# NM_000287.4(PEX6):c.781C>T (p.Pro261Ser)

https://sugi.bio/variant/pex6-p-pro261ser

## Summary

**PEX6 p.Pro261Ser (c.781C>T)** is classified **Uncertain significance** in PEX6 (ClinVar, Multiple submitters, 5 submitters; last evaluated 2025-07-01). AlphaMissense: likely benign (0.0664); Very rare (popmax 0.00873%, nfe); Associated with peroxisome biogenesis disorder.

**At a glance:** Uncertain significance · review: Multiple submitters · rsID rs758866060 · 5 submitters · 2 linked conditions · AlphaMissense likely benign · very rare (popmax 0.00873%, nfe)

## For patients & families {#patients}

This is a change in the PEX6 gene that is currently of uncertain significance — a definitive interpretation has not yet been established, submitted by 5 submitters, and is linked to peroxisome biogenesis disorder.

*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 | 5 registered for this condition — see ClinicalTrials.gov |

**Support & next steps:** [Condition overview & support (NIH GARD)](https://rarediseases.info.nih.gov/diseases/0011890/index) · [Find a genetic counselor (NSGC)](https://findageneticcounselor.nsgc.org/).

## Identity {#identity}

| Field | Value |
| --- | --- |
| Gene | [PEX6](https://sugi.bio/atlas/gene/PEX6/) |
| Protein change (HGVS p.) | p.Pro261Ser |
| Coding change (HGVS c.) | c.781C>T |
| MANE Select transcript | [NM_000287](https://www.ncbi.nlm.nih.gov/nuccore/NM_000287) |
| dbSNP | [rs758866060](https://www.ncbi.nlm.nih.gov/snp/rs758866060/) |
| Variant type | single nucleotide variant |
| Location | chr6:42978370-42978370 (GRCh38) |
| ClinVar | [VCV593848](https://www.ncbi.nlm.nih.gov/clinvar/variation/593848/) |

**All HGVS expressions:** `NC_000006.11:g.42946108G>A`, `NC_000006.12:g.42978370G>A`, `NG_008370.1:g.5874C>T`, `NM_000287.4:c.781C>T`, `NM_001316313.2:c.618+163C>T`, `NR_133009.2:n.812C>T`

## Computational & population evidence {#evidence}

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

- AlphaMissense **likely benign** (0.0664)
- REVEL 0.066 (moderately benign-leaning) — agrees with AlphaMissense
- SaProt LLR -6.057 (tolerated) — agrees with AlphaMissense
- → **In-silico consensus:** AlphaMissense, REVEL and SaProt all call this tolerated
- Conservation: phyloP 5.311, GERP 0.465, phastCons 1 — highly conserved (differs from AlphaMissense)
- CADD: **PHRED 16.94**. 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 0.95** across the covering region of the MANE Select transcript (42,968,928–42,979,150), spanning 10,222 bp. Chi-square p 0.19. Describes the region, not this allele; gnomAD v4.1.1's own constrained determination. *Descriptive; no ACMG code 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 (gnomAD v4.1): grpmax **0.00873%** (nfe) · FAF95 0.00733% · FAF99 0.00684% · 103/1,180,030 in the highest group · 107/1,614,058 alleles overall — very rare (popmax 0.00873%, nfe).

| Ancestry group | Allele frequency | 1 in |
| --- | --- | --- |
| European (non-Finnish) (grpmax) | 0.00873% | 11,457 |
| Remaining individuals (not grpmax-eligible) | 0.0032% | 31,245 |
| African / African-American | 0.00267% | 37,459 |

*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}

**PEX6** population constraint: LOEUF 0.799, pLI 1.1594e-11, missense-Z 1.3471. *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):

- **peroxisome biogenesis disorder** — Definitive (AR)

## Protein context {#protein}


AlphaFold model confidence (whole protein): pLDDT 69.87, 1% of residues very-high.

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

*Describes the biological roles of PEX6 (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:** PEX6's established molecular role includes ATP binding.


### Pathways affected {#pathways}

PEX6 participates in **1 Reactome pathway** (⚕ = disease pathway):

| Pathway (Reactome) | Evidence |
| --- | --- |
| [Peroxisomal protein import](https://reactome.org/content/detail/R-HSA-9033241) | electronic |

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

**Molecular function:** ATP binding, ATP hydrolysis activity, protein-containing complex binding, ubiquitin-modified protein reader activity, protein transporter activity.

**Biological process:** protein targeting to peroxisome, peroxisome organization, protein import into peroxisome matrix, translocation, protein import into peroxisome matrix, receptor recycling, protein unfolding, protein stabilization.

## Clinical significance {#significance}

**Uncertain significance** — review status Multiple submitters *(criteria provided, multiple submitters, no conflicts)*, last evaluated 2025-07-01.

**Submitter consensus:** unanimous (5/5 Uncertain significance).

**Submission history:** 5 submissions (2017–2025); classifications have been stable.

### Submitter classifications {#submitters}

| Submitter | Classification | Review | Method | Date |
| --- | --- | --- | --- | --- |
| Natera, Inc. | Uncertain significance | no assertion criteria provided | clinical testing | 2019-10-28 |
| Labcorp Genetics (formerly Invitae), Labcorp | Uncertain significance | criteria provided, single submitter | clinical testing | 2022-10-08 |
| PreventionGenetics, part of Exact Sciences | Uncertain significance | no assertion criteria provided | clinical testing | 2024-06-10 |
| Eurofins Ntd Llc (ga) | Uncertain significance | criteria provided, single submitter | clinical testing | 2017-09-13 |
| Ambry Genetics | Uncertain significance | criteria provided, single submitter | clinical testing | 2025-07-01 |

## Associated conditions {#conditions}

[peroxisome biogenesis disorder](https://sugi.bio/atlas/disease/peroxisome-biogenesis-disorder/), [Zellweger spectrum disorders](https://sugi.bio/atlas/disease/zellweger-spectrum-disorders/).

**Reported phenotype names (ClinVar):** Peroxisome biogenesis disorder, not provided, Zellweger spectrum disorders, PEX6-related disorder, Inborn genetic diseases, PEX6-related condition, PEX6-related disorders, Zellweger Spectrum Disorder, Zellweger Spectrum, Zellweger Spectrum Disorder (ZSD).

## Similar variants {#similar}

Related PEX6 variant pages (same residue, condition, or type): [PEX6 p.Pro261Leu](/variant/pex6-p-pro261leu), [PEX6 p.Pro261=](/variant/pex6-p-pro261), [PEX6 p.Pro261dup](/variant/pex6-p-pro261dup), [PEX6 c.1130+1G>A](/variant/pex6-c-1130-plus-1g-a), [PEX6 c.1233+1G>A](/variant/pex6-c-1233-plus-1g-a), [PEX6 c.1688+1G>A](/variant/pex6-c-1688-plus-1g-a), [PEX6 c.1689-1G>A](/variant/pex6-c-1689-minus-1g-a), [PEX6 c.1885-1G>A](/variant/pex6-c-1885-minus-1g-a).

### 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 593848). 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.*