2020
DOI: 10.1186/s13073-020-0711-1
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A proactive genotype-to-patient-phenotype map for cystathionine beta-synthase

Abstract: Background: For the majority of rare clinical missense variants, pathogenicity status cannot currently be classified. Classical homocystinuria, characterized by elevated homocysteine in plasma and urine, is caused by variants in the cystathionine beta-synthase (CBS) gene, most of which are rare. With early detection, existing therapies are highly effective. Methods: Damaging CBS variants can be detected based on their failure to restore growth in yeast cells lacking the yeast ortholog CYS4. This assay has only… Show more

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Cited by 46 publications
(61 citation statements)
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“… 78 Most other human genes subjected to full-length mutational scans thus far have shown substantially higher overall constraint: for instance, 40.5% of missense variants in the pharmacogene NUDT15 scored as damaging, 62 as were 39% of variants in the homocysteine metabolic factor CBS . 79 A recent activity-agnostic protein stability screen showed the fraction of missense variants with substantially destabilizing effects to range from 25.1% to 43.1% across three different genes; 62 , 80 these could be taken as a lower bound given that an unknown fraction of true LoF variants may remain stable.…”
Section: Discussionmentioning
confidence: 99%
“… 78 Most other human genes subjected to full-length mutational scans thus far have shown substantially higher overall constraint: for instance, 40.5% of missense variants in the pharmacogene NUDT15 scored as damaging, 62 as were 39% of variants in the homocysteine metabolic factor CBS . 79 A recent activity-agnostic protein stability screen showed the fraction of missense variants with substantially destabilizing effects to range from 25.1% to 43.1% across three different genes; 62 , 80 these could be taken as a lower bound given that an unknown fraction of true LoF variants may remain stable.…”
Section: Discussionmentioning
confidence: 99%
“…Recent deployments of functional assays to study protein variants have proven to be highly accurate at predicting pathogenicity when results are benchmarked to clinically established annotations. A yeast complementation assay was used to create a variant-effect map for CBS , the gene underlying classical homocystinuria ( 67 ). In addition to predicting pathogenic variants more accurately than computational models, the authors show that the degree of assay impairment correlates with the age of disease onset and severity in patients.…”
Section: Developing Multiplex Assays With High Clinical Relevancementioning
confidence: 99%
“…Most of the currently available tools, v.g. SIFT (Vaser, Adusumalli, Leng, Sikic, & Ng, 2016), PolyPhen (Adzhuvei, et al, 2010, and Revel (Ioannidis, et al, 2016) are designed to yield scores for missense type variants exclusively, resulting in a lower performance in the dataset as it includes diverse variant consequence types. Only a third of the variants of this dataset are missense type, and there are significant numbers of synonymous, non coding transcript exon, intron, and splice variants.…”
Section: High Performance Among Different Variant Consequence Typesmentioning
confidence: 99%