# NM_001308093.3(GATA4):c.307C>G (p.Pro103Ala)

https://sugi.bio/variant/gata4-p-pro103ala

## Summary

**GATA4 p.Pro103Ala (c.307C>G)** is classified **Uncertain significance** in GATA4 (ClinVar, Single submitter, 1 submitter; last evaluated 2024-01-01). AlphaMissense: likely benign (0.0539); No allele count reported in gnomAD v4.1 (AN 1,342,804); Associated with atrioventricular septal defect 4.

**At a glance:** Uncertain significance · review: Single submitter · rsID rs1800009849 · 1 submitter · 1 linked condition · AlphaMissense likely benign · no allele count reported in gnomAD v4.1 (AN 1,342,804)

## 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 atrioventricular septal defect 4.

*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:** [Condition overview & support (NIH GARD)](https://rarediseases.info.nih.gov/diseases/0024944/index) · [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.Pro103Ala |
| Coding change (HGVS c.) | c.307C>G |
| MANE Select transcript | [NM_001308093](https://www.ncbi.nlm.nih.gov/nuccore/NM_001308093) |
| dbSNP | [rs1800009849](https://www.ncbi.nlm.nih.gov/snp/rs1800009849/) |
| Variant type | single nucleotide variant |
| Location | chr8:11708619-11708619 (GRCh38) |
| ClinVar | [VCV2735120](https://www.ncbi.nlm.nih.gov/clinvar/variation/2735120/) |

**All HGVS expressions:** `NC_000008.10:g.11566128C>G`, `NC_000008.11:g.11708619C>G`, `NG_008177.2:g.36701C>G`, `NM_001308093.3:c.307C>G`, `NM_001308094.2:c.-6+7841C>G`, `NM_001374273.1:c.-3+4315C>G`, `NM_001374274.1:c.-3+605C>G`, `NM_002052.5:c.307C>G`

## Computational & population evidence {#evidence}

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

- AlphaMissense **likely benign** (0.0539)
- REVEL 0.756 (pathogenic-leaning) — differs from AlphaMissense
- SaProt LLR -5.703 (tolerated) — agrees with AlphaMissense
- → **In-silico consensus:** REVEL calls this damaging; AlphaMissense and SaProt do not
- Conservation: phyloP 5.337, GERP 1.52, phastCons 1 — highly conserved (differs from AlphaMissense)
- CADD: **PHRED 23.0**. 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: **no splice effect predicted**. SpliceAI outputs four numbers per variant, not one: acceptor loss, donor loss, acceptor gain, donor gain (DS_AL / DS_DL / DS_AG / DS_DG). A loss score is an existing splice site weakened or destroyed; a gain score is a new site created or an existing one strengthened. The release publishes its own filter rule, which we read from the dataset rather than assume: an allele is reported only if the largest of its four deltas reaches 0.2. No allele at this position is in the release, so all four are under 0.2 for every alternate allele here. No figure is shown because none was read: the bound is deduced from that absence. It is a result, not a gap in our data, because the release scores every possible substitution across the transcripts it covers (Ensembl MANE v1.4) before it filters, so what survives for a gene is one continuous stretch. What is measured is that this position sits inside the stretch covered for GATA4 (595 scored positions, the nearest 310 bases away); what is taken from the release's own description, rather than measured, is that coverage inside that stretch is continuous. On that, SpliceAI did score it. *ClinGen's SVI treats the largest of the four as evidence against a splicing effect at or below 0.1, where it may support BP4, and as uninformative between 0.1 and 0.2. We cannot tell which applies here, so these SpliceAI data support neither BP4 nor PP3; that is a statement about this evidence alone, not about the variant's other evidence.*
- Population frequency: **no allele count reported in gnomAD v4.1 (AN 1,342,804)** — rarity (ACMG PM2) and BA1/BS1 cannot be assessed for this variant.

*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}

Residue **103** lies in the 'disordered' region.

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. p.Pro103Ala falls in the disordered region.


### 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 2024-01-01.

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

### Submitter classifications {#submitters}

| Submitter | Classification | Review | Method | Date |
| --- | --- | --- | --- | --- |
| Labcorp Genetics (formerly Invitae), Labcorp | Uncertain significance | criteria provided, single submitter | clinical testing | 2024-01-01 |

## Associated conditions {#conditions}

[atrioventricular septal defect 4](https://sugi.bio/atlas/disease/atrioventricular-septal-defect-4/).

**Reported phenotype names (ClinVar):** Atrioventricular septal defect 4.

## Similar variants {#similar}

Related GATA4 variant pages (same residue, condition, or type): [GATA4 p.Pro103=](/variant/gata4-p-pro103), [GATA4 p.Pro103Arg](/variant/gata4-p-pro103arg), [GATA4 p.Arg231Ter](/variant/gata4-p-arg231ter), [GATA4 p.Arg284His](/variant/gata4-p-arg284his), [GATA4 p.Gly297Ser](/variant/gata4-p-gly297ser), [GATA4 c.1001-3C>T](/variant/gata4-c-1001-minus-3c-t), [GATA4 c.912+5G>A](/variant/gata4-c-912-plus-5g-a), [GATA4 c.913-5T>G](/variant/gata4-c-913-minus-5t-g).

### 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 2735120). 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.*