# NM_000527.5(LDLR):c.859G>T (p.Gly287Cys)

https://sugi.bio/variant/ldlr-p-gly287cys

## Summary

**LDLR p.Gly287Cys (c.859G>T)** is classified **Pathogenic** in LDLR (ClinVar, Expert panel, 9 submitters; last evaluated 2023-03-24). AlphaMissense: likely pathogenic (0.954); Absent from gnomAD v4.1; Associated with hypercholesterolemia, familial, 1.

**At a glance:** Pathogenic · review: Expert panel · rsID rs375495026 · 9 submitters · 2 linked conditions · AlphaMissense likely pathogenic · absent from gnomAD v4.1

## For patients & families {#patients}

This is a change in the LDLR gene that is considered disease-causing, submitted by 9 submitters, and is linked to hypercholesterolemia, familial, 1.

*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.*

|  |  |
| --- | --- |
| Clinical trials | 28 registered for this condition — see ClinicalTrials.gov |

**Support & next steps:** [Condition overview & support (NIH GARD)](https://rarediseases.info.nih.gov/diseases/0024574/index) · [Find a genetic counselor (NSGC)](https://findageneticcounselor.nsgc.org/).

## Identity {#identity}

| Field | Value |
| --- | --- |
| Gene | [LDLR](https://sugi.bio/atlas/gene/LDLR/) |
| Protein change (HGVS p.) | p.Gly287Cys |
| Coding change (HGVS c.) | c.859G>T |
| MANE Select transcript | [NM_000527](https://www.ncbi.nlm.nih.gov/nuccore/NM_000527) |
| dbSNP | [rs375495026](https://www.ncbi.nlm.nih.gov/snp/rs375495026/) |
| Variant type | single nucleotide variant |
| Location | chr19:11107433-11107433 (GRCh38) |
| ClinVar | [VCV251489](https://www.ncbi.nlm.nih.gov/clinvar/variation/251489/) |

**All HGVS expressions:** `LRG_274:g.23053G>T`, `LRG_274t1:c.859G>T`, `NC_000019.10:g.11107433G>T`, `NC_000019.9:g.11218109G>T`, `NG_009060.1:g.23053G>T`, `NM_000527.5:c.859G>T`, `NM_001195798.2:c.859G>T`, `NM_001195799.2:c.736G>T`, `NM_001195800.2:c.355G>T`, `NM_001195803.2:c.478G>T`

## Computational & population evidence {#evidence}

**Concordance:** 1 independent predictor **concordant** with the ClinVar classification.

- AlphaMissense **likely pathogenic** (0.954) — concordant with the pathogenic call
- REVEL 0.928 (moderately pathogenic-leaning) — agrees with AlphaMissense
- SaProt LLR -14.443 (damaging) — agrees with AlphaMissense
- → **In-silico consensus:** AlphaMissense, REVEL and SaProt all call this damaging
- Conservation: phyloP 9.614, GERP 1.83, phastCons 1 — highly conserved (agrees)
- CADD: **PHRED 27.7**. 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 1.00** across the covering region of the MANE Select transcript (11,089,549–11,131,313), spanning 41,764 bp. Chi-square p 0.91. 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 LDLR (717 scored positions, the nearest 42 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: **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}

**LDLR** population constraint: LOEUF 1.091, pLI 1.2477e-30, missense-Z 0.60522; 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):

- **hypercholesterolemia, familial, 1** — Definitive (SD)

## Protein context {#protein}

Residue **287** lies in the ldl-receptor class a 7 domain.

AlphaFold model confidence (whole protein): pLDDT 75.81, 29% of residues very-high.

**36 experimental structure(s)** (PDB): [1AJJ](https://www.rcsb.org/structure/1AJJ), [1D2J](https://www.rcsb.org/structure/1D2J), [1F5Y](https://www.rcsb.org/structure/1F5Y), [1F8Z](https://www.rcsb.org/structure/1F8Z), [1HJ7](https://www.rcsb.org/structure/1HJ7), [1HZ8](https://www.rcsb.org/structure/1HZ8) — incl. mutant structure 2W2N.

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

*Describes the biological roles of LDLR (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:** LDLR's established molecular role includes protease binding. p.Gly287Cys falls in the ldl-receptor class a 7 domain.


### Pathways affected {#pathways}

LDLR participates in **5 Reactome pathways** (⚕ = disease pathway):

| Pathway (Reactome) | Evidence |
| --- | --- |
| [Cargo recognition for clathrin-mediated endocytosis](https://reactome.org/content/detail/R-HSA-8856825) | curated |
| [Clathrin-mediated endocytosis](https://reactome.org/content/detail/R-HSA-8856828) | curated |
| [LDL clearance](https://reactome.org/content/detail/R-HSA-8964038) | curated |
| [Chylomicron clearance](https://reactome.org/content/detail/R-HSA-8964026) | electronic |
| [Retinoid metabolism and transport](https://reactome.org/content/detail/R-HSA-975634) | electronic |

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

**Molecular function:** protease binding, low-density lipoprotein particle receptor activity, low-density lipoprotein particle binding, very-low-density lipoprotein particle receptor activity, identical protein binding, molecular adaptor activity.

**Biological process:** negative regulation of receptor recycling, long-term memory, negative regulation of low-density lipoprotein particle clearance, intestinal cholesterol absorption, cholesterol transport, low-density lipoprotein particle clearance.

## Clinical significance {#significance}

**Pathogenic** — review status Expert panel *(reviewed by expert panel)*, last evaluated 2023-03-24.

**Submitter consensus:** conflicting (6 Pathogenic, 3 Likely pathogenic).

**Submission history:** 8 submissions (2016–2025); classifications have differed over time.

**ClinGen expert panel:** Pathogenic — Familial Hypercholesterolemia VCEP (hypercholesterolemia, familial). *Expert-panel curated (ACMG); the highest ClinVar review tier.*
**Applied ACMG criteria (met):** `PM2`, `PP1_Strong`, `PS4`, `PP3`, `PP4`.
*Considered but not met:* `PS3`, `PM3`, `PM5`.
Inheritance: Semidominant inheritance.

> **Curation rationale (ClinGen, verbatim):** The NM_000527.5 (LDLR):c.859G>T (p.Gly287Cys) variant is classified as Pathogenic for Familial Hypercholesterolemia by applying evidence codes (PM2, PP3, PP4, PS4, PP1_Strong) as defined by the ClinGen Familial Hypercholesterolemia Expert Panel LDLR-specific variant curation guidelines (https://doi.org/10.1016/j.gim.2021.09.012).  The supporting evidence is as follows: PM2: This variant is absent from gnomAD (gnomAD v2.1.1). PP3: REVEL=0.928. PP4: Variant meets PM2 and is identified in ˃1 index cases who fulfil criteria for FH after alternative causes of high cholesterol were excluded. PS4: Variant meets PM2 and is identified in at least 11 unrelated index cases fulfil DLCN ≥ 6 reported in ClinGen VCI, PubMed and ClinVar: 7 cases reported in VCI, 6 of them from Service de Biochimie et de Biologie Moléculaire, Hospices Civils de Lyon, France, and 1 from Research Lab of Molecular Genetics of Lipid Metabolism-Prof. M.Arca; 3 cases reported from PubMed and at least 1 additional case reported in ClinVar from U4M-Lille University, France. From PubMed, 1 case reported In PMID 12730724 by El Messal et al, 2003, from Laboratoire de Biochimie, Faculte des Sciences Ain Chock, Casablanca, Morocco; 1 case reported in PMID 17196209 by Campagna et al, 2008, from University of Rome, Italy; 1 case reported in PMID 22669020 by El Aziz et al, 2012, from Ibn Rochd University Hospital, Casablanca, Morocco. PP1_Strong: Variant segregates with FH phenotype in 6 informative meiosis from 6 families reported from different laboratories: 4 affected relatives from 4 families tested positive for the variant, reported in VCI from Service de Biochimie et de Biologie Moléculaire, Hospices Civils de Lyon, Lyon, France; 2 affected relative is positive for the variant, reported in PMID 17196209 by Campagna et al, 2008, from University of Rome, Italy, and in PMID 22669020 by El Aziz et al, 2012, from Ibn Rochd University Hospital, Casablanca, Morocco.   PS3 not met: Functional data is not available. PM5 not met: One other variant at same codon: NM_000527.5(LDLR):c.859G>A (p.Gly287Ser), ClinVar ID 161280, is classified as Uncertain significance by these guidelines, therefore PM5 is not met. PM3 not met: One case reported in VCI from Service de Biochimie et de Biologie Moléculaire, Hospices Civils de Lyon, Lyon, France. The subject is homozygous for the variant, however patient’s LDL-C is 5.32 mmol/l and no indication of lipid lowering medication. In PMID 22669020, two brothers of 21 and 18 years old are homozygous for the variant with untreated LDL-C at 12.8 mmol/l and 10.1 mmol/l respectively, which are just below 13 mmol/l threshold for HoFH phenotype. Additionally, one of 2 brothers (21 yrs with LDL-C 12.8 mmol/l) also had Type 1 diabetes.
*Source: https://cspec.clinicalgenome.org/cspec/ui/svi/affiliation/50004 · approved 2023-03-24 · [ClinGen Evidence Repository](https://erepo.genome.network/evrepo/ui/classification/a146f460-92d1-4395-9894-8c05b643abb6).*
*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 |
| --- | --- | --- | --- | --- |
| LDLR-LOVD, British Heart Foundation | Likely pathogenic | criteria provided, single submitter | literature only | 2016-03-25 |
| Centre de Génétique Moléculaire et Chromosomique, Unité de génétique de l'Obésité et des Dyslipidémies, APHP, GH Hôpitaux Universitaires Pitié-Salpêtrière / Charles-Foix | Pathogenic | criteria provided, single submitter | clinical testing | 2016-12-16 |
| Laboratorium voor Moleculaire Diagnostiek Experimentele Vasculaire Geneeskunde, Academisch Medisch Centrum | Pathogenic | no assertion criteria provided | research |  |
| U4M - Lille University & CHRU Lille, Université de Lille - CHRU de Lille | Pathogenic | criteria provided, single submitter | clinical testing | 2017-03-30 |
| Laboratory of molecular diagnosis of dyslipidemias, Università egli studi di Napoli Federico II | Likely pathogenic | criteria provided, single submitter | clinical testing | 2021-05-24 |
| Natera, Inc. | Likely pathogenic | no assertion criteria provided | clinical testing | 2020-08-21 |
| ClinGen Familial Hypercholesterolemia Variant Curation Expert Panel | Pathogenic | reviewed by expert panel | curation | 2023-03-24 |
| Women's Health and Genetics/Laboratory Corporation of America, LabCorp | Pathogenic | criteria provided, single submitter | clinical testing | 2025-05-02 |
| Labcorp Genetics (formerly Invitae), Labcorp | Pathogenic | criteria provided, single submitter | clinical testing | 2025-09-18 |

## Associated conditions {#conditions}

[hypercholesterolemia, familial, 1](https://sugi.bio/atlas/disease/hypercholesterolemia-familial-1/), [familial hypercholesterolemia](https://sugi.bio/atlas/disease/familial-hypercholesterolemia/).

**Reported phenotype names (ClinVar):** Hypercholesterolemia, familial, 1, Familial hypercholesterolemia, Familial hypercholesterolemias, Familial hypercholesterolaemia, LDL RECEPTOR DISORDER, Hyperlipoproteinemia Type IIa, HYPER-LOW-DENSITY-LIPOPROTEINEMIA, HYPERCHOLESTEROLEMIC XANTHOMATOSIS, FAMILIAL, Fredrickson type IIa hyperlipoproteinemia, Hyperlipoproteinemia type 2.

## Same-residue context {#hotspot}

Residue **287** carries **1 other pathogenic ClinVar variant** — a recurrently-mutated position: [LDLR p.Gly287fs](/variant/ldlr-p-gly287fs). *Positional co-occurrence of independent ClinVar records, not functional proof.*

## Similar variants {#similar}

Related LDLR variant pages (same residue, condition, or type): [LDLR p.Gly287Ser](/variant/ldlr-p-gly287ser), [LDLR p.Gly287=](/variant/ldlr-p-gly287), [LDLR p.Gly287fs](/variant/ldlr-p-gly287fs), [LDLR c.1186+5G>A](/variant/ldlr-c-1186-plus-5g-a), [LDLR c.1359-1G>A](/variant/ldlr-c-1359-minus-1g-a), [LDLR c.1359-5C>G](/variant/ldlr-c-1359-minus-5c-g), [LDLR c.1705+2T>C](/variant/ldlr-c-1705-plus-2t-c), [LDLR c.190+4A>T](/variant/ldlr-c-190-plus-4a-t).

### 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 251489). 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.*