Is OTC p.Arg141Pro (c.422G>C) pathogenic?

OTC p.Arg141Pro (c.422G>C) is classified Likely pathogenic in OTC (ClinVar, Single submitter, 2 submitters; last evaluated 2019-05-28). AlphaMissense: likely pathogenic (0.9892); Very rare (popmax 0.00902%, eas); Associated with ornithine carbamoyltransferase deficiency.

What condition is associated with OTC p.Arg141Pro (c.422G>C)?

OTC p.Arg141Pro (c.422G>C) is associated with ornithine carbamoyltransferase deficiency (ClinVar).

How common is OTC p.Arg141Pro (c.422G>C) in the general population?

OTC p.Arg141Pro (c.422G>C) is very rare (popmax 0.00902%, eas) (gnomAD).

How is Ornithine transcarbamylase deficiency inherited?

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

What do computational predictors say about OTC p.Arg141Pro (c.422G>C)?

AlphaMissense predicts likely pathogenic (score 0.9892) — an in-silico prediction, not a clinical call.

OTC p.Arg141Pro

c.422G>C · rs68026851 · VCV97198

Likely pathogenic Single submitter

Classification

Likely pathogenic

ClinVar

Review

Single submitter ★☆☆☆

ClinVar · 2 submitters

AlphaMissense

likely pathogenic

0.9892 · ACMG-weighted

gnomAD v4.1

Rare

very rare (popmax 0.00902%, eas)

Missense predictors

3/3 damaging

AlphaMissense, REVEL, SaProt

Conditions

ornithine carbamoyltransferase deficiency

Computational evidence

Protein change
AlphaMissense	0.9892	likely pathogenic ✓ concordant with ClinVar · top 5% in OTC
REVEL	0.978	strongly pathogenic-leaning
SaProt	LLR -13.41	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 9.8	GERP 2.4, phastCons 1
Regional constraint	o/e 0.75	unconstrained · MANE · 68 kb · p 3.9e-05 · regional, not allelic
Overall
CADD	27.9	PHRED · no single calibrated threshold — expert panels disagree

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

Population frequency

gnomAD v4.1 · exomes + genomes

Grpmax group 0.00902% East Asian · 3/33,243 alleles

Filtering AF 0.00239% ClinGen BA1/BS1 input FAF95, joint · FAF99 0.00126%

Overall 0.000417% 5/1,199,189 alleles · very rare exomes 5/1,086,053 · genomes 0/113,136 · joint denominator

Ancestry group	Frequency	1 in
East Asiangrpmax	0.00902%	11,081
Admixed American	0.0022%	45,481
European (non-Finnish)	0.000113%	886,156

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: OTC
Protein: p.Arg141Pro
Coding: c.422G>C
MANE Select: NM_000531
dbSNP: rs68026851
Type: single nucleotide variant
Location: chrX:38401310 (GRCh38)
Structure: AlphaFold pLDDT 91.94 · 4 PDB
Residue 141: a β-strand; a binding site; a UniProt-annotated variant site (in otcd); a UniProt-annotated variant site (in otcd; most common variant; loss of ornithine carbamoyltransferase activity; activity is 100-fold lower)

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

Disease context

ornithine carbamoyltransferase deficiency — disease report on Sugi Atlas → Associated genes, phenotypes, clinical trials & treatments

For Ornithine transcarbamylase deficiency (Orphanet):

Inheritance: X-linked recessive
Onset: All ages
Prevalence: 1-9 / 100 000 (Europe)

Similar variants

OTC p.Arg141Gln Pathogenic ★★ same residue
OTC p.Arg141Ter Pathogenic ★ same residue
OTC p.Arg141= Likely benign ★ same residue
OTC p.Arg141Gly Pathogenic ★ same residue
OTC c.298+2T>G Pathogenic ★★ same condition
OTC c.299-1G>A Likely pathogenic ★★ same condition
OTC c.386+1G>A Pathogenic ★★ same condition
OTC c.540+1G>A 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/otc-p-arg141pro (accessed [today's date]).

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