Clinical spectrum of individuals with pathogenic NF1 missense variants affecting p.Met1149, p.Arg1276, and p.Lys1423: genotype–phenotype study in neurofibromatosis type 1

Magdalena Koczkowska, Tom Callens, Yunjia Chen, Alicia Gomes, Alesha D. Hicks, Angela Sharp, Eric Johns, Kim Armfield Uhas, Linlea Armstrong, Katherine Armstrong Bosanko, Dusica Babovic-Vuksanovic, Laura Baker, Donald G. Basel, Mario Bengala, James T. Bennett, Chelsea Chambers, Lola K. Clarkson, Maurizio Clementi, Fanny M. Cortés, Mitch CunninghamM. Daniela D'Agostino, Martin B. Delatycki, Maria C. Digilio, Laura Dosa, Silvia Esposito, Stephanie Fox, Mary Louise Freckmann, Christine Fauth, Teresa Giugliano, Sandra Giustini, Allison Goetsch, Yael Goldberg, Robert S. Greenwood, Cristin Griffis, Karen W. Gripp, Punita Gupta, Eric Haan, Rachel K. Hachen, Tamara L. Haygarth, Concepción Hernández-Chico, Katelyn Hodge, Robert J. Hopkin, Louanne Hudgins, Sandra Janssens, Kory Keller, Geraldine Kelly-Mancuso, Aaina Kochhar, Bruce R. Korf, Andrea M. Lewis, Jan Liebelt, Angie Lichty, Robert H. Listernick, Michael J. Lyons, Isabelle Maystadt, Mayra Martinez Ojeda, Carey McDougall, Lesley K. McGregor, Daniela Melis, Nancy Mendelsohn, Malgorzata J.M. Nowaczyk, June Ortenberg, Karin Panzer, John G. Pappas, Mary Ella Pierpont, Giulio Piluso, Valentina Pinna, Eniko K. Pivnick, Dinel A. Pond, Cynthia M. Powell, Caleb Rogers, Noa Ruhrman Shahar, S. Lane Rutledge, Veronica Saletti, Sarah A. Sandaradura, Claudia Santoro, Ulrich A. Schatz, Allison Schreiber, Daryl A. Scott, Elizabeth A. Sellars, Ruth Sheffer, Elizabeth Siqveland, John M. Slopis, Rosemarie Smith, Alberto Spalice, David W. Stockton, Haley Streff, Amy Theos, Gail E. Tomlinson, Grace Tran, Pamela L. Trapane, Eva Trevisson, Nicole J. Ullrich, Jenneke Van den Ende, Samantha A. Schrier Vergano, Stephanie E. Wallace, Michael F. Wangler, David D. Weaver, Kaleb H. Yohay, Elaine Zackai, Jonathan Zonana, Vickie Zurcher, Kathleen B.M. Claes, Marica Eoli, Yolanda Martin, Katharina Wimmer, Alessandro De Luca, Eric Legius, Ludwine M. Messiaen

Research output: Contribution to journalArticlepeer-review

73 Scopus citations


We report 281 individuals carrying a pathogenic recurrent NF1 missense variant at p.Met1149, p.Arg1276, or p.Lys1423, representing three nontruncating NF1 hotspots in the University of Alabama at Birmingham (UAB) cohort, together identified in 1.8% of unrelated NF1 individuals. About 25% (95% confidence interval: 20.5–31.2%) of individuals heterozygous for a pathogenic NF1 p.Met1149, p.Arg1276, or p.Lys1423 missense variant had a Noonan-like phenotype, which is significantly more compared with the “classic” NF1-affected cohorts (all p <.0001). Furthermore, p.Arg1276 and p.Lys1423 pathogenic missense variants were associated with a high prevalence of cardiovascular abnormalities, including pulmonic stenosis (all p <.0001), while p.Arg1276 variants had a high prevalence of symptomatic spinal neurofibromas (p <.0001) compared with “classic” NF1-affected cohorts. However, p.Met1149-positive individuals had a mild phenotype, characterized mainly by pigmentary manifestations without externally visible plexiform neurofibromas, symptomatic spinal neurofibromas or symptomatic optic pathway gliomas. As up to 0.4% of unrelated individuals in the UAB cohort carries a p.Met1149 missense variant, this finding will contribute to more accurate stratification of a significant number of NF1 individuals. Although clinically relevant genotype–phenotype correlations are rare in NF1, each affecting only a small percentage of individuals, together they impact counseling and management of a significant number of the NF1 population.

Original languageEnglish (US)
Pages (from-to)299-315
Number of pages17
JournalHuman mutation
Issue number1
StatePublished - Jan 1 2020

Bibliographical note

Publisher Copyright:
© 2019 The Authors. Human Mutation Published by Wiley Periodicals, Inc.


  • NF1
  • genotype–phenotype correlation
  • p.Arg1276
  • p.Lys1423
  • p.Met1149


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