Characteristics predicting reduced penetrance variants in the high-risk cancer predisposition gene TP53

Summary: Disease-causing variants with penetrance that is lower than the average expected for a given gene complicate classification, even when using gene-specific guidelines. For TP53, a gene associated with some of the highest cancer risks, even reduced penetrance disease-predisposition variants r...

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Main Authors: Cristina Fortuno, Marcy E. Richardson, Tina Pesaran, Kelly McGoldrick, Paul A. James, Amanda B. Spurdle
Format: Article
Language:English
Published: Elsevier 2025-10-01
Series:HGG Advances
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Online Access:http://www.sciencedirect.com/science/article/pii/S2666247725000879
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author Cristina Fortuno
Marcy E. Richardson
Tina Pesaran
Kelly McGoldrick
Paul A. James
Amanda B. Spurdle
author_facet Cristina Fortuno
Marcy E. Richardson
Tina Pesaran
Kelly McGoldrick
Paul A. James
Amanda B. Spurdle
author_sort Cristina Fortuno
collection DOAJ
description Summary: Disease-causing variants with penetrance that is lower than the average expected for a given gene complicate classification, even when using gene-specific guidelines. For TP53, a gene associated with some of the highest cancer risks, even reduced penetrance disease-predisposition variants remain clinically actionable. We conducted a review of ClinVar submissions to identify TP53 variants flagged as having reduced penetrance by genetic testing laboratories and analyzed functional, bioinformatic, immunogenicity, frequency, and clinical features of these variants compared with standard pathogenic and benign variants. Our findings show that reported reduced penetrance TP53 variants are more likely to exhibit intermediate functional activity in multiple assays and are predicted as deleterious with bioinformatic tools, though with lower scores than pathogenic variants. These variants also have a higher population frequency than pathogenic variants, and heterozygotes tend to manifest disease later in life, suggesting a need for refined clinical criteria to better capture attenuated Li-Fraumeni syndrome phenotypes. Finally, by applying a random forest prediction model to all TP53 uncertain or conflicting variants in ClinVar, we identified 106 additional variants with potential reduced penetrance.
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spelling doaj-art-410bbac4c62b4b42a58ece80d768f4ac2025-08-20T03:15:42ZengElsevierHGG Advances2666-24772025-10-016410048410.1016/j.xhgg.2025.100484Characteristics predicting reduced penetrance variants in the high-risk cancer predisposition gene TP53Cristina Fortuno0Marcy E. Richardson1Tina Pesaran2Kelly McGoldrick3Paul A. James4Amanda B. Spurdle5Population Health Program, QIMR Berghofer, Herston, QLD 4006, AustraliaAmbry Genetics, Aliso Viejo, CA, USAAmbry Genetics, Aliso Viejo, CA, USAAmbry Genetics, Aliso Viejo, CA, USAParkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, AustraliaPopulation Health Program, QIMR Berghofer, Herston, QLD 4006, Australia; Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia; Corresponding authorSummary: Disease-causing variants with penetrance that is lower than the average expected for a given gene complicate classification, even when using gene-specific guidelines. For TP53, a gene associated with some of the highest cancer risks, even reduced penetrance disease-predisposition variants remain clinically actionable. We conducted a review of ClinVar submissions to identify TP53 variants flagged as having reduced penetrance by genetic testing laboratories and analyzed functional, bioinformatic, immunogenicity, frequency, and clinical features of these variants compared with standard pathogenic and benign variants. Our findings show that reported reduced penetrance TP53 variants are more likely to exhibit intermediate functional activity in multiple assays and are predicted as deleterious with bioinformatic tools, though with lower scores than pathogenic variants. These variants also have a higher population frequency than pathogenic variants, and heterozygotes tend to manifest disease later in life, suggesting a need for refined clinical criteria to better capture attenuated Li-Fraumeni syndrome phenotypes. Finally, by applying a random forest prediction model to all TP53 uncertain or conflicting variants in ClinVar, we identified 106 additional variants with potential reduced penetrance.http://www.sciencedirect.com/science/article/pii/S2666247725000879reduced penetrancepenetranceLi-Fraumeni syndromevariant classificationACMGClinGen
spellingShingle Cristina Fortuno
Marcy E. Richardson
Tina Pesaran
Kelly McGoldrick
Paul A. James
Amanda B. Spurdle
Characteristics predicting reduced penetrance variants in the high-risk cancer predisposition gene TP53
HGG Advances
reduced penetrance
penetrance
Li-Fraumeni syndrome
variant classification
ACMG
ClinGen
title Characteristics predicting reduced penetrance variants in the high-risk cancer predisposition gene TP53
title_full Characteristics predicting reduced penetrance variants in the high-risk cancer predisposition gene TP53
title_fullStr Characteristics predicting reduced penetrance variants in the high-risk cancer predisposition gene TP53
title_full_unstemmed Characteristics predicting reduced penetrance variants in the high-risk cancer predisposition gene TP53
title_short Characteristics predicting reduced penetrance variants in the high-risk cancer predisposition gene TP53
title_sort characteristics predicting reduced penetrance variants in the high risk cancer predisposition gene tp53
topic reduced penetrance
penetrance
Li-Fraumeni syndrome
variant classification
ACMG
ClinGen
url http://www.sciencedirect.com/science/article/pii/S2666247725000879
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