  • REVEL result: unavailable; the available record reports no REVEL score for chrX:154534419.
  • SpliceAI lookup reports max delta 0.024, but this splice-path result is excluded for the missense variant and cannot substitute for a missing REVEL result.
  • BayesDel score 0.453964 is not used because no generic ACMG-strength calibration is established for BayesDel.
Still missing
  • A validated REVEL score for NM_001360016.2:c.563C>T is unavailable.
Sources
spliceai ↗generic_acmg_combination_rules
BP7 N/ANot applicable: BP7 requires a synonymous variant, and this is a missense 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_001360016.2:c.563C>T in G6PD is a missense substitution predicted to produce NP_001346945.1:p.(Ser188Phe). 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 G6PD, 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: missense (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 = 0.02). BayesDel score = 0.453964.

10 paper records listed. 4 cited in the classification.

Cited in the classification

  • Molecular heterogeneity of the glucose-6-phosphate dehydrogenase deficiency in the Hellenic population.
    The paper identifies c.563C>T / p.(S188F) as the G6PD Mediterranean variant, described as the 188 Ser→Phe substitution. Among 299 G6PD-deficient Hellenic male subjects, 231 were hemizygous for this variant, accounting for 77% of deficient samples; it does not report a distinct nucleotide change producing the same amino-acid change or a different pathogenic missense change at residue 188.
    → PS3 · supporting Names this variant
    PMID 10782016 ↗
    Source detail
    By means of MboII endonuclease digestion, 231 out of 299 individuals were found to be hemizygotes for the G6PD Mediterranean variant (188 Ser→Phe).

    Location Results, paragraphs 1–2; Table 1 and Table 2

    Context Hellenic cohort of 299 G6PD-deficient male subjects; MboII endonuclease digestion was used to identify the G6PD Mediterranean variant.

  • Molecular variants of G6PD deficiency among certain tribal communities of Orissa, India.
    The paper describes G6PD Mediterranean as the residue-188 Ser-to-Phe substitution and reports enzyme activity of 0.64–1.1 IU/g Hb for this variant type among deficient males from tribal communities in Orissa, India.
    → PS3 · supporting Does not name this variant
    PMID 18568599 ↗
    Source detail
    "the G6PD Mediterranean variant (188 Ser ! Phe) predominates throughout the Mediterranean and Middle East"; "The enzyme activity of the G6PD Med type found in these populations was within the range of 0.64–1.1 IU/g Hb"

    Location Introduction, paragraph 3; Results and discussion, paragraph 2

    Context A total of 3480 males from 14 tribal communities were screened by fluorescent spot testing and quantitative enzyme assay; deficient samples were molecularly characterized by PCR-RFLP.

  • Five novel glucose-6-phosphate dehydrogenase deficiency haplotypes correlating with disease severity.
    Dallol A et al. · 2012 Sep 24
    The paper explicitly identifies the p.Ser188Phe G6PD variant, corresponding to the specified G6PD c.563C>T variant, as the mutation defining the Mediterranean haplotype. It was observed in 29 of 164 reported haplotypes (17.79%) among the Saudi cohort and was described as one of the three most common pathogenic six-locus haplotypes; it does not report a distinct nucleotide change producing the same amino-acid change or a different pathogenic missense change at residue 188.
    → PS3 · supporting Names this variant
    PMID 23006493 ↗
    Source detail
    Mediterranean, characterised by a single p.Ser188Phe mutation (29/164, 17.79%)

    Location Results, 6-locus haplotyping paragraph

    Context Saudi cohort of 249 individuals with suspected G6PD deficiency; six-locus haplotyping was based on DNA sequencing, with quantitative G6PD enzyme activity measured by UV/kinetic spectrophotometry.

  • Incidence of Glucose-6-Phosphate Dehydrogenase Deficiency among Swedish Newborn Infants.
    The paper explicitly identifies G6PD c.563C>T (p.(Ser188Phe)), also called the Mediterranean variant. It was the most common disease-causing variant in the newborn-screening cohort, detected on 16 alleles. The paper states that most disease-causing variants are either missense or nonsense, rather than primarily truncating.
    → PS3 · supporting Names this variant
    PMID 33072997 ↗
    Source detail
    Most disease-causing variants are either missense or nonsense, the latter only found in heterozygous females since the complete loss of enzyme activity is considered not to be compatible with life [2]. Disease-causing variants have often been named after the geographic area where they are common, for example the “Mediterranean” variant, c.563C>T (p.(Ser188Phe)) [17].

    Location Section 1.2, The G6PD Gene

    Context Swedish newborn-screening study of 10,098 dried blood spot samples; G6PD activity was measured by a fluorometric assay, and low-activity samples underwent Sanger sequencing of G6PD exons 2–13 and exon/intron boundaries.

Other recorded publications

  • Two new class III G6PD variants [G6PD Tunis (c.920A&gt;C: p.307Gln&gt;Pro) and G6PD Nefza (c.968T&gt;C: p.323 Leu&gt;Pro)] and overview of the spectrum of mutations in Tunisia.
    Benmansour I et al. · 2013
    No paper-specific finding is recorded.
    PMID 22963789 ↗
  • Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for rasburicase therapy in the context of G6PD deficiency genotype.
    No paper-specific finding is recorded.
    PMID 24787449 ↗
  • Modeling the ACMG/AMP variant classification guidelines as a Bayesian classification framework.
    No paper-specific finding is recorded.
    PMID 29300386 ↗
  • Acute Hemolytic Anemia Caused by G6PD Deficiency in Children in Mayotte: A Frequent and Severe Complication.
    No paper-specific finding is recorded.
    PMID 34966093 ↗
  • Specific guidelines for assessing and improving the methodological quality of economic evaluations of newborn screening.
    No paper-specific finding is recorded.
    PMID 22947299 ↗
  • Offering prenatal diagnostic tests: European guidelines for clinical practice [corrected].
    No paper-specific finding is recorded.
    PMID 24022298 ↗

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= 0.00140938; MAF= 0.14094%, 1705/1209752 alleles, homozygotes = 23) and has highest observed frequency in the Middle Eastern population (AF= 0.04204; MAF= 4.20400%, 183/4353 alleles, homozygotes = 4); grpmax FAF= 0.0370614.

gnomAD v2.1

This variant is present in gnomAD v2.1 (AF= 0.00230096; MAF= 0.23010%, 471/204697 alleles, homozygotes = 6) and has highest observed frequency in the South Asian population (AF= 0.0173498; MAF= 1.73498%, 331/19078 alleles, homozygotes = 4); grpmax FAF= 0.0158107.

gnomAD-Canada

This variant is present in gnomAD-Canada v1.0 (AF= 0.0021542738012508686, 31/14390 alleles, homozygotes = 0).

ClinVar

This variant has been reported in ClinVar as Pathogenic (55 clinical laboratories) and as Likely pathogenic (6 clinical laboratories). (ClinVarID = 100057)

In silico

SpliceAI predicts no significant splice impact for this variant (max delta score = 0.02). BayesDel score = 0.453964.

Somatic

This variant does not lie in a statistically significant hotspot. This variant has not previously been reported in somatic cancers (COSMIC).

Cancer Hotspots

This variant does not lie in a statistically significant hotspot.