Is NPHP4 p.Arg286Cys (c.856C>T) pathogenic?

NPHP4 p.Arg286Cys (c.856C>T) is classified Uncertain significance in NPHP4 (ClinVar, Multiple submitters, 2 submitters; last evaluated 2022-07-05). AlphaMissense: likely pathogenic (0.5737); Ultra-rare (popmax 0.0135%, eas); Associated with nephronophthisis.

What condition is associated with NPHP4 p.Arg286Cys (c.856C>T)?

NPHP4 p.Arg286Cys (c.856C>T) is associated with nephronophthisis (ClinVar).

How common is NPHP4 p.Arg286Cys (c.856C>T) in the general population?

NPHP4 p.Arg286Cys (c.856C>T) is ultra-rare (popmax 0.0135%, eas) (gnomAD).

How is Nephronophthisis inherited?

Typically Autosomal recessive (Orphanet). A genetic counselor can assess individual risk for a family.

What do computational predictors say about NPHP4 p.Arg286Cys (c.856C>T)?

AlphaMissense predicts likely pathogenic (score 0.5737) — an in-silico prediction, not a clinical call.

NPHP4 p.Arg286Cys

c.856C>T · rs189511182 · VCV498135

Uncertain significance Multiple submitters

Classification

Uncertain significance

ClinVar

Review

Multiple submitters ★★☆☆

ClinVar · 2 submitters

AlphaMissense

likely pathogenic

0.5737 · ACMG-weighted

gnomAD v4.1

Rare

ultra-rare (popmax 0.0135%, eas)

Missense predictors

3/3 damaging

AlphaMissense, REVEL, SaProt

Conditions

nephronophthisis

Computational evidence

Protein change
AlphaMissense	0.5737	likely pathogenic
REVEL	0.727	pathogenic-leaning
SaProt	LLR -13.31	damaging
⇒ AlphaMissense, REVEL and SaProt all call this damaging.
Splicing
SpliceAI	—	not assessed · no allele here is in the release
Constraint at this position
Conservation	phyloP 8.4	GERP 2.1, phastCons 1
Regional constraint	o/e 1.02	unconstrained · MANE · 123 kb · p 0.49 · regional, not allelic
Overall
CADD	31.0	PHRED · no single calibrated threshold — expert panels disagree

ClinVar classifies this uncertain; the computational predictors unanimously lean damaging — a triage signal, not a reclassification

AlphaMissense carries the ACMG weight for missense; REVEL and SaProt are independent agreement signals.

Population frequency

gnomAD v4.1 · exomes + genomes

Grpmax group 0.0135% East Asian · 6/44,436 alleles

Filtering AF 0.00583% ClinGen BA1/BS1 input FAF95, joint · FAF99 0.00507%

Overall 0.0063% 101/1,602,296 alleles · ultra-rare exomes 92/1,449,994 · genomes 9/152,302 · joint denominator

Ancestry group	Frequency	1 in
East Asiangrpmax	0.0135%	7,406
Ashkenazi Jewishnot grpmax-eligible	0.0102%	9,789
European (non-Finnish)	0.00672%	14,887
South Asian	0.0067%	14,931
Admixed American	0.00342%	29,253
Remaining individualsnot grpmax-eligible	0.00321%	31,113
African / African-American	0.00267%	37,434
Finnishnot grpmax-eligible	0.00166%	60,282

Rarity supports pathogenicity (ACMG PM2); frequency above a disease-specific BA1/BS1 threshold argues against it. A variant frequent in one ancestry group can be near-absent in others, so a single global figure can mislead.

Variant & gene context

Gene: NPHP4
Protein: p.Arg286Cys
Coding: c.856C>T
MANE Select: NM_015102
dbSNP: rs189511182
Type: single nucleotide variant
Location: chr1:5948206 (GRCh38)
Gene constraint: LOEUF 1.183 · pLI <0.01 (gnomAD)
Structure: AlphaFold pLDDT 72.44

Full NPHP4 gene report on Sugi Atlas → Gene function, pathways, protein structure, interactions & more

Disease context

nephronophthisis — disease report on Sugi Atlas → Associated genes, phenotypes, clinical trials & treatments

For Nephronophthisis (Orphanet):

Inheritance: Autosomal recessive
Onset: Adolescent, Adult, Antenatal, Childhood, Infancy, Neonatal
Prevalence: 1-9 / 100 000 (Finland)

Similar variants

NPHP4 p.Arg286His Uncertain significance ★★ ⚠ same residue
NPHP4 p.Arg286Leu Uncertain significance ★ ⚠ same residue
NPHP4 c.2304+1G>A Pathogenic ★★ same condition
NPHP4 c.2611+1G>A Pathogenic/Likely pathogenic ★★ same condition
NPHP4 c.2611+1G>C Pathogenic ★★ same condition
NPHP4 c.3644+1G>A Pathogenic/Likely pathogenic ★★ same condition
NPHP4 c.3644+1G>T Pathogenic/Likely pathogenic ★★ same condition
NPHP4 c.518-2A>G Likely pathogenic ★★ same condition

Built on 18 open, versioned datasets — ClinVar, gnomAD, AlphaMissense, REVEL, ClinGen & more — plus Sugi Variant's own cross-source analysis. Source data 2026-01–2026-10, ClinVar 2026-10. Full sources & versions →

Cite Sugi Variant

Gür T. Sugi Variant: A Deterministic Per-Variant Germline Reference from a Knowledge Graph for Humans and AI Agents. 2026. doi:10.5281/zenodo.21509445. This variant: https://sugi.bio/variant/nphp4-p-arg286cys (accessed [today's date]).

Preprint & method: sugi.bio/variant/method Machine-readable: this page as Markdown