# NM_002382.5(MAX):c.216G>A (p.Gln72=)

https://sugi.bio/variant/max-p-gln72

## Summary

**MAX p.Gln72= (c.216G>A)** is classified **Likely benign** in MAX (ClinVar, Single submitter, 1 submitter; last evaluated 2021-09-03). Absent from gnomAD v4.1; Associated with hereditary pheochromocytoma-paraganglioma.

**At a glance:** Likely benign · review: Single submitter · rsID rs2139754832 · 1 submitter · 1 linked condition · absent from gnomAD v4.1

## For patients & families {#patients}

This is a change in the MAX gene that is classified as likely benign — not considered disease-causing, submitted by 1 submitter, and is linked to hereditary pheochromocytoma-paraganglioma.

*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) | Autosomal dominant |
| Age of onset (of this condition) | Childhood |
| Prevalence | 1-9 / 1 000 000 (Worldwide) |
| Clinical trials | 1 registered for this condition — see ClinicalTrials.gov |
| Diagnostic panels | MAX is a diagnostic-grade gene on 11 Genomics England panels |

**Commonly reported features of Hereditary pheochromocytoma-paraganglioma** (across patients with this condition; presentation varies — frequencies from Orphanet):

- Paraganglioma — Very frequent (99-80%)
- Extraadrenal pheochromocytoma — Very frequent (99-80%)
- Adrenal pheochromocytoma — Very frequent (99-80%)
- Proteinuria — Frequent (79-30%)
- Glomerulosclerosis — Frequent (79-30%)
- Episodic paroxysmal anxiety — Frequent (79-30%)
- Episodic hyperhidrosis — Frequent (79-30%)
- Hypertensive retinopathy — Frequent (79-30%)

**Support & next steps:** [Condition overview & support (NIH GARD)](https://rarediseases.info.nih.gov/diseases/0011984/index) · [Find a genetic counselor (NSGC)](https://findageneticcounselor.nsgc.org/).

## Identity {#identity}

| Field | Value |
| --- | --- |
| Gene | [MAX](https://sugi.bio/atlas/gene/MAX/) |
| Protein change (HGVS p.) | p.Gln72= |
| Coding change (HGVS c.) | c.216G>A |
| MANE Select transcript | [NM_002382](https://www.ncbi.nlm.nih.gov/nuccore/NM_002382) |
| dbSNP | [rs2139754832](https://www.ncbi.nlm.nih.gov/snp/rs2139754832/) |
| Variant type | single nucleotide variant |
| Location | chr14:65077992-65077992 (GRCh38) |
| ClinVar | [VCV1672227](https://www.ncbi.nlm.nih.gov/clinvar/variation/1672227/) |

**All HGVS expressions:** `LRG_530:g.29518G>A`, `LRG_530t1:c.216G>A`, `NC_000014.8:g.65544710C>T`, `NC_000014.9:g.65077992C>T`, `NG_029830.1:g.29518G>A`, `NG_129272.1:g.690C>T`, `NM_001271069.2:c.144+15716G>A`, `NM_001320415.2:c.-59G>A`, `NM_001407094.1:c.216G>A`, `NM_001407095.1:c.189G>A`, `NM_001407096.1:c.216G>A`, `NM_001407097.1:c.216G>A`, `NM_001407098.1:c.108G>A`, `NM_001407099.1:c.189G>A`, `NM_001407100.1:c.189G>A`, `NM_001407101.1:c.189G>A`, `NM_001407102.1:c.189G>A`, `NM_001407103.1:c.216G>A`, `NM_001407104.1:c.216G>A`, `NM_001407105.1:c.-59G>A`, `NM_001407106.1:c.-59G>A`, `NM_001407107.1:c.-59G>A`, `NM_001407108.1:c.189G>A`, `NM_001407109.1:c.189G>A`, `NM_001407110.1:c.189G>A`, `NM_001407111.1:c.-152G>A`, `NM_001407112.1:c.-152G>A`, `NM_002382.5:c.216G>A`, `NM_145112.3:c.189G>A`, `NM_145113.3:c.216G>A`, `NM_197957.4:c.171+15716G>A`, `NR_073137.2:n.340G>A`, `NR_176275.1:n.358G>A`, `NR_176278.1:n.189G>A`, `NR_176279.1:n.292G>A`, `NR_176280.1:n.358G>A`, `NR_176281.1:n.358G>A`, `NR_176282.1:n.162G>A`

## 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 2.786, GERP 0.963, phastCons 1 — highly conserved position (PP3-type support)
- CADD: **PHRED 9.71**. 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: **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}

**MAX** population constraint: LOEUF 0.288, pLI 0.99819, missense-Z 1.8678; 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):

- **hereditary pheochromocytoma-paraganglioma** — Definitive (AD)

## Protein context {#protein}

Residue **72** lies in the bhlh domain; a UniProt-annotated variant site (in pcc; does not repress myc transcriptional activity); an α-helix.

AlphaFold model confidence (whole protein): pLDDT 82.07, 55% of residues very-high.

**12 experimental structure(s)** (PDB): [1AN2](https://www.rcsb.org/structure/1AN2), [1HLO](https://www.rcsb.org/structure/1HLO), [1NKP](https://www.rcsb.org/structure/1NKP), [1NLW](https://www.rcsb.org/structure/1NLW), [1R05](https://www.rcsb.org/structure/1R05), [5EYO](https://www.rcsb.org/structure/5EYO).

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

*Describes the biological roles of MAX (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:** MAX's established molecular role includes DNA-binding transcription factor activity, RNA polymerase II-specific. p.Gln72= falls in the bhlh domain.


### Pathways affected {#pathways}

MAX participates in **4 Reactome pathways** (⚕ = disease pathway):

| Pathway (Reactome) | Evidence |
| --- | --- |
| [Cyclin A:Cdk2-associated events at S phase entry](https://reactome.org/content/detail/R-HSA-69656) | curated |
| [Cyclin E associated events during G1/S transition ](https://reactome.org/content/detail/R-HSA-69202) | curated |
| [Transcription of E2F targets under negative control by DREAM complex](https://reactome.org/content/detail/R-HSA-1362277) | curated |
| [Transcriptional Regulation by E2F6](https://reactome.org/content/detail/R-HSA-8953750) | curated |

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

**Molecular function:** DNA-binding transcription factor activity, RNA polymerase II-specific, DNA-binding transcription repressor activity, RNA polymerase II-specific, DNA binding, identical protein binding, E-box binding, DNA-binding transcription factor binding.

**Biological process:** negative regulation of transcription by RNA polymerase II, regulation of transcription by RNA polymerase II, positive regulation of DNA-templated transcription.

## Clinical significance {#significance}

**Likely benign** — review status Single submitter *(criteria provided, single submitter)*, last evaluated 2021-09-03.

**Submitter consensus:** unanimous (1/1 Likely benign).

### Submitter classifications {#submitters}

| Submitter | Classification | Review | Method | Date |
| --- | --- | --- | --- | --- |
| Labcorp Genetics (formerly Invitae), Labcorp | Likely benign | criteria provided, single submitter | clinical testing | 2021-09-03 |

## Associated conditions {#conditions}

[hereditary pheochromocytoma-paraganglioma](https://sugi.bio/atlas/disease/hereditary-pheochromocytoma-paraganglioma/).

**Reported phenotype names (ClinVar):** Hereditary pheochromocytoma and paraganglioma, Hereditary pheochromocytoma-paraganglioma, Hereditary paragangliomas and pheochromocytomas, Hereditary Paraganglioma-Pheochromocytoma Syndromes.

## Similar variants {#similar}

Related MAX variant pages (same residue, condition, or type): [MAX p.Gln72His](/variant/max-p-gln72his), [MAX c.295+1G>A](/variant/max-c-295-plus-1g-a), [MAX c.295+1G>T](/variant/max-c-295-plus-1g-t), [MAX p.Ala67Asp](/variant/max-p-ala67asp), [MAX p.Arg33Ter](/variant/max-p-arg33ter), [MAX p.Arg75Ter](/variant/max-p-arg75ter), [MAX p.Gln19Ter](/variant/max-p-gln19ter), [MAX p.Gln91Ter](/variant/max-p-gln91ter).

### 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 1672227). 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.*