Reclassification of a likely pathogenic Dutch founder variant in KCNH2; implications of reduced penetrance

Abstract Background: Variants in KCNH2, encoding the human ether a-go-go (hERG) channel that is responsible for the rapid component of the cardiac delayed rectifier K+ current (IKr), are causal to long QT syndrome type 2 (LQTS2). We identified eight index patients with a new variant of unknown significance (VUS), KCNH2:c.2717C > T:p.(Ser906Leu). We aimed to elucidate the biophysiological effect of this variant, to enable reclassification and consequent clinical decision-making. Methods: A genotype–phenotype overview of the patients and relatives was created. The biophysiological effects... Mehr ...

Verfasser: Copier, Jaël S
Bootsma, Marianne
Ng, Chai A
Wilde, Arthur A M
Bertels, Robin A
Bikker, Hennie
Christiaans, Imke
van der Crabben, Saskia N
Hol, Janna A
Koopmann, Tamara T
Knijnenburg, Jeroen
Lommerse, Aafke A J
van der Smagt, Jasper J
Bezzina, Connie R
Vandenberg, Jamie I
Verkerk, Arie O
Barge-Schaapveld, Daniela Q C M
Lodder, Elisabeth M
Dokumenttyp: Artikel
Erscheinungsdatum: 2022
Reihe/Periodikum: Human Molecular Genetics ; volume 32, issue 7, page 1072-1082 ; ISSN 0964-6906 1460-2083
Verlag/Hrsg.: Oxford University Press (OUP)
Sprache: Englisch
Permalink: https://search.fid-benelux.de/Record/base-27442617
Datenquelle: BASE; Originalkatalog
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Link(s) : http://dx.doi.org/10.1093/hmg/ddac261

Abstract Background: Variants in KCNH2, encoding the human ether a-go-go (hERG) channel that is responsible for the rapid component of the cardiac delayed rectifier K+ current (IKr), are causal to long QT syndrome type 2 (LQTS2). We identified eight index patients with a new variant of unknown significance (VUS), KCNH2:c.2717C > T:p.(Ser906Leu). We aimed to elucidate the biophysiological effect of this variant, to enable reclassification and consequent clinical decision-making. Methods: A genotype–phenotype overview of the patients and relatives was created. The biophysiological effects were assessed independently by manual-, and automated calibrated patch clamp. HEK293a cells expressing (i) wild-type (WT) KCNH2, (ii) KCNH2-p.S906L alone (homozygous, Hm) or (iii) KCNH2-p.S906L in combination with WT (1:1) (heterozygous, Hz) were used for manual patching. Automated patch clamp measured the variants function against known benign and pathogenic variants, using Flp-In T-rex HEK293 KCNH2-variant cell lines. Results: Incomplete penetrance of LQTS2 in KCNH2:p.(Ser906Leu) carriers was observed. In addition, some patients were heterozygous for other VUSs in CACNA1C, PKP2, RYR2 or AKAP9. The phenotype of carriers of KCNH2:p.(Ser906Leu) ranged from asymptomatic to life-threatening arrhythmic events. Manual patch clamp showed a reduced current density by 69.8 and 60.4% in KCNH2-p.S906L-Hm and KCNH2-p.S906L-Hz, respectively. The time constant of activation was significantly increased with 80.1% in KCNH2-p.S906L-Hm compared with KCNH2-WT. Assessment of KCNH2-p.S906L-Hz by calibrated automatic patch clamp assay showed a reduction in current density by 35.6%. Conclusion: The reduced current density in the KCNH2-p.S906L-Hz indicates a moderate loss-of-function. Combined with the reduced penetrance and variable phenotype, we conclude that KCNH2:p.(Ser906Leu) is a low penetrant likely pathogenic variant for LQTS2.