Reasoning
PS2 is not met. The criterion requires a de novo occurrence of the variant in a patient with the disease, with both maternity and paternity confirmed, and no family history. No such observation exists for RAC1 NM_006908.5:c.85C>T (p.Pro29Ser): the variant is absent from ClinVar, and none of the five reviewed publications reports a germline proband, trio testing, parental confirmation of maternity or paternity, or a family history. The literature instead characterises c.85C>T as a UV-signature somatic missense hotspot of melanoma. In the exome-sequencing cohort of PMID:22842228 the mutation was somatic in every case for which matched normal DNA was available, and it was absent from dbSNP, 1000 Genomes, 2,577 germline exomes and 2,596 individuals from 57 populations; PMID:25056119 independently states that P29S has not been detected as a germline mutation in 1000 Genomes or among over 2,500 germline exomes. With no affected proband, no parental testing and affirmative evidence that this variant arises somatically rather than being transmitted or arising de novo in the germline, the evidentiary predicate of PS2 is unmet.
Rule
De novo (both maternity and paternity confirmed) in a patient with the disease and no family history. ... Confirmation of paternity only is insufficient. Egg donation, surrogate motherhood, errors in embryo transfer, etc. can contribute to non-maternity.
Evidence considered
- ClinVar search for RAC1 c.85C>T returned no records, so no submitted de novo observation, family history, or parental confirmation is available from that source.
- Evans et al. (PMID:22842228): matched tumour-normal analysis found RAC1P29S somatic in all cases with available normal DNA, and the variant was absent from dbSNP, 1000 Genomes, 2,577 Yale germline exomes and 2,596 individuals from 57 populations.
- Hodis et al. (PMID:25056119) Discussion: RAC1 P29S is a somatic mutation caused by presumptive UVB-induced C>T damage and has not been detected as a germline mutation in 1000 Genomes or among over 2,500 germline exomes sequenced at Yale.
- No reviewed publication describes an affected proband, parental testing, or a pedigree for this variant; all five papers concern somatic melanoma cohorts, cell lines, or function.
Still missing
- No germline trio data (proband plus both parents) exist for this variant in any reviewed source; a documented de novo germline occurrence in an affected patient with confirmed maternity and paternity would be required to revisit PS2.
Sources