# NM_001308093.3(GATA4):c.76T>G (p.Phe26Val)

https://sugi.bio/variant/gata4-p-phe26val

## Summary

**GATA4 p.Phe26Val (c.76T>G)** is classified **Uncertain significance** in GATA4 (ClinVar, Single submitter, 1 submitter; last evaluated 2023-04-17). AlphaMissense: likely pathogenic (0.6438); Absent from gnomAD v4.1; Associated with Cardiovascular phenotype.

**At a glance:** Uncertain significance · review: Single submitter · rsID rs1554488388 · 1 submitter · 1 linked condition · AlphaMissense likely pathogenic · absent from gnomAD v4.1

## For patients & families {#patients}

This is a change in the GATA4 gene that is currently of uncertain significance — a definitive interpretation has not yet been established, submitted by 1 submitter, 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 | [GATA4](https://sugi.bio/atlas/gene/GATA4/) |
| Protein change (HGVS p.) | p.Phe26Val |
| Coding change (HGVS c.) | c.76T>G |
| MANE Select transcript | [NM_001308093](https://www.ncbi.nlm.nih.gov/nuccore/NM_001308093) |
| dbSNP | [rs1554488388](https://www.ncbi.nlm.nih.gov/snp/rs1554488388/) |
| Variant type | single nucleotide variant |
| Location | chr8:11708388-11708388 (GRCh38) |
| ClinVar | [VCV518676](https://www.ncbi.nlm.nih.gov/clinvar/variation/518676/) |

**All HGVS expressions:** `NC_000008.10:g.11565897T>G`, `NC_000008.11:g.11708388T>G`, `NG_008177.2:g.36470T>G`, `NM_001308093.3:c.76T>G`, `NM_001308094.2:c.-6+7610T>G`, `NM_001374273.1:c.-3+4084T>G`, `NM_001374274.1:c.-3+374T>G`, `NM_002052.5:c.76T>G`

## Computational & population evidence {#evidence}

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

- AlphaMissense **likely pathogenic** (0.6438)
- REVEL 0.81 (moderately pathogenic-leaning) — agrees with AlphaMissense
- SaProt LLR -5.462 (tolerated) — differs from AlphaMissense
- → **In-silico consensus:** AlphaMissense and REVEL call this damaging; SaProt does not
- Conservation: phyloP 7.442, GERP 1.7, phastCons 1 — highly conserved (agrees)
- CADD: **PHRED 23.9**. 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 1.13** across the covering region of the MANE Select transcript (11,708,313–11,748,940), spanning 40,627 bp. Chi-square p 0.015. 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: **absent from gnomAD v4.1** — a rarity signal (ACMG PM2-supporting), not evidence of pathogenicity on its own.

*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}

**GATA4** population constraint: LOEUF 0.468, pLI 0.99122, missense-Z -1.4458; 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):

- **GATA4-related congenital heart disease with or without pancreatic hypoplasia or diabetes** — Definitive (AD)

## Protein context {#protein}


AlphaFold model confidence (whole protein): pLDDT 58.64, 20% of residues very-high.

**3 experimental structure(s)** (PDB): [2M9W](https://www.rcsb.org/structure/2M9W), [8VG0](https://www.rcsb.org/structure/8VG0), [8VG1](https://www.rcsb.org/structure/8VG1).

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

*Describes the biological roles of GATA4 (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:** GATA4's established molecular role includes transcription cis-regulatory region binding.


### Pathways affected {#pathways}

GATA4 participates in **11 Reactome pathways** (⚕ = disease pathway):

| Pathway (Reactome) | Evidence |
| --- | --- |
| [Developmental Lineage of Multipotent Pancreatic Progenitor Cells](https://reactome.org/content/detail/R-HSA-9937080) | curated |
| [Developmental Lineage of Pancreatic Acinar Cells](https://reactome.org/content/detail/R-HSA-9925561) | curated |
| [Developmental Lineage of Pancreatic Ductal Cells](https://reactome.org/content/detail/R-HSA-9925563) | curated |
| [Factors involved in megakaryocyte development and platelet production](https://reactome.org/content/detail/R-HSA-983231) | curated |
| [Physiological factors](https://reactome.org/content/detail/R-HSA-5578768) | curated |
| [Synthesis, secretion, and inactivation of Glucose-dependent Insulinotropic Polypeptide (GIP)](https://reactome.org/content/detail/R-HSA-400511) | curated |
| [YAP1- and WWTR1 (TAZ)-stimulated gene expression](https://reactome.org/content/detail/R-HSA-2032785) | curated |
| [Cardiogenesis](https://reactome.org/content/detail/R-HSA-9733709) | electronic |
| [Formation of definitive endoderm](https://reactome.org/content/detail/R-HSA-9823730) | electronic |
| [Formation of lateral plate mesoderm](https://reactome.org/content/detail/R-HSA-9758920) | electronic |
| [Transcriptional regulation of testis differentiation](https://reactome.org/content/detail/R-HSA-9690406) | electronic |

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

**Molecular function:** transcription cis-regulatory region binding, RNA polymerase II transcription regulatory region sequence-specific DNA binding, RNA polymerase II cis-regulatory region sequence-specific DNA binding, DNA-binding transcription activator activity, DNA-binding transcription activator activity, RNA polymerase II-specific, DNA binding.

**Biological process:** aortic valve morphogenesis, endocardial cushion development, atrial septum secundum morphogenesis, male gonad development, response to xenobiotic stimulus, positive regulation of DNA-templated transcription.

## Clinical significance {#significance}

**Uncertain significance** — review status Single submitter *(criteria provided, single submitter)*, last evaluated 2023-04-17.

**Submitter consensus:** unanimous (1/1 Uncertain significance).

### Submitter classifications {#submitters}

| Submitter | Classification | Review | Method | Date |
| --- | --- | --- | --- | --- |
| Ambry Genetics | Uncertain significance | criteria provided, single submitter | clinical testing | 2023-04-17 |

## Associated conditions {#conditions}

[Cardiovascular phenotype](https://sugi.bio/atlas/disease/cardiovascular-phenotype/).

**Reported phenotype names (ClinVar):** Cardiovascular phenotype.

## Similar variants {#similar}

Related GATA4 variant pages (same residue, condition, or type): [GATA4 c.1001-3C>T](/variant/gata4-c-1001-minus-3c-t), [GATA4 p.Ala138Gly](/variant/gata4-p-ala138gly), [GATA4 p.Ala139Thr](/variant/gata4-p-ala139thr), [GATA4 p.Ala155Val](/variant/gata4-p-ala155val), [GATA4 p.Ala171Gly](/variant/gata4-p-ala171gly), [GATA4 p.Ala196Thr](/variant/gata4-p-ala196thr), [GATA4 p.Ala264Ser](/variant/gata4-p-ala264ser), [GATA4 p.Ala32Thr](/variant/gata4-p-ala32thr).

### Data sources & attribution {#sources}

ClinVar (NCBI — public domain, built 2026-10-14); 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 2026-10-14); 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 518676). 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.*