Thanks for your comments. The Hemophilia A intron 22 inversion is well described in the literature - here is a quote: "It is hypothesized that the inversion mutations occur almost exclusively in germ cells during meiotic cell division by an intrachromosomal recombination between a 9.6-kb sequence within intron 22 and 1 of 2 almost identical copies located about 300 kb distal to the factor VIII gene at the telomeric end of the X chromosome".
Meanwhile, I also heard back from the CDC, and here is their response:
[Question #1] I'm not following your HGVS syntax for intron22 inversions. For instance, you have [c.6429+?_6430-?h-2inv] and c.6429+?_6430-?inv], neither of which parse correctly here [https://mutalyzer.nl/]. I'm a bit new to HGVS, but your expression appears to only show one end of the inversion? Please help me understand what these strings are saying.
[CDC Response to #1] While we use HGVS nomenclature standards, the standards are frequently changing – particularly for complex rearrangements. The nomenclature we use reflects that the inversion involves intron 22 (c.6429+1_6430-1) but that the exact break points within intron 22 are unmapped (hence the ‘?’). Furthermore, we capture the differences between Type 1, Type 2, and atypical intron 22 inversions. Type 1 inversions occur when there is intrachromosomal rearrangement between a region inside intron 22 (h-1) and a homologous region outside the F8 gene (h-3) – these would be called c.6429+?_6430-?h-3inv in our database. Type 2 inversions occur when there is intrachromosomal rearrangement between h-1 and a second homologous region outside the F8 gene (h-2) – these would be called c.6429+?_6430-?h-2inv in our database. The rearrangement pattern is unclear for atypical intron 22 inversions – these would be called c.6429+?_6430-?inv.
[Question #2] I don't see these mutations registered in ClinVar or dbVar. Will they be? The intron22 inversion can be found in ClinVar by a search "hemophilia f8 inversion", but not by an HGVS search; and I don't find anything in dbVar.
[CDC Response to #2] The variant referenced in ClinVar (https://www.ncbi.nlm.nih.gov/clinvar/variation/10150/) appears to be generic reference to the Intron 22 inversion. Because HGVS nomenclature standards change frequently for complex rearrangements, the HGVS name would probably not be the best search mechanism to identify other reports of intron 22 inversions in these large databases. Because the intron 22 inversions have been studied for many years, a more productive search would be to search the literature with historical nomenclature (Intron 22 Type 1 inversion, Intron 22 Type 2 inversion, etc.).
So, I feel like HGVS syntax should be something like (6429+?)_(1-?)inv, where the "(1-?)" indicates that the other end of the inverted segment is an unknown distance 5' from the start of the first position of the first exon.
cpad0112 : Please use
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