# NM_001098.3(ACO2):c.1049A>G (p.Asn350Ser)

https://sugi.bio/variant/aco2-p-asn350ser

## Summary

**ACO2 p.Asn350Ser (c.1049A>G)** is classified **Benign/Likely benign** in ACO2 (ClinVar, Multiple submitters, 4 submitters; last evaluated 2025-09-15). AlphaMissense: likely benign (0.2276); Rare (popmax 0.565%, sas).

**At a glance:** Benign/Likely benign · review: Multiple submitters · rsID rs370742333 · 4 submitters · AlphaMissense likely benign · rare (popmax 0.565%, sas)

## For patients & families {#patients}

This is a change in the ACO2 gene that is classified as benign/likely benign — not considered disease-causing, submitted by 4 submitters.

*Reference information, not medical advice, and not a prediction for any individual. A genetic counselor or clinician can interpret what it means for you and your family.*

**Support & next steps:** [Find a genetic counselor (NSGC)](https://findageneticcounselor.nsgc.org/).

## Identity {#identity}

| Field | Value |
| --- | --- |
| Gene | [ACO2](https://sugi.bio/atlas/gene/ACO2/) |
| Protein change (HGVS p.) | p.Asn350Ser |
| Coding change (HGVS c.) | c.1049A>G |
| MANE Select transcript | [NM_001098](https://www.ncbi.nlm.nih.gov/nuccore/NM_001098) |
| dbSNP | [rs370742333](https://www.ncbi.nlm.nih.gov/snp/rs370742333/) |
| Variant type | single nucleotide variant |
| Location | chr22:41520187-41520187 (GRCh38) |
| ClinVar | [VCV214020](https://www.ncbi.nlm.nih.gov/clinvar/variation/214020/) |

**All HGVS expressions:** `NC_000022.10:g.41916191A>G`, `NC_000022.11:g.41520187A>G`, `NG_032143.1:g.56063A>G`, `NM_001098.3:c.1049A>G`

## Computational & population evidence {#evidence}

**Concordance:** Mixed / partial computational evidence (see below).

- AlphaMissense **likely benign** (0.2276)
- REVEL 0.779 (moderately pathogenic-leaning) — differs from AlphaMissense
- SaProt LLR -11.776 (damaging) — differs from AlphaMissense
- → **In-silico consensus:** REVEL and SaProt call this damaging; AlphaMissense does not
- Conservation: phyloP 9.278, GERP 1.81, phastCons 1 — highly conserved (differs from AlphaMissense)
- CADD: **PHRED 26.2**. No single ClinGen-calibrated threshold exists and the expert panels that use CADD disagree — GUCY2D/AIPL1 require ≥ 20.0 for an untranslated-region variant, ABCA4 ≥ 28.1 for a synonymous or indel variant, the Pulmonary Hypertension panel imports Pejaver 2022's missense-calibrated numbers, and the Antibody Deficiencies panel declines CADD entirely for PIK3CD. CADD v1.7 also incorporates Zoonomia phyloP, so it partly re-expresses the conservation above. *Descriptive; no threshold applied.*
- Regional missense constraint: **o/e 0.70** across the covering region of the MANE Select transcript (41,515,784–41,525,297), spanning 9,513 bp. Chi-square p 5.1e-10. Describes the region, not this allele; gnomAD v4.1.1's own constrained determination. *Descriptive; no ACMG code applied.*
- SpliceAI: **not assessed** — no allele at this position is in our SpliceAI release, either because it lies outside the scored MANE transcript scope or because every allele is below Δ0.2. We cannot tell which, so this claims neither; absence is not evidence against a splicing effect.
- Population frequency (gnomAD v4.1): grpmax **0.565%** (sas) · FAF95 0.524% · FAF99 0.508% · 514/91,052 in the highest group · 526/1,613,500 alleles overall — rare (popmax 0.565%, sas).

| Ancestry group | Allele frequency | 1 in |
| --- | --- | --- |
| South Asian (grpmax) | 0.565% | 177 |
| Remaining individuals (not grpmax-eligible) | 0.008% | 12,493 |
| European (non-Finnish) | 0.000593% | 168,516 |

*Computational predictors are not independent (ClinGen Variant Classification guidance): AlphaMissense (Cheng et al. 2023) carries the ACMG weight for missense and conservation (phyloP/GERP/phastCons) for non-missense; REVEL (Pejaver-2022 calibrated strength bands) and SaProt (Su et al. 2023, structure-aware, ClinVar-independent protein language model, raw LLR) are shown as orthogonal agreement signals, not additive. For frequency, the gnomAD v4.1 grpmax filtering allele frequency (FAF95) is ClinGen's designated BA1/BS1 input (gnomAD v4 guidance v3.0, June 2025); BA1/BS1 thresholds are disease-specific, not a blanket 5%. Predictions, not a clinical determination.*

## Gene constraint & dosage {#gene-context}

**ACO2** population constraint: LOEUF 0.489, pLI 0.98113, missense-Z 4.3358. *Lower LOEUF and higher pLI indicate a gene that tolerates loss-of-function poorly; ClinGen dosage is the curated haploinsufficiency call.*

Curated gene–disease validity (ClinGen):

- **optic atrophy 9** — Definitive (SD)
- **mitochondrial disease** — Strong (AD)
- **mitochondrial disease** — Definitive (AR)

## Protein context {#protein}


AlphaFold model confidence (whole protein): pLDDT 95.44, 95% of residues very-high.

## What this gene does {#gene-function}

*Describes the biological roles of ACO2 (the gene this variant disrupts) — not effects measured for this specific variant. A damaging variant is expected to affect these functions and pathways; the degree depends on the variant.*

**How this variant is thought to act:** ACO2's established molecular role includes iron ion binding.


### Pathways affected {#pathways}

ACO2 participates in **4 Reactome pathways** (⚕ = disease pathway):

| Pathway (Reactome) | Evidence |
| --- | --- |
| [Citric acid cycle (TCA cycle)](https://reactome.org/content/detail/R-HSA-71403) | other |
| [Maturation of TCA enzymes and regulation of TCA cycle](https://reactome.org/content/detail/R-HSA-9854311) | other |
| [Mitochondrial protein degradation](https://reactome.org/content/detail/R-HSA-9837999) | other |
| [Mitochondrial protein import](https://reactome.org/content/detail/R-HSA-1268020) | other |

### Molecular function & processes (GO — experimentally supported) {#go}

**Molecular function:** iron ion binding.

**Biological process:** tricarboxylic acid cycle, citrate metabolic process.

## Clinical significance {#significance}

**Benign/Likely benign** — review status Multiple submitters *(criteria provided, multiple submitters, no conflicts)*, last evaluated 2025-09-15.

**Submitter consensus:** conflicting (2 Benign, 2 Likely benign).

**Submission history:** 4 submissions (2019–2025); classifications have differed over time.

### Submitter classifications {#submitters}

| Submitter | Classification | Review | Method | Date |
| --- | --- | --- | --- | --- |
| Breakthrough Genomics, Breakthrough Genomics | Benign | criteria provided, single submitter | not provided |  |
| PreventionGenetics, part of Exact Sciences | Likely benign | no assertion criteria provided | clinical testing | 2019-11-26 |
| Labcorp Genetics (formerly Invitae), Labcorp | Benign | criteria provided, single submitter | clinical testing | 2025-09-15 |
| Blueprint Genetics | Likely benign | criteria provided, single submitter | clinical testing | 2024-11-05 |

**Reported phenotype names (ClinVar):** not provided, ACO2-related disorder, not specified, ACO2-Related Disorders, AllHighlyPenetrant, none provided.

## Similar variants {#similar}

Related ACO2 variant pages (same residue, condition, or type): [ACO2 p.Arg378Ter](/variant/aco2-p-arg378ter), [ACO2 p.Arg58Ter](/variant/aco2-p-arg58ter), [ACO2 p.Arg84Ter](/variant/aco2-p-arg84ter), [ACO2 p.Glu464Ter](/variant/aco2-p-glu464ter), [ACO2 p.Gly503Ter](/variant/aco2-p-gly503ter), [ACO2 c.1605+5G>C](/variant/aco2-c-1605-plus-5g-c), [ACO2 c.2208+5G>C](/variant/aco2-c-2208-plus-5g-c), [ACO2 c.2208+5G>T](/variant/aco2-c-2208-plus-5g-t).

### Data sources & attribution {#sources}

ClinVar (NCBI — public domain, built 2026-10-11); gnomAD v4.1 (Broad Institute, built 2026-10-06); AlphaMissense (Cheng et al. 2023, © Google DeepMind — CC BY 4.0, built 2026-01-27); REVEL (Ioannidis et al. 2016 — ODbL, built 2026-07-13); SaProt (Su et al. 2023 — MIT, built 2026-07-14); SpliceAI (Illumina — free for non-commercial use, built 2026-10-13); CADD (Rentzsch et al. 2019, University of Washington — free for non-commercial use, built 2026-10-10); Conservation (phyloP/phastCons/GERP) (UCSC hg38 470-way mammal (Hiller Lab) + Ensembl Compara, built 2026-07-12); gnomAD Non-coding Constraint (Gnocchi) (Chen et al. 2024, Broad Institute — CC0, built 2026-10-11); gnomAD Regional Missense Constraint (Broad Institute — CC0, built 2026-10-13); Pangolin (Zeng & Li 2022 — CC BY 4.0, built 2026-10-11); Repeat regions (UCSC — RepeatMasker, TRF, segmental duplications, built 2026-10-11); ClinGen (ClinGen, built 2026-09-22); UniProt (CC BY 4.0); Reactome / GO (CC BY 4.0, built 2026-09-23); MaveDB (per-record license, built 2026-10-11); CIViC (CC0, built 2026-09-22); Orphanet (Orphanet, built 2026-06-12)

*Primary record: NCBI ClinVar (variation 214020). Classifications reflect these databases as of the page's build date and may change. Free reference use — not medical advice; consult the primary submitters and a clinician.*