# NM_000243.3(MEFV):c.453G>C (p.Arg151Ser)

https://sugi.bio/variant/mefv-p-arg151ser

## Summary

**MEFV p.Arg151Ser (c.453G>C)** is classified **Uncertain significance** in MEFV (ClinVar, Multiple submitters, 6 submitters; last evaluated 2025-01-01). AlphaMissense: likely benign (0.2457); Ultra-rare (popmax 0.0386%, sas); Associated with sweet syndrome.

**At a glance:** Uncertain significance · review: Multiple submitters · rsID rs104895185 · 6 submitters · 3 linked conditions · AlphaMissense likely benign · ultra-rare (popmax 0.0386%, sas)

## For patients & families {#patients}

This is a change in the MEFV gene that is currently of uncertain significance — a definitive interpretation has not yet been established, submitted by 6 submitters, and is linked to sweet syndrome.

*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) | Multigenic/multifactorial |
| Age of onset (of this condition) | Adult |
| Clinical trials | 1 registered for this condition — see ClinicalTrials.gov |
| Diagnostic panels | MEFV is a diagnostic-grade gene on 6 Genomics England panels |

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

- Pain — Very frequent (99-80%)
- Erythematous plaque — Very frequent (99-80%)
- Erythematous papule — Very frequent (99-80%)
- Predominantly dermal neutrophilic infiltrate — Very frequent (99-80%)
- Skin nodule — Very frequent (99-80%)
- Abnormal circulating interleukin concentration — Very frequent (99-80%)
- Elevated erythrocyte sedimentation rate — Frequent (79-30%)
- Abnormality of the face — Frequent (79-30%)

**Support & next steps:** [Condition overview & support (NIH GARD)](https://rarediseases.info.nih.gov/diseases/0000521/index) · [Find a genetic counselor (NSGC)](https://findageneticcounselor.nsgc.org/).

## Identity {#identity}

| Field | Value |
| --- | --- |
| Gene | [MEFV](https://sugi.bio/atlas/gene/MEFV/) |
| Protein change (HGVS p.) | p.Arg151Ser |
| Coding change (HGVS c.) | c.453G>C |
| MANE Select transcript | [NM_000243](https://www.ncbi.nlm.nih.gov/nuccore/NM_000243) |
| dbSNP | [rs104895185](https://www.ncbi.nlm.nih.gov/snp/rs104895185/) |
| Variant type | single nucleotide variant |
| Location | chr16:3254615-3254615 (GRCh38) |
| ClinVar | [VCV97524](https://www.ncbi.nlm.nih.gov/clinvar/variation/97524/) |

**All HGVS expressions:** `LRG_190:g.7013G>C`, `LRG_190t1:c.453G>C`, `NC_000016.10:g.3254615C>G`, `NC_000016.9:g.3304615C>G`, `NG_007871.1:g.7013G>C`, `NM_000243.3:c.453G>C`, `NM_001198536.2:c.277+1696G>C`

## Computational & population evidence {#evidence}

**Concordance:** ClinVar classifies this **uncertain**; the computational predictors unanimously lean **tolerated** — a triage signal, not a reclassification.

- AlphaMissense **likely benign** (0.2457)
- REVEL 0.206 (benign-leaning) — agrees with AlphaMissense
- SaProt LLR -5.882 (tolerated) — agrees with AlphaMissense
- → **In-silico consensus:** AlphaMissense, REVEL and SaProt all call this tolerated
- Conservation: phyloP -2.163, GERP -4.07 — fast-evolving / accelerated position
- CADD: **PHRED 1.621**. 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 1.16** across the covering region of the MANE Select transcript (3,243,144–3,256,587), spanning 13,443 bp. Chi-square p 2.1e-07. 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 MEFV (599 scored positions, the nearest 65 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 (gnomAD v4.1): grpmax **0.0386%** (sas) · FAF95 0.0284% · FAF99 0.025% · 35/90,738 in the highest group · 41/1,603,124 alleles overall — ultra-rare (popmax 0.0386%, sas).

| Ancestry group | Allele frequency | 1 in |
| --- | --- | --- |
| South Asian (grpmax) | 0.0386% | 2,593 |
| Remaining individuals (not grpmax-eligible) | 0.00805% | 12,421 |
| European (non-Finnish) | 8.5e-05% | 1,176,887 |

*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}

**MEFV** population constraint: LOEUF 1.147, pLI 2.305e-19, missense-Z -1.6136; ClinGen dosage — haploinsufficiency 0/3, 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):

- **familial Mediterranean fever** — Definitive (SD)

## Protein context {#protein}

Residue **151** lies in the 'disordered' region.

AlphaFold model confidence (whole protein): pLDDT 73.64, 50% of residues very-high.

**11 experimental structure(s)** (PDB): [2MPC](https://www.rcsb.org/structure/2MPC), [2WL1](https://www.rcsb.org/structure/2WL1), [4CG4](https://www.rcsb.org/structure/4CG4), [8C28](https://www.rcsb.org/structure/8C28), [8C2Y](https://www.rcsb.org/structure/8C2Y), [8C30](https://www.rcsb.org/structure/8C30).

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

*Describes the biological roles of MEFV (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:** MEFV's established molecular role includes actin binding. p.Arg151Ser falls in the disordered region. In Reactome, MEFV is annotated in disease pathway(s) including **Purinergic signaling in leishmaniasis infection**.

**Disease mechanism (Reactome):** MEFV loss or alteration is curated in [Purinergic signaling in leishmaniasis infection](https://reactome.org/content/detail/R-HSA-9660826).

### Pathways affected {#pathways}

MEFV participates in **2 Reactome pathways** (⚕ = disease pathway):

| Pathway (Reactome) | Evidence |
| --- | --- |
| ⚕ [Purinergic signaling in leishmaniasis infection](https://reactome.org/content/detail/R-HSA-9660826) | curated |
| [The NLRP3 inflammasome](https://reactome.org/content/detail/R-HSA-844456) | curated |

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

**Molecular function:** actin binding, identical protein binding.

**Biological process:** inflammatory response, positive regulation of autophagy, regulation of interleukin-1 beta production, negative regulation of interleukin-1 beta production, negative regulation of interleukin-12 production, positive regulation of interleukin-1 beta production.

## Clinical significance {#significance}

**Uncertain significance** — review status Multiple submitters *(criteria provided, multiple submitters, no conflicts)*, last evaluated 2025-01-01.

**Submitter consensus:** conflicting (5 Uncertain significance, 1 not provided).

**Submission history:** 6 submissions (2020–2025); classifications have differed over time.

### Submitter classifications {#submitters}

| Submitter | Classification | Review | Method | Date |
| --- | --- | --- | --- | --- |
| Unité médicale des maladies autoinflammatoires, CHRU Montpellier | not provided | no classification provided | not provided |  |
| Natera, Inc. | Uncertain significance | no assertion criteria provided | clinical testing | 2020-03-09 |
| Labcorp Genetics (formerly Invitae), Labcorp | Uncertain significance | criteria provided, single submitter | clinical testing | 2022-02-17 |
| Fulgent Genetics, Fulgent Genetics | Uncertain significance | criteria provided, single submitter | clinical testing | 2024-03-05 |
| Genome-Nilou Lab | Uncertain significance | criteria provided, single submitter | clinical testing | 2021-07-14 |
| CeGaT Center for Human Genetics Tuebingen | Uncertain significance | criteria provided, single submitter | clinical testing | 2025-01-01 |

## Associated conditions {#conditions}

[sweet syndrome](https://sugi.bio/atlas/disease/sweet-syndrome/), [familial Mediterranean fever, autosomal dominant](https://sugi.bio/atlas/disease/familial-mediterranean-fever-autosomal-dominant/), [familial Mediterranean fever](https://sugi.bio/atlas/disease/familial-mediterranean-fever/).

**Reported phenotype names (ClinVar):** Acute febrile neutrophilic dermatosis, Familial Mediterranean fever, Familial Mediterranean fever, autosomal dominant, not provided, Sweet Syndrome, Gomm Button disease, POLYSEROSITIS, FAMILIAL PAROXYSMAL, POLYSEROSITIS, RECURRENT, Periodic peritonitis, Benign paroxysmal peritonitis.

## Similar variants {#similar}

Related MEFV variant pages (same residue, condition, or type): [MEFV p.Arg151Gly](/variant/mefv-p-arg151gly), [MEFV p.Arg151Trp](/variant/mefv-p-arg151trp), [MEFV p.Arg151=](/variant/mefv-p-arg151), [MEFV p.Arg151fs](/variant/mefv-p-arg151fs), [MEFV p.Arg151Thr](/variant/mefv-p-arg151thr), [MEFV p.Arg761His](/variant/mefv-p-arg761his), [MEFV p.Ser242Arg](/variant/mefv-p-ser242arg), [MEFV p.Val726Ala](/variant/mefv-p-val726ala).

### 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 97524). 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.*