# NM_001148.6(ANK2):c.1638A>G (p.Ala546=)

https://sugi.bio/variant/ank2-p-ala546

## Summary

**ANK2 p.Ala546= (c.1638A>G)** is classified **Benign/Likely benign** in ANK2 (ClinVar, Multiple submitters, 5 submitters; last evaluated 2026-04-03). Ultra-rare (popmax 0.068%, afr); Associated with Cardiovascular phenotype.

**At a glance:** Benign/Likely benign · review: Multiple submitters · rsID rs372133055 · 5 submitters · 2 linked conditions · ultra-rare (popmax 0.068%, afr)

## For patients & families {#patients}

This is a change in the ANK2 gene that is classified as benign/likely benign — not considered disease-causing, submitted by 5 submitters, and is linked to Cardiovascular phenotype.

*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 | [ANK2](https://sugi.bio/atlas/gene/ANK2/) |
| Protein change (HGVS p.) | p.Ala546= |
| Coding change (HGVS c.) | c.1638A>G |
| MANE Select transcript | [NM_001148](https://www.ncbi.nlm.nih.gov/nuccore/NM_001148) |
| dbSNP | [rs372133055](https://www.ncbi.nlm.nih.gov/snp/rs372133055/) |
| Variant type | single nucleotide variant |
| Location | chr4:113274604-113274604 (GRCh38) |
| ClinVar | [VCV406466](https://www.ncbi.nlm.nih.gov/clinvar/variation/406466/) |

**All HGVS expressions:** `LRG_327:g.461522A>G`, `LRG_327t1:c.1638A>G`, `NC_000004.11:g.114195760A>G`, `NC_000004.12:g.113274604A>G`, `NG_009006.2:g.461522A>G`, `NM_001127493.3:c.1575A>G`, `NM_001148.6:c.1638A>G`, `NM_001354225.2:c.1638A>G`, `NM_001354228.2:c.1638A>G`, `NM_001354230.2:c.1683A>G`, `NM_001354231.2:c.1683A>G`, `NM_001354232.2:c.1638A>G`, `NM_001354235.2:c.1638A>G`, `NM_001354236.2:c.1638A>G`, `NM_001354237.2:c.1683A>G`, `NM_001354239.2:c.1575A>G`, `NM_001354240.2:c.1683A>G`, `NM_001354241.2:c.1683A>G`, `NM_001354242.2:c.1683A>G`, `NM_001354243.2:c.1575A>G`, `NM_001354244.2:c.1575A>G`, `NM_001354245.2:c.1638A>G`, `NM_001354246.2:c.1638A>G`, `NM_001354249.2:c.1551A>G`, `NM_001354252.2:c.1575A>G`, `NM_001354253.2:c.1575A>G`, `NM_001354254.2:c.1575A>G`, `NM_001354255.2:c.1575A>G`, `NM_001354256.2:c.1575A>G`, `NM_001354257.2:c.1575A>G`, `NM_001354258.2:c.1638A>G`, `NM_001354260.2:c.1551A>G`, `NM_001354261.2:c.1596A>G`, `NM_001354262.2:c.1575A>G`, `NM_001354264.2:c.1551A>G`, `NM_001354265.2:c.1638A>G`, `NM_001354266.2:c.1551A>G`, `NM_001354267.2:c.1551A>G`, `NM_001354268.2:c.1638A>G`, `NM_001354269.3:c.1428A>G`, `NM_001354270.2:c.1575A>G`, `NM_001354271.2:c.1551A>G`, `NM_001354272.2:c.1575A>G`, `NM_001354273.2:c.1440A>G`, `NM_001354274.2:c.1551A>G`, `NM_001354275.2:c.1575A>G`, `NM_001354276.2:c.1551A>G`, `NM_001354277.2:c.1353A>G`, `NM_001386142.1:c.1551A>G`, `NM_001386143.1:c.1575A>G`, `NM_001386144.1:c.1683A>G`, `NM_001386146.1:c.1551A>G`, `NM_001386147.1:c.1596A>G`, `NM_001386148.2:c.1626A>G`, `NM_001386149.1:c.1551A>G`, `NM_001386150.1:c.1551A>G`, `NM_001386151.1:c.1551A>G`, `NM_001386152.1:c.1683A>G`, `NM_001386153.1:c.1551A>G`, `NM_001386154.1:c.1551A>G`, `NM_001386156.1:c.1575A>G`, `NM_001386157.1:c.1353A>G`, `NM_001386158.1:c.1353A>G`, `NM_001386160.1:c.1596A>G`, `NM_001386161.1:c.1575A>G`, `NM_001386162.1:c.1551A>G`, `NM_001386174.1:c.1689A>G`, `NM_001386175.1:c.1665A>G`, `NM_001386186.2:c.1626A>G`, `NM_001386187.2:c.1602A>G`, `NM_020977.5:c.1638A>G`

## Computational & population evidence {#evidence}

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

- **Missense predictors (AlphaMissense/REVEL/SaProt) do not apply** to this variant type — they score amino-acid substitutions only. For non-missense variants the computational signal comes from conservation (below), not from a missing predictor score.
- Conservation: phyloP -6.774, GERP -4.94 — fast-evolving / accelerated position
- CADD: **PHRED 0.274**. 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.*
- 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 **0.068%** (afr) · FAF95 0.0531% · FAF99 0.0478% · 51/74,948 in the highest group · 58/1,614,098 alleles overall — ultra-rare (popmax 0.068%, afr).

| Ancestry group | Allele frequency | 1 in |
| --- | --- | --- |
| African / African-American (grpmax) | 0.068% | 1,470 |
| Remaining individuals (not grpmax-eligible) | 0.0048% | 20,826 |
| South Asian | 0.0011% | 91,086 |
| European (non-Finnish) | 0.000254% | 393,349 |

*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}

**ANK2** population constraint: LOEUF 0.271, pLI 1, missense-Z 4.2752; ClinGen dosage — haploinsufficiency 3, triplosensitivity 0 (0–3 scale). *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):

- **complex neurodevelopmental disorder** — Definitive (AD)
- **Brugada syndrome** — Disputed (AD)
- **catecholaminergic polymorphic ventricular tachycardia** — Disputed (AD)
- **long QT syndrome** — Disputed (AD)

## Protein context {#protein}

Residue **546** lies in an α-helix.

**11 experimental structure(s)** (PDB): [4D8O](https://www.rcsb.org/structure/4D8O), [4RLV](https://www.rcsb.org/structure/4RLV), [4RLY](https://www.rcsb.org/structure/4RLY), [5Y4D](https://www.rcsb.org/structure/5Y4D), [5Y4E](https://www.rcsb.org/structure/5Y4E), [5Y4F](https://www.rcsb.org/structure/5Y4F).

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

*Describes the biological roles of ANK2 (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:** ANK2's established molecular role includes enzyme binding.


### Pathways affected {#pathways}

ANK2 participates in **2 Reactome pathways** (⚕ = disease pathway):

| Pathway (Reactome) | Evidence |
| --- | --- |
| [COPI-mediated anterograde transport](https://reactome.org/content/detail/R-HSA-6807878) | curated |
| [Interaction between L1 and Ankyrins](https://reactome.org/content/detail/R-HSA-445095) | electronic |

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

**Molecular function:** enzyme binding, protein kinase binding, spectrin binding, transmembrane transporter binding, phosphorylation-dependent protein binding.

**Biological process:** regulation of heart rate, atrial septum development, intracellular protein localization, positive regulation of gene expression, regulation of cardiac muscle contraction by regulation of the release of sequestered calcium ion, regulation of cardiac muscle contraction by calcium ion signaling.

## Clinical significance {#significance}

**Benign/Likely benign** — review status Multiple submitters *(criteria provided, multiple submitters, no conflicts)*, last evaluated 2026-04-03.

**Submitter consensus:** conflicting (4 Likely benign, 1 Benign).

**Submission history:** 5 submissions (2018–2026); classifications have differed over time.

### Submitter classifications {#submitters}

| Submitter | Classification | Review | Method | Date |
| --- | --- | --- | --- | --- |
| GeneDx | Likely benign | criteria provided, single submitter | clinical testing | 2020-10-12 |
| Ambry Genetics | Likely benign | criteria provided, single submitter | clinical testing | 2018-09-06 |
| PreventionGenetics, part of Exact Sciences | Likely benign | no assertion criteria provided | clinical testing | 2022-02-15 |
| Labcorp Genetics (formerly Invitae), Labcorp | Likely benign | criteria provided, single submitter | clinical testing | 2026-01-19 |
| Women's Health and Genetics/Laboratory Corporation of America, LabCorp | Benign | criteria provided, single submitter | clinical testing | 2026-04-03 |

## Associated conditions {#conditions}

[Cardiovascular phenotype](https://sugi.bio/atlas/disease/cardiovascular-phenotype/), [long QT syndrome](https://sugi.bio/atlas/disease/long-qt-syndrome/).

**Reported phenotype names (ClinVar):** Cardiovascular phenotype, Long QT syndrome, not provided, ANK2-related disorder, not specified, AllHighlyPenetrant, none provided, ANK2-related condition.

## Similar variants {#similar}

Related ANK2 variant pages (same residue, condition, or type): [ANK2 p.Arg3113Ter](/variant/ank2-p-arg3113ter), [ANK2 p.Arg895Ter](/variant/ank2-p-arg895ter), [ANK2 p.Arg977Ter](/variant/ank2-p-arg977ter), [ANK2 c.11611-3T>A](/variant/ank2-c-11611-minus-3t-a), [ANK2 c.1783-3C>T](/variant/ank2-c-1783-minus-3c-t), [ANK2 c.2079+5T>G](/variant/ank2-c-2079-plus-5t-g), [ANK2 c.2278-3C>T](/variant/ank2-c-2278-minus-3c-t), [ANK2 c.3125+6G>A](/variant/ank2-c-3125-plus-6g-a).

### 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 406466). 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.*