# NM_014000.3(VCL):c.135C>A (p.Ala45=)

https://sugi.bio/variant/vcl-p-ala45

## Summary

**VCL p.Ala45= (c.135C>A)** is classified **Likely benign** in VCL (ClinVar, Single submitter, 1 submitter; last evaluated 2024-04-17). Absent from gnomAD v4.1; Associated with dilated cardiomyopathy 1W.

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

## For patients & families {#patients}

This is a change in the VCL gene that is classified as likely benign — not considered disease-causing, submitted by 1 submitter, and is linked to dilated cardiomyopathy 1W.

*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, Autosomal recessive, Mitochondrial inheritance |
| Age of onset (of this condition) | All ages |
| Prevalence | 1-9 / 100 000 (Europe) |
| Diagnostic panels | VCL is a diagnostic-grade gene on 5 Genomics England panels |

**Commonly reported features of Familial isolated dilated cardiomyopathy** (across patients with this condition; presentation varies — frequencies from Orphanet):

- Dilated cardiomyopathy — Very frequent (99-80%)
- Left ventricular systolic dysfunction — Very frequent (99-80%)
- Edema — Frequent (79-30%)
- Congestive heart failure — Frequent (79-30%)
- Exertional dyspnea — Frequent (79-30%)
- Arrhythmia — Frequent (79-30%)
- Fatigue — Frequent (79-30%)
- Orthopnea — Frequent (79-30%)

**Support & next steps:** [Condition overview & support (NIH GARD)](https://rarediseases.info.nih.gov/diseases/0015515/index) · [Find a genetic counselor (NSGC)](https://findageneticcounselor.nsgc.org/).

## Identity {#identity}

| Field | Value |
| --- | --- |
| Gene | [VCL](https://sugi.bio/atlas/gene/VCL/) |
| Protein change (HGVS p.) | p.Ala45= |
| Coding change (HGVS c.) | c.135C>A |
| MANE Select transcript | [NM_014000](https://www.ncbi.nlm.nih.gov/nuccore/NM_014000) |
| Variant type | single nucleotide variant |
| Location | chr10:73998342-73998342 (GRCh38) |
| ClinVar | [VCV3689902](https://www.ncbi.nlm.nih.gov/clinvar/variation/3689902/) |

**All HGVS expressions:** `LRG_383:g.5229C>A`, `LRG_383t1:c.135C>A`, `NC_000010.10:g.75758100C>A`, `NC_000010.11:g.73998342C>A`, `NG_008868.1:g.5229C>A`, `NG_119849.1:g.26C>A`, `NG_119849.2:g.28C>A`, `NG_183555.1:g.298C>A`, `NM_003373.4:c.135C>A`, `NM_014000.3:c.135C>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 -2.008, GERP -1.7 — fast-evolving / accelerated position
- CADD: **PHRED 12.03**. 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}

**VCL** population constraint: LOEUF 0.461, pLI 0.99858, missense-Z 4.2503. *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):

- **hypertrophic cardiomyopathy** — Disputed (AD)
- **dilated cardiomyopathy 1W** — Strong (AD)
- **congenital heart disease** — No Known Disease Relationship (UD)

## Protein context {#protein}

Residue **45** lies in the 'n-terminal globular head' region; an α-helix.

AlphaFold model confidence (whole protein): pLDDT 86.69, 63% of residues very-high.

**37 experimental structure(s)** (PDB): [1RKC](https://www.rcsb.org/structure/1RKC), [1RKE](https://www.rcsb.org/structure/1RKE), [1SYQ](https://www.rcsb.org/structure/1SYQ), [1TR2](https://www.rcsb.org/structure/1TR2), [1YDI](https://www.rcsb.org/structure/1YDI), [2GWW](https://www.rcsb.org/structure/2GWW) — incl. mutant structure 3VF0.

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

*Describes the biological roles of VCL (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:** VCL's established molecular role includes dystroglycan binding. p.Ala45= falls in the n-terminal globular head region. In Reactome, VCL is annotated in disease pathway(s) including **Paradoxical activation of RAF signaling by kinase inactive BRAF**, **Signaling by ALK fusions and activated point mutants**.

**Disease mechanism (Reactome):** VCL loss or alteration is curated in [Paradoxical activation of RAF signaling by kinase inactive BRAF](https://reactome.org/content/detail/R-HSA-6802955), [Signaling by ALK fusions and activated point mutants](https://reactome.org/content/detail/R-HSA-9725370), [Signaling by BRAF and RAF1 fusions](https://reactome.org/content/detail/R-HSA-6802952).

### Pathways affected {#pathways}

VCL participates in **15 Reactome pathways** (⚕ = disease pathway):

| Pathway (Reactome) | Evidence |
| --- | --- |
| ⚕ [Paradoxical activation of RAF signaling by kinase inactive BRAF](https://reactome.org/content/detail/R-HSA-6802955) | curated |
| ⚕ [Signaling by ALK fusions and activated point mutants](https://reactome.org/content/detail/R-HSA-9725370) | curated |
| ⚕ [Signaling by BRAF and RAF1 fusions](https://reactome.org/content/detail/R-HSA-6802952) | curated |
| ⚕ [Signaling by RAF1 mutants](https://reactome.org/content/detail/R-HSA-9656223) | curated |
| ⚕ [Signaling by high-kinase activity BRAF mutants](https://reactome.org/content/detail/R-HSA-6802948) | curated |
| ⚕ [Signaling by moderate kinase activity BRAF mutants](https://reactome.org/content/detail/R-HSA-6802946) | curated |
| ⚕ [Signaling downstream of RAS mutants](https://reactome.org/content/detail/R-HSA-9649948) | curated |
| [High laminar flow shear stress activates signaling by PIEZO1 and PECAM1:CDH5:KDR in endothelial cells](https://reactome.org/content/detail/R-HSA-9856530) | curated |
| [MAP2K and MAPK activation](https://reactome.org/content/detail/R-HSA-5674135) | curated |
| [Neutrophil degranulation](https://reactome.org/content/detail/R-HSA-6798695) | curated |
| [Platelet degranulation ](https://reactome.org/content/detail/R-HSA-114608) | curated |
| [Regulation of CDH1 Function](https://reactome.org/content/detail/R-HSA-9764561) | curated |
| [Smooth Muscle Contraction](https://reactome.org/content/detail/R-HSA-445355) | curated |
| [Turbulent (oscillatory, disturbed) flow shear stress activates signaling by PIEZO1 and integrins in endothelial cells](https://reactome.org/content/detail/R-HSA-9860927) | curated |
| [Activation of STAT3 by cadherin engagement](https://reactome.org/content/detail/R-HSA-9958825) | electronic |

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

**Molecular function:** dystroglycan binding, actin binding, ubiquitin protein ligase binding, alpha-catenin binding, cadherin binding, molecular adaptor activity.

**Biological process:** morphogenesis of an epithelium, adherens junction assembly, protein localization to cell surface, apical junction assembly, regulation of focal adhesion assembly, epithelial cell-cell adhesion.

## Clinical significance {#significance}

**Likely benign** — review status Single submitter *(criteria provided, single submitter)*, last evaluated 2024-04-17.

**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 | 2024-04-17 |

## Associated conditions {#conditions}

[dilated cardiomyopathy 1W](https://sugi.bio/atlas/disease/dilated-cardiomyopathy-1w/).

**Reported phenotype names (ClinVar):** Dilated cardiomyopathy 1W.

## Similar variants {#similar}

Related VCL variant pages (same residue, condition, or type): [VCL c.1176+4G>C](/variant/vcl-c-1176-plus-4g-c), [VCL c.1352+5G>A](/variant/vcl-c-1352-plus-5g-a), [VCL c.1543+1G>T](/variant/vcl-c-1543-plus-1g-t), [VCL c.1543+4A>G](/variant/vcl-c-1543-plus-4a-g), [VCL c.1743+6A>G](/variant/vcl-c-1743-plus-6a-g), [VCL c.1744-1G>T](/variant/vcl-c-1744-minus-1g-t), [VCL c.2022+5G>T](/variant/vcl-c-2022-plus-5g-t), [VCL c.2023-1G>C](/variant/vcl-c-2023-minus-1g-c).

### Data sources & attribution {#sources}

ClinVar (NCBI — public domain, built 2026-10-14); gnomAD v4.1 (Broad Institute, built 2026-10-14); 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 3689902). 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.*