Is VDR p.Arg274His (c.821G>A) pathogenic?

VDR p.Arg274His (c.821G>A) is classified Pathogenic/Likely pathogenic in VDR (ClinVar, Multiple submitters, 7 submitters; last evaluated 2026-04-15). AlphaMissense: likely pathogenic (0.8207); Very rare (popmax 0.0011%, sas); Associated with vitamin D-dependent rickets, type 2A.

What condition is associated with VDR p.Arg274His (c.821G>A)?

VDR p.Arg274His (c.821G>A) is associated with vitamin D-dependent rickets, type 2A, rickets (ClinVar).

How common is VDR p.Arg274His (c.821G>A) in the general population?

VDR p.Arg274His (c.821G>A) is very rare (popmax 0.0011%, sas) (gnomAD).

How is Hypocalcemic vitamin D-resistant rickets inherited?

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

What do computational predictors say about VDR p.Arg274His (c.821G>A)?

AlphaMissense predicts likely pathogenic (score 0.8207) — an in-silico prediction, not a clinical call.

VDR p.Arg274His

c.821G>A · rs121909796 · VCV915348

Pathogenic/Likely pathogenic Multiple submitters

Classification

Pathogenic/Likely pathogenic

ClinVar

Review

Multiple submitters ★★☆☆

ClinVar · 7 submitters

AlphaMissense

likely pathogenic

0.8207 · ACMG-weighted

gnomAD v4.1

Rare

very rare (popmax 0.0011%, sas)

Missense predictors

2/3 damaging

AlphaMissense, REVEL, SaProt

Conditions

vitamin D-dependent rickets, type 2A

Computational evidence

Protein change
AlphaMissense	0.8207	likely pathogenic ✓ concordant with ClinVar
REVEL	0.924	moderately pathogenic-leaning
SaProt	LLR -9.49	tolerated
⇒ AlphaMissense and REVEL call this damaging; SaProt does not.
Splicing
SpliceAI	—	not assessed · no allele here is in the release
Constraint at this position
Conservation	phyloP 7.6	GERP 1.7, phastCons 1
Regional constraint	o/e 0.69	unconstrained · MANE · 11 kb · p 6.4e-07 · regional, not allelic
Overall
CADD	33.0	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 0.0011% South Asian · 1/91,076 alleles

Overall 0.000205% 3/1,461,876 alleles · very rare

Ancestry group	Frequency	1 in
Remaining individualsnot grpmax-eligible	0.0016%	62,510
South Asiangrpmax	0.0011%	91,076
European (non-Finnish)	8.47e-05%	1,180,027

Remaining individuals shows a higher raw frequency than the grpmax group above it. gnomAD excludes bottlenecked groups — Finnish, Ashkenazi Jewish, Amish and “Remaining individuals” — from grpmax, because founder effects make their frequencies unrepresentative for filtering. The table is sorted by frequency, so an excluded group can sit above the grpmax row.

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: VDR
Protein: p.Arg274His
Coding: c.821G>A
MANE Select: NM_000376
dbSNP: rs121909796
Type: single nucleotide variant
Location: chr12:47846743 (GRCh38)
Gene constraint: LOEUF 0.714 · pLI 0.01 (gnomAD)
Structure: AlphaFold pLDDT 84.56 · 52 PDB
Residue 274: the nr lbd domain; a binding site; a UniProt-annotated variant site (in vddr2a; loss of calcitriol receptor activity; loss of affinity for calcitriol; no effect on ligand-independent localization to the nucleus); a UniProt-annotated variant site (in vddr2a; loss of calcitriol receptor activity; decreased affinity for calcitriol by a factor of 1000; no effect on interaction with rxra; changed interaction with ncor1; loss of interaction with ncoa1; no effect on sequence-specific dna-binding); an α-helix

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

Disease context

vitamin D-dependent rickets, type 2A — disease report on Sugi Atlas → Associated genes, phenotypes, clinical trials & treatments

Also linked: rickets

For Hypocalcemic vitamin D-resistant rickets (Orphanet):

Inheritance: Autosomal recessive
Onset: Infancy, Neonatal

Similar variants

VDR p.Arg274Cys Uncertain significance ★ ⚠ same residue
VDR p.Arg274Leu Pathogenic same residue
VDR p.Arg274Pro Uncertain significance ★ ⚠ same residue
VDR p.Arg30Ter Pathogenic ★★ same condition
VDR p.Arg343Cys Likely pathogenic ★★ same condition
VDR p.Arg391His Pathogenic ★★ same condition
VDR p.Arg50Ter Pathogenic ★★ same condition
VDR p.Arg73Gln Pathogenic/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/vdr-p-arg274his (accessed [today's date]).

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