Is ALK p.Pro1398Leu (c.4193C>T) pathogenic?

ALK p.Pro1398Leu (c.4193C>T) is classified Conflicting classifications of pathogenicity in ALK (ClinVar, Conflicting submitters, 5 submitters; last evaluated 2025-12-15). AlphaMissense: likely pathogenic (0.89); Ultra-rare (popmax 0.028%, afr); Associated with neuroblastoma, susceptibility to, 3.

What condition is associated with ALK p.Pro1398Leu (c.4193C>T)?

ALK p.Pro1398Leu (c.4193C>T) is associated with neuroblastoma, susceptibility to, 3, hereditary neoplastic syndrome (ClinVar).

How common is ALK p.Pro1398Leu (c.4193C>T) in the general population?

ALK p.Pro1398Leu (c.4193C>T) is ultra-rare (popmax 0.028%, afr) (gnomAD).

What do computational predictors say about ALK p.Pro1398Leu (c.4193C>T)?

AlphaMissense predicts likely pathogenic (score 0.89) — an in-silico prediction, not a clinical call.

ALK p.Pro1398Leu

c.4193C>T · rs531490912 · VCV470866

Conflicting classifications of pathogenicity Conflicting submitters

Classification

Conflicting classifications of pathogenicity

ClinVar

Review

Conflicting submitters ★☆☆☆

ClinVar · 5 submitters

AlphaMissense

likely pathogenic

0.89 · ACMG-weighted

gnomAD v4.1

Rare

ultra-rare (popmax 0.028%, afr)

Missense predictors

3/3 damaging

AlphaMissense, REVEL, SaProt

Conditions

neuroblastoma, susceptibility to, 3

Computational evidence

Protein change
AlphaMissense	0.89	likely pathogenic
REVEL	0.729	pathogenic-leaning
SaProt	LLR -16.09	damaging
⇒ AlphaMissense, REVEL and SaProt all call this damaging.
Splicing
SpliceAI	—	not assessed · no allele here is in the release
Constraint at this position
Conservation	phyloP 12	GERP 2.4, phastCons 1
Regional constraint	o/e 1.10	unconstrained · MANE · 4,393 bp · p 0.054 · regional, not allelic
Overall
CADD	25.7	PHRED · no single calibrated threshold — expert panels disagree

AlphaMissense carries the ACMG weight for missense; REVEL and SaProt are independent agreement signals.

Population frequency

gnomAD v4.1 · exomes + genomes

Grpmax group 0.028% African / African-American · 21/75,024 alleles

Filtering AF 0.0187% ClinGen BA1/BS1 input FAF95, joint · FAF99 0.0157%

Overall 0.00471% 76/1,614,104 alleles · ultra-rare

Ancestry group	Frequency	1 in
African / African-Americangrpmax	0.028%	3,573
Middle Eastern	0.0165%	6,062
South Asian	0.0132%	7,589
East Asian	0.00891%	11,220
Remaining individualsnot grpmax-eligible	0.0064%	15,628
European (non-Finnish)	0.0028%	35,758
Admixed American	0.00167%	60,008

Rarity supports pathogenicity (ACMG PM2); frequency above a disease-specific BA1/BS1 threshold argues against it. A variant frequent in one ancestry group can be near-absent in others, so a single global figure can mislead.

Variant & gene context

Gene: ALK
Protein: p.Pro1398Leu
Coding: c.4193C>T
MANE Select: NM_004304
dbSNP: rs531490912
Type: single nucleotide variant
Location: chr2:29193894 (GRCh38)
Gene constraint: LOEUF 0.562 · pLI <0.01 · ClinGen HI 0/3 (gnomAD)
Structure: AlphaFold pLDDT 68.26 · 79 PDB
Residue 1398: an α-helix

Full ALK gene report on Sugi Atlas → Gene function, pathways, protein structure, interactions & more

Disease context

neuroblastoma, susceptibility to, 3 — disease report on Sugi Atlas → Associated genes, phenotypes, clinical trials & treatments

Also linked: hereditary neoplastic syndrome

Similar variants

ALK p.Pro1398Arg Uncertain significance ★★ ⚠ same residue
ALK p.Pro1398Thr Uncertain significance ★★ ⚠ same residue
ALK p.Pro1398= Likely benign ★ same residue
ALK p.Arg1275Gln Pathogenic ★★ same condition
ALK c.1154+5G>A Uncertain significance ★★ same condition
ALK c.1155-3C>T Uncertain significance ★★ same condition
ALK c.1282+3A>G Uncertain significance ★★ same condition
ALK c.1414+1G>A Uncertain significance ★★ same condition

Built on 18 open, versioned datasets — ClinVar, gnomAD, AlphaMissense, REVEL, ClinGen & more — plus Sugi Variant's own cross-source analysis. Source data 2026-01–2026-10, ClinVar 2026-10. Full sources & versions →

Cite Sugi Variant

Gür T. Sugi Variant: A Deterministic Per-Variant Germline Reference from a Knowledge Graph for Humans and AI Agents. 2026. doi:10.5281/zenodo.21509445. This variant: https://sugi.bio/variant/alk-p-pro1398leu (accessed [today's date]).

Preprint & method: sugi.bio/variant/method Machine-readable: this page as Markdown