KCNH2 Variant R20L Detail

We estimate the penetrance of LQTS for KCNH2 R20L is 57%. This variant was found in a total of 3 carriers in 1 papers or gnomAD, 1 had LQTS. R20L is not present in gnomAD. R20L has not been functionally characterized. 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 6 individuals with LQT2 and 4 unaffected individuals.These data combined with observations of carriers lead us to estimate the LQTS penetrance for KCNQ1 R20L around 57% (7/13).

In Silico Data

PROVEAN PolyPhen-2 BLAST-PSSM REVEL Penetrance Density (%)
-3.959 0.025 -3 0.835 63
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
Japan Cohort 2020 3 2 1
LITERATURE, COHORT, AND GNOMAD: - 3 2 1 -
VARIANT FEATURES ALONE: - 10 4 6 -
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.

R20L has 32 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
20 0 R20G, R20L,
16 6 D16A,
17 6
19 7 I19F,
23 7
21 7
24 8
18 8 I18M,
22 9 F22Y, F22S,
785 10 G785S, G785D, G785fsX,
786 10
826 10 T826A, T826I,
15 11 L15V,
13 11 T13N,
25 11 Q25P,
801 11 K801T,
825 12
479 12
14 12
784 12 R784G, R784W, R784Q,
800 12
26 13 S26I,
43 13 Y43C, Y43D,
27 13 R27X, R27P,
29 13 F29L, F29S, F29L, F29L, F29V,
827 13
45 13 N45K, N45K, N45D,
798 13 I798fsX,
828 13
480 14 E480V,
787 15
46 15 D46E, D46E, D46Y,