SCN5A Variant R680H Detail

We estimate the penetrance of LQTS for SCN5A R680H around 4% and the Brugada syndrome penetrance around 11%. SCN5A R680H was found in a total of 1 carriers in 3 papers and/or in gnomAD: 0 had Brugada syndrome, 0 had LQTS. R680H is present in 1 alleles in gnomAD. R680H has been functionally characterized in 4 papers. This residue is located in a Mild_Hotspot region for Brugada syndrome and a Non_Hotspot region for LQTS. In silico predictions, functional data (if available), and location in structure are equivalent to phenotyping 10 individuals for Brugada syndrome (1 diagnosed with Brugada syndrome) and 5 individuals for LQTS (0 with LQTS). These data combined with observations of carriers lead us to estimate the LQTS penetrance for SCN5A R680H around 4% (0/11) and the Brugada syndrome penetrance around 11% (1/11).

In Silico Data

PROVEAN PolyPhen-2 BLAST-PSSM REVEL Penetrance Density BrS (%) Penetrance Density LQT3 (%)
-1.95 0 1.2 0.572 13 3
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 BrS/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 LQT3 BrS1 Other Other Disease
21385947 2011 1 0 0 1 SCD
17210841 2007 1 0 0 1 SIDS
22677073 2012 1 0 0 1 SUDS
LITERATURE, COHORT, AND GNOMAD: - 1 1 0 0 -
VARIANT FEATURES ALONE: - 15 14 0 1 - -
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

Peak and late/persistent 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.
PubMed ID Year Cell Type Peak Current (%WT) V1/2 Act. (mV) V1/2 Inact. (mV) Late/Persistent Current (%WT)
22677073 2012
17646591 2007
17210841 2007 tsA204 110 -1.9 0.1 82
21385947 2011 HEK 104 -1.2 -0.9 212

R680H has 31 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. 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
665 15 A665S, A665T,
666 14
667 14
668 13 V668I,
669 13
670 12
671 11 S671C,
672 11 A672T, A672S,
673 10 L673V, L673P,
674 9
675 8 c.2024_2025delAG,
676 8
677 7 E677V,
678 5
679 4
680 0 R680H, R680C,
681 4 H681P,
682 5
683 7 C683G, C683R, C683S,
684 8
685 8
686 9 C686F,
687 10
688 11
689 11 R689C, R689H,
690 12
691 13 A691T, A691S,
692 13 Q692K,
693 14 R693C, R693H,
694 14 Y694C,
695 15