# NM_000133.4(F9):c.969_975del (p.Pro324fs)

https://sugi.bio/variant/f9-p-pro324fs

## Summary

**F9 p.Pro324fs (c.969_975del)** is classified **Pathogenic** in F9 (ClinVar, Expert panel, 1 submitter; last evaluated 2024-12-06). Associated with hemophilia B.

**At a glance:** Pathogenic · review: Expert panel · 1 submitter · 1 linked condition

## For patients & families {#patients}

This is a change in the F9 gene that is considered disease-causing, submitted by 1 submitter, and is linked to hemophilia B.

*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.*

|  |  |
| --- | --- |
| Typical inheritance (of this condition) | X-linked recessive |
| Age of onset (of this condition) | Childhood, Infancy, Neonatal |
| Prevalence | 1-9 / 100 000 (Europe) |
| Clinical trials | 171 registered for this condition — see ClinicalTrials.gov |
| Diagnostic panels | F9 is a diagnostic-grade gene on 3 Genomics England panels |

**Commonly reported features of Hemophilia B** (across patients with this condition; presentation varies — frequencies from Orphanet):

- Hematuria — Very frequent (99-80%)
- Poor wound healing — Very frequent (99-80%)
- Intracranial hemorrhage — Very frequent (99-80%)
- Prolonged bleeding time — Very frequent (99-80%)
- Prolonged partial thromboplastin time — Very frequent (99-80%)
- Spontaneous, recurrent epistaxis — Very frequent (99-80%)
- Prolonged bleeding after surgery — Very frequent (99-80%)
- Joint hemorrhage — Very frequent (99-80%)

**Support & next steps:** [Condition overview & support (NIH GARD)](https://rarediseases.info.nih.gov/diseases/0008732/index) · [Find a genetic counselor (NSGC)](https://findageneticcounselor.nsgc.org/).

## Identity {#identity}

| Field | Value |
| --- | --- |
| Gene | [F9](https://sugi.bio/atlas/gene/F9/) |
| Protein change (HGVS p.) | p.Pro324fs |
| Coding change (HGVS c.) | c.969_975del |
| MANE Select transcript | [NM_000133](https://www.ncbi.nlm.nih.gov/nuccore/NM_000133) |
| Variant type | Deletion |
| Location | chrX:139561653-139561659 (GRCh38) |
| ClinVar | [VCV3390364](https://www.ncbi.nlm.nih.gov/clinvar/variation/3390364/) |

**All HGVS expressions:** `LRG_556:g.35919_35925del`, `LRG_556t1:c.969_975del`, `NC_000023.10:g.138643813_138643819del`, `NC_000023.11:g.139561654_139561660del`, `NG_007994.1:g.35919_35925del`, `NM_000133.4:c.969_975del`, `NM_001313913.2:c.855_861del`

## 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 1.059, GERP -2.47, phastCons 0.028 — weakly conserved position
- Molecular consequence: **frameshift** — a predicted loss-of-function variant. ClinGen curates **sufficient evidence for haploinsufficiency** in this gene, supporting a loss-of-function disease mechanism. *Descriptive; not an applied PVS1 code.*
- Nonsense-mediated decay: the premature termination codon is **in the last exon (8 of 8)** — predicted to **escape NMD**, so the truncated protein is likely expressed. An input to PVS1, not an applied code.
- SpliceAI: **not assessed** — the release is built from a substitutions-only source, so it holds no deletion variants. That is a property of the dataset, not of the variant, and is not evidence against a splicing effect.

*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}

**F9** population constraint: ClinGen dosage — haploinsufficiency 3/3, triplosensitivity 0/3. *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):

- **hemophilia B** — Definitive (XL)
- **thrombophilia, X-linked, due to factor 9 defect** — Limited (XL)

## Protein context {#protein}

Residue **324** lies in an α-helix; the peptidase s1 domain.

AlphaFold model confidence (whole protein): pLDDT 80.45, 51% of residues very-high.

**57 experimental structure(s)** (PDB): [1CFH](https://www.rcsb.org/structure/1CFH), [1CFI](https://www.rcsb.org/structure/1CFI), [1EDM](https://www.rcsb.org/structure/1EDM), [1IXA](https://www.rcsb.org/structure/1IXA), [1MGX](https://www.rcsb.org/structure/1MGX), [1NL0](https://www.rcsb.org/structure/1NL0) — incl. mutant structure 2WPH.

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

*Describes the biological roles of F9 (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:** F9's established molecular role includes endopeptidase activity. p.Pro324fs falls in the peptidase s1 domain. In Reactome, F9 is annotated in disease pathway(s) including **Defective F9 activation**, **Defective F9 secretion**.

**Disease mechanism (Reactome):** F9 loss or alteration is curated in [Defective F9 activation](https://reactome.org/content/detail/R-HSA-9673221), [Defective F9 secretion](https://reactome.org/content/detail/R-HSA-9673218), [Defective F9 variant does not activate FX](https://reactome.org/content/detail/R-HSA-9673202).

### Pathways affected {#pathways}

F9 participates in **16 Reactome pathways** (⚕ = disease pathway):

| Pathway (Reactome) | Evidence |
| --- | --- |
| ⚕ [Defective F9 activation](https://reactome.org/content/detail/R-HSA-9673221) | curated |
| ⚕ [Defective F9 secretion](https://reactome.org/content/detail/R-HSA-9673218) | curated |
| ⚕ [Defective F9 variant does not activate FX](https://reactome.org/content/detail/R-HSA-9673202) | curated |
| ⚕ [Defective cofactor function of FVIIIa variant](https://reactome.org/content/detail/R-HSA-9672396) | curated |
| ⚕ [Defective factor IX causes thrombophilia](https://reactome.org/content/detail/R-HSA-9672383) | curated |
| ⚕ [Defective gamma-carboxylation of F9](https://reactome.org/content/detail/R-HSA-9673240) | curated |
| [Amplification and propagation of coagulation cascade](https://reactome.org/content/detail/R-HSA-9769743) | curated |
| [FXIIa, PKa-dependent activation of coagulation pathway](https://reactome.org/content/detail/R-HSA-9935598) | curated |
| [Gamma-carboxylation of protein precursors](https://reactome.org/content/detail/R-HSA-159740) | curated |
| [Initiation of coagulation cascade](https://reactome.org/content/detail/R-HSA-9769735) | curated |
| [Regulation of clotting cascade](https://reactome.org/content/detail/R-HSA-9769739) | curated |
| [Removal of aminoterminal propeptides from gamma-carboxylated proteins](https://reactome.org/content/detail/R-HSA-159782) | curated |
| [Transport of gamma-carboxylated protein precursors from the endoplasmic reticulum to the Golgi apparatus](https://reactome.org/content/detail/R-HSA-159763) | curated |
| [None](https://reactome.org/content/detail/R-HSA-140834) | other |
| [None](https://reactome.org/content/detail/R-HSA-140837) | other |
| [Protein hydroxylation](https://reactome.org/content/detail/R-HSA-9629569) | electronic |

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

**Molecular function:** endopeptidase activity, calcium ion binding, metal ion binding.

**Biological process:** proteolysis, blood coagulation, zymogen activation.

## Clinical significance {#significance}

**Pathogenic** — review status Expert panel *(reviewed by expert panel)*, last evaluated 2024-12-06.

**Submitter consensus:** unanimous (1/1 Pathogenic).

**ClinGen expert panel:** Pathogenic — Coagulation Factor Deficiency VCEP (hemophilia B). *Expert-panel curated (ACMG); the highest ClinVar review tier.*
**Applied ACMG criteria (met):** `PVS1`, `PP4_Moderate`, `PM2_Supporting`.
*Considered but not met:* `PS4`.
Inheritance: X-linked inheritance.

> **Curation rationale (ClinGen, verbatim):** The NM_000133.4(F9):c.969_975del variant deletes 7bp in exon 8 of the F9 gene, causing a frameshift and premature termination of translation. NMD is not predicted to occur, but the truncation of the peptidase S1 domain is expected to be detrimental to protein function (PVS1). The variant is absent from gnomAD v2.1 (PM2_Supporting). The variant is reported in at least one individual with severe Hemophilia B with full gene sequencing and deletion/duplication analysis in the literature (PP4_Moderate - PMID: 26612714). In summary, this variant meets criteria to be classified as pathogenic. ACMG/AMP criteria applied, as specified by the Coagulation Factor Deficiency VCEP for F9: PVS1, PP4_Moderate, PM2_Supporting.
*Source: https://cspec.clinicalgenome.org/cspec/ui/svi/affiliation/50041 · approved 2024-12-06 · [ClinGen Evidence Repository](https://erepo.genome.network/evrepo/ui/classification/c7549989-d137-47b7-be33-3e2d6db9914d).*
*These are ClinGen's applied codes, reported verbatim — Sugi Variant does not re-tally or combine them into its own classification.*

### Submitter classifications {#submitters}

| Submitter | Classification | Review | Method | Date |
| --- | --- | --- | --- | --- |
| ClinGen Coagulation Factor Deficiency Variant Curation Expert Panel, Clingen | Pathogenic | reviewed by expert panel | curation | 2024-12-06 |

## Associated conditions {#conditions}

[hemophilia B](https://sugi.bio/atlas/disease/hemophilia-b/).

**Reported phenotype names (ClinVar):** Hereditary factor IX deficiency disease, F9 DEFICIENCY, FACTOR IX DEFICIENCY, PLASMA THROMBOPLASTIN COMPONENT DEFICIENCY, Hemophilia B, Christmas Disease.

## Similar variants {#similar}

Related F9 variant pages (same residue, condition, or type): [F9 p.Pro324=](/variant/f9-p-pro324), [F9 c.838+1_838+16del](/variant/f9-c-838-plus-1-838-plus-16del), [F9 p.Ser182fs](/variant/f9-p-ser182fs), [F9 c.392-7_392-4del](/variant/f9-c-392-minus-7-392-minus-4del), [F9 p.Arg364fs](/variant/f9-p-arg364fs), [F9 p.Asn245fs](/variant/f9-p-asn245fs), [F9 p.Cys382fs](/variant/f9-p-cys382fs), [F9 p.Gly94fs](/variant/f9-p-gly94fs).

### Data sources & attribution {#sources}

ClinVar (NCBI — public domain, built 2026-10-14); gnomAD v4.1 (Broad Institute, built 2026-10-15); 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 2026-10-14); 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 3390364). 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.*