SCN5A Variant c.5445_5446insT Detail

We estimate the penetrance of LQTS for SCN5A c.5445_5446insT around 2% and the Brugada syndrome penetrance around 28%. SCN5A c.5445_5446insT was found in a total of 5 carriers in 1 papers and/or in gnomAD: 2 had Brugada syndrome, 0 had LQTS. c.5445_5446insT is not present in gnomAD. c.5445_5446insT has been functionally characterized in 1 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 (2 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 c.5445_5446insT around 2% (0/15) and the Brugada syndrome penetrance around 28% (4/15).

In Silico Data

PROVEAN PolyPhen-2 BLAST-PSSM REVEL Penetrance Density BrS (%) Penetrance Density LQT3 (%)
NA NA NA None 13 2
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
24363796 2013 8 0 2 3 AF, VF, syncope
LITERATURE, COHORT, AND GNOMAD: - 5 3 0 2 -
VARIANT FEATURES ALONE: - 15 13 0 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

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)
24363796 2013 CHO 0

c.5445_5446insT has 37 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
1803 15
1814 7
1794 13
1853 13 I1853V,
1828 10 A1828S, A1828T,
1834 14 S1834R,
1813 5
1818 6
1801 7
1802 13
1832 11 Q1832E,
1820 7 A1820V, A1820T,
1811 10 Y1811N, Y1811X,
1857 13
1812 8 S1812L, S1812X,
1829 7
1835 11 L1835F,
1819 6 D1819N,
1821 10
1815 4
1798 12 W1798X,
1826 12 R1826H, R1826C,
1825 14 L1825P,
1797 10 I1797V,
1800 11
1793 15 M1793K,
1848 13
1817 6
1827 10
1799 15
1816 0 D1816N, D1816E, c.5445_5446insT,
1831 9
1810 10
1809 10 I1809M,
1830 11
1840 15
1822 13 c.5464-5467delTCTG, c.5464_5467delTCTG,