KCNH2 Variant I593R Detail

We estimate the penetrance of LQTS for KCNH2 I593R is 28%. This variant was found in a total of 5 carriers in 3 papers or gnomAD (version 4), 2 had LQTS. I593R is not present in gnomAD. We have tested the trafficking efficiency of this variant, 0% of WT with a standard error of 11%; in our analysis we used SE < 20% as 'high quality'. Approximately below 50% of WT is considered PS3 moderate and below 30% is PS3 strong. I593R has been functionally characterized in 3 papers. This residue is located in a Hotspot region for LQT2. In silico predictions, functional data (if available), and location in structure are equivalent to observing 2 individuals with LQT2 and 8 unaffected individuals.These data combined with observations of carriers lead us to estimate the LQTS penetrance for KCNQ1 I593R around 28% (4/15).

In Silico Data

PROVEAN PolyPhen-2 BLAST-PSSM REVEL Penetrance Density (%)
-5.189 0.994 -3 0.957 55
PROVEAN scores less than -2 are considered deleterious. REVEL scores higher than 0.5 or 0.75 are considered likely pathogenic (higher sensitivity with the former cutoff, higher specificity with the latter cutoff). A PolyPhen-2 score of 0.85 or greater is considered likely pathogenic. BLAST-PSSM reflects the evolutionary conservation of residue substitutions, more negative numbers indicate fewer observations of the specific substitution than is expected. Penetrance density is our previously published method to calculate the average LQTS probability density in a shell of residues surrounding a residue of interest (Kroncke et al. 2019).

Reported Carrier Data

PubMed ID Year Carriers Unaffected LQT2 Other Disease
28438721 2017 3 3
10973849 2000 1 0 1
16922724 2006 1 0 1
LITERATURE, COHORT, AND GNOMAD: - 5 3 2 -
VARIANT FEATURES ALONE: - 10 8 2 -
Summary totals might not agree with the literature table because of duplicate patients, which were excluded from the total counts. We do not distinguish here between multiple missense codons. Missense variants are combined across degenerate codon substitutions since codon-level data were not consistently available for curation.

Functional Data Homozygously Collected

Steady state (S.S.) and peak tail current are relative % to wildtype (100% being no different from wildtype). V0.5 act/inact are the voltages at which half of the maximal current is reached during an activation and inactivation protocol, each is in units of mV and relative to wildtype. Recovery from inactivation (Rec. inact.) and deactivation time (Deactivation) are the ratio of characteristic time constants with wildtype (unitless).

PubMed ID Cell Type S.S Peak (%WT) Peak Tail IKr (%WT) V1/2 Act. V1/2 Inact. Recov. Inact. Deactivation (%WT)
9694858 HEK293 0 0 None None None None
16244363 HEK293 None None None None
16432067 HEK293 10 None None None None

Functional Data Heterozygously Collected

Functional parameters are the same as defined above.

PubMed ID Cell Type S.S Peak (%WT) Peak Tail IKr (%WT) V1/2 Act. V1/2 Inact. Deactivation (%WT)
9694858 HEK293 None None None
16244363 HEK293 17 30 None -20.0 None
16432067 HEK293 None None None

I593R has 46 previously observed neighbors within 15 angstroms

A residue within a folded protein on average has nearest neighbors that fall roughly into two shells: a "nearest" neighbor around 5-6 angstroms and a second shell around 11 angstroms. NOTE: some residues appear multiple times at different distances since the functional KV11.1 channel (protein product of KCNH2/hERG) is a homotetramer and occasionally the same residue from multiple subunits is present within the 15A window. All variants shown in the rightmost column have been observed in at least one individual in the literature or gnomAD.

Neighbor Distance (Angstroms) Variants Observed in Individuals
593 0 I593R, I593X, I593K, I593T, I593V,
594 4
592 5 Q592X,
595 5 K595E, K595N, K595N,
590 5 G590V, G590D,
589 5 L589P,
633 7 N633I, N633D, N633S,
591 7 D591N, D591H,
583 8 I583V,
605 8 P605L,
634 8 T634S, T634S, T634P, T634A, T634I,
596 8 P596L, P596T, P596R, P596S,
609 9 D609N, D609G,
606 9 S606Del, S606F, S606P,
635 9 N635I,
588 9 N588D, N588K, N588K,
604 9 G604D, G604C, G604S,
584 9 G584C, G584R, G584S,
613 10 T613L, T613M, T613A, T613K,
586 10 L586M,
610 10
629 11 N629D, N629K, N629K, N629T, N629S, N629I,
638 11 K638Del, K638D, K638E, K638R,
632 11 P632S, P632A,
597 11 Y597H, Y597C,
637 11 E637G, E637K, E637X,
587 12
612 12 V612L, V612A, V612L,
585 12 W585C, W585C,
630 12 V630T, V630I, V630A,
608 12
631 12 S631F,
636 12
603 13 G603D,
607 13
588 13 N588D, N588K, N588K,
577 13
616 13 Y616S,
587 13
614 14 A614V, A614T,
628 14 G628A, G628Del, G628S, G628R, G628V, G628D,
584 14 G584C, G584R, G584S,
575 14 E575K,
631 15 S631F,
585 15 W585C, W585C,
639 15 I639F, I639N,