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Table 2 Tabulated form of SMAD4 variants and associated phenotypes, where families are bolded

From: SMAD4 variants and its genotype–phenotype correlations to juvenile polyposis syndrome

Author & year

Location

Type of mutation

SMAD4 nucleotide mutation

SMAD4 predicted protein change

ClinVar Class

Dx Age

Phenotype

Extra-gastrointestinal phenotypes

Schwenter et al. (2012) [94]

Exon 9; MH2 domain

Substitution, missense

c.1146C > A

p.(His382Gln)

Unclassified

1

JPS with multiple colorectal hamartomatous polyps and duodenal adenomatous polyps

HHT: Epistaxis, telangiectases, lung AVMs

Intron 12; MH2 domain

Intronic

c.1447 + 1G > A

p.( =)

Pathogenic

28

JPS with FHx, multiple rectal hamartomatous polyps and gastric hyperplastic polyps; diagnosis of CRC

HHT: Epistaxis, telangiectases

Exon 8; MH2 domain

Substitution, missense

c.1082G > T

p.(Arg361Leu)

Pathogenic

57

JPS with multiple colorectal hyperplastic polyps and few gastric hamartomatous polyps

HHT: Epistaxis, telangiectases, lung AVMs, cyanosis, digital clubbing, stroke

Exon 8; MH2 domain

Substitution, missense

c.1082G > A

p.(Arg361His)

Pathogenic

34

JPS with FHx and multiple colorectal hamartomatous polyps

HHT: Epistaxis, telangiectases, lung AVMs

Exon 11; MH2 domain

Deletion-insertion, frameshift

c.1596_1597delinsT

p.(Leu533Serfs*4)

Pathogenic

20

JPS with 10 colorectal polyps and 4 gastric polyps; diagnosis of CRC

HHT: Epistaxis, telangiectases, lung/liver AVMs

Exon 5; Linker domain

Deletion, frameshift

c.728_735del

p.(Gly243Alafs*18)

Pathogenic

17

JPS with FHx and 20 colorectal hamartomatous polyps

HHT: Telangiectases, lung AVMs, cyanosis

Exon 9; MH2 domain

Deletion, frameshift

c.1231_1232del

p.(Ser411Leufs*17)

Pathogenic

22

JPS with 28 colorectal polyps and multiple gastric hyperplastic polyps

HHT: Epistaxis, telangiectases, cyanosis

Exon 8; MH2 domain

Substitution, miisense

c.1082G > A

p.(Arg361His)

Pathogenic

27

JPS with multiple colonic hamartomatous polyps and multiple duodenal adenomatous polyps

HHT: Epistaxis, telangiectases, lung AVMs, stroke, cyanosis

Exon 9; MH2 domain

Deletion, frameshift

c.1231_1232del

p.(Ser411Leufs*17)

Pathogenic

31

JPS with FHx

HHT: telangiectases

Exon 5; Linker domain

Substitution, missense

c.746_747delAGinsCC

p.(Gln249Pro)

Unclassified

10

JPS with FHx

HHT: Epistaxis, telangiectases

Exon 8; MH2 domain

Substitution, missense

c.1082G > T

p.(Arg361Leu)

Pathogenic

12

JPS with FHx and 6 colorectal polyps

HHT: Epistaxis, lung AVMs

Exon 5; Linker domain

Deletion, frameshift

c.728_735del

p.(Gly243Alafs*18)

Pathogenic

N/A

JPS with FHx, multiple colorectal hyperplastic polyps

HHT: Epistaxis

Intron 12; MH2 domain

Intronic

c.1447 + 1G > A

p.( =)

Pathogenic

10

JPS with FHx and 9 colorectal juvenile polyps

HHT: Epistaxis, lung AVMs

Ngeow et al. (2013) [77]

Exon 6; SMAD4 activation domain

Deletion

c.(787 + 1_830)_(1139 + 1_1140-1)del

p.?

Unclassified

59

Juvenile; adenomatous polyps; diagnosis of CRC

 

Exon 10; MH2 domain

Deletion

c.1309-?_1659 + ?del

p.?

Unclassified

17

Juvenile polyps

 

Exon 3; Linker domain

Deletion, frameshift

c.430_431del

p.(Ser144Argfs*7)

Pathogenic

27

Juvenile polyps

 

Exon 3; Linker domain

Deletion, frameshift

c.430_431del

p.(Ser144Argfs*7)

Pathogenic

44

Adenomatous; hamartomatous polyps

 

Exon 6; Linker domain

Deletion, frameshift

c.798del

p.(Thr267Profs*69)

Unclassified

43

Juvenile; adenomatous polyps

 

Exon 6; SMAD4 activation domain

Insertion

c.902dup

p.(Tyr301*)

Unclassified

47

Juvenile; hyperplastic polyps

 

Exon 8; MH2 domain

Substitution, missense

c.1049 T > A

p.(Val350Asp)

Unclassified

9

Juvenile polyps

 

Exon 8; MH2 domain

Substitution, missense

c.1087 T > C

p.(Cys363Arg)

Pathogenic

2

Juvenile polyps

 

Exon 9; MH2 domain

Substitution, nonsense

c.1193G > A

p.(Trp398*)

Pathogenic

37

Juvenile; adenomatous polyps; diagnosis of gastric cancer

 

Exon 9; MH2 domain

Deletion, frameshift

c.1231_1232del

p.(Ser411Leufs*17)

Pathogenic

21

Juvenile; adenomatous polyps

HHT: brain & lung arteriovenous malformations

Exon 9; MH2 domain

Deletion, frameshift

c.1231_1232del

p.(Ser411Leufs*17)

Pathogenic

46

Juvenile; adenomatous polyps

 

Exon 9; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

37

Juvenile; hyperplastic polyps

 

Exon 9; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

29

Juvenile polyps

 

Exon 9; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

32

Juvenile; adenomatous polyps

Goitre

Exon 9; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

24

Juvenile; hamartomatous polyps

 

Exon 9; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

39

Hyperplastic; adenomatous polyps

 

Exon 9; MH2 domain

Deletion, frameshift

c.1247_1250del

p.(Arg416Lysfs*19)

Unclassified

44

Juvenile polyps

HHT: telangiectasia

Exon 10; MH2 domain

Deletion, frameshift

c.1343_1367del

p.(Gln448Leufs*20)

Pathogenic

45

Juvenile polyps

 

Exon 10; MH2 domain

Deletion, frameshift

c.1343_1367del

p.(Gln448Leufs*20)

Pathogenic

47

Juvenile; hyperplastic polyps

 

Exon 10; MH2 domain

Deletion, frameshift

c.1343_1367del

p.(Gln448Leufs*20)

Pathogenic

45

Inflammatory, adenomatous, hyperplastic, juvenile polyps

 

Exon 11; MH2 domain

Substitution, missense

c.1573A > G

p.(Ile525Val)

Conflicting interpretations of pathogenicity

57

Adenomatous; hyperplastic polyps

 

Exon 11; MH2 domain

Substitution, missense

c.1573A > G

p.(Ile525Val)

Conflicting interpretations of pathogenicity

50

Adenomtaous; hyperplastic polyps

 

Howe et al. (2004) [48]

Exon 4; Linker domain

Deletion; premature stop codon

c.608del

p.(Pro203Hisfs*38)

Pathogenic

N/A

Familial JPS

 

Exon 8; MH2 domain

Substitution, missense

c.989A > G

p.(Glu330Gly)

Likely pathogenic

N/A

Familial JPS

 

Exon 8; MH2 domain

Deletion; premature stop codon

c.1037del

p.(Pro346Leufs*38)

Pathogenic

N/A

JPS

 

Exon 8; MH2 domain

Substitution, missense

c.1054G > A

p.(Gly352Arg)

Pathogenic

N/A

Familial JPS

 

Exon 8; MH2 domain

Substitution, missense

c.1081C > G

p.(Arg361Gly)

Likely pathogenic

N/A

Familial JPS

 

Exon 8; MH2 domain

Substitution, missense

c.1081C > G

p.(Arg361Gly)

Likely pathogenic

N/A

Familial JPS

 

Exon 9; MH2 domain

Substitution, nonsense

c.1162C > T

p.(Gln388*)

Pathogenic

N/A

Familial JPS

 

Exon 9; MH2 domain

Deletion; premature stop codon

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

Familial JPS

 

Exon 9; MH2 domain

Deletion; premature stop codon

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

Familial JPS

 

Exon 9; MH2 domain

Deletion; premature stop codon

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

Familial JPS

 

Exon 9; MH2 domain

Deletion; premature stop codon

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

Familial JPS

 

Exon 10; MH2 domain

Deletion; premature stop codon

c.1343_1365del

p.(Gln448Argfs*38)

Pathogenic

N/A

JPS

 

Exon 11; MH2 domain

Substitution, missense

c.1529G > T

p.(Gly510Val)

Pathogenic

N/A

JPS

 

Exon 11; MH2 domain

Deletion; premature stop codon

c.1588del

p.(His530Thrfs*7)

Pathogenic

N/A

Familial JPS

 

Friedl et al. (2002) [34]

Exon 9; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

35

JPS with gastric polyposis & gastrectomy at age 35

 

Exon 9; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

4

JPS with nil extracolonic anomalies and FHx

Lennox disease, macrocephaly, severe psychomotoric retardation

Exon 9; MH2 domain

Substituiton, missense

c.1157G > A

p.(Gly386Asp)

Pathogenic/Likely pathogenic

10

JPS

HHT features including: pulmonary arteriovenous fistulae, finger clubbing, skeletal thorax abnormalities

Exon 6

Deletion

c.831_832del

p.(Pro278*)

Pathogenic

12

JPS with massive polyposis at 28y with no gastric polyps

Asymptomatic ventricular septal defect

Exon 10; MH2 domain

Substitution; missense

c.1342C > T

p.(Gln448*)

Pathogenic

12

JPS

Nil extracolonic features

Exon 11; MH2 domain

Deletion, frameshift

c.1544del

p.(Arg515Asnfs*22)

Pathogenic

39

JPS with gastric polyposis, giant gastric folds & gastrectomy at 40y

 

Exon 11; MH2 domain

Insertion, frameshift

c.1547_1550dup

p.(Ser517Argfs*11)

Unclassified

21

JPS with gastric polyposis at age 36 & gastrectomy at 40y

 

Handra-Luca et al. (2005) [41]

Exon 2; MH1 domain

Duplication, frameshift

c.375_381dup

p.(Val128Cysfs*17)

Pathogenic

N/A

JPS

 

Exon 2; MH1 domain

Duplication, frameshift

c.375_381dup

p.(Val128Cysfs*17)

Pathogenic

N/A

JPS

 

Exon 9; MH2 domain

Substitution, nonsense

c.1236C > G

p.(Tyr412*)

Pathogenic

N/A

JPS

 

Exon 9; MH2 domain

Deletion, frameshift

c.1242del

p.(Asp415Thrfs*21)

Pathogenic

N/A

JPS

 

Exon 9; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

JPS

 

Exon 9; MH2 domain

Deletion, frameshift

c.1268del

p.(Gly423Glufs*13)

Pathogenic

N/A

JPS

 

Exon 10; MH2 domain

Substitution, nonsense

c.1333C > T

p.(Arg445*)

Pathogenic

N/A

JPS

 

Exon 11; MH2 domain

Substitution, missense

c.1571G > T

p.(Trp524Leu)

Pathogenic

N/A

JPS

 

Exon 11; MH2 domain

Insertion, frameshift

c.1607dup

p.(Asp537Argfs*40)

Pathogenic

N/A

JPS

 

Jelsig et al. (2016) [55]

Exon 9; MH2 domain

Substitution, missense

c.1156G > A

p.(Gly386Ser)

Likely pathogenic

48

JPS with FHx, 3 colorectal adenomatous polyps and multiple duodenal polyps

HHT features: epistaxis, telangiectasia, pulmonary and GI AVM, anaemia, stroke

Exon 9; MH2 domain

Substitution, missense

c.1156G > A

p.(Gly386Ser)

Likely pathogenic

27

Unconfirmed JPS with FHx and 1 caecal inflammatory polyp

HHT features: epistaxis, telangiectasia, pulmonary AVM

Exon 9; MH2 domain

Substitution, missense

c.1156G > A

p.(Gly386Ser)

Likely pathogenic

16

Unconfirmed JPS with FHx and 1 colonic juvenile polyp

HHT features: epistaxis, telangiectasia, pulmonary AVM

Exon 8; MH2 domain

Substitution. Missense

c.1081C > T

p.(Arg361Cys)

Pathogenic

3

JPS with > 50 juvenile polyps throughout colon, 1 jejunal adenomatous polyp, nil FHx

HHT features: epistaxis, telangiectasia, pulmonary and GI AVM, anaemia, cyanosis, digital clubbing

Exon 8; SMAD4 activation domain

Deletion, frameshift

c.939del

p.(Ile314Phefs*22)

Pathogenic (unconfirmed)

21

JPS with < 10 colorectal polyps and several ileal polyps; diagnosis of CRC (21) & gastric cancer (37)

HHT features: epistaxis, telangiectasia, anaemia Passed away at 40y

Exon 10; MH2 domain

Deletion, frameshift

c.1325_1326del

p.(Gln442Leufs*51)

Pathogenic (unconfirmed)

13

JPS with FHx and 3 colorectal juvenile polyps

HHT features: epistaxis, telangiectasia, pulmonary AVM, aortopathy (aortic root dilated 5 cm)

Exon 10; MH2 domain

Deletion, frameshift

c.1325_1326del

p.(Gln442Leufs*51)

Pathogenic (unconfirmed)

17

JPS with FHx, > 50 juvenile polyps throughout GIT

HHT features: epistaxis, telangiectasia

Exon 10; MH2 domain

Deletion, frameshift

c.1325_1326del

p.(Gln442Leufs*51)

Pathogenic (unconfirmed)

60

JPS with FHx, > 50 juvenile polyps throughout GIT; diagnosis of CRC (48)

HHT features: epistaxis, telangiectasia

Exon 10; MH2 domain

Deletion, frameshift

c.1325_1326del

p.(Gln442Leufs*51)

Pathogenic (unconfirmed)

64

JPS with FHx, < 10 colorectal juvenile polyps

 

Exon 11; MH2 domain

Duplication, frameshift

c.1587dup

p.(His530Thrfs*47)

Pathogenic

3

JPS with > 50 juvenile polyps throughout GIT

Anaemia

Exon 1; MH1 domain

Deletion, frameshift

c.1421del

p.(Ser474*)

Pathogenic

21

JPS with FHx, > 10–30 colorectal juvenile polyps and several small bowel polyps; diagnosis of CRC (35)

Anaemia

Exon 1; MH1 domain

Deletion, frameshift

c.1421del

p.(Ser474*)

Pathogenic

43

JPS with FHx, > 50 colorectal juvenile polyps and several hyperplastic small bowel hyperplastic polyps

 

Exon 1; MH1 domain

Deletion, frameshift

c.1421del

p.(Ser474*)

Pathogenic

15

JPS with FHx, 10–30 colorectal juvenile polyps

 

Exon 5; Linker domain

Insertion, frameshift

c.692dup

p.(Ser232Glnfs*3)

Pathogenic

18

JPS with > 50 colorectal juvenile polyps

Anaemia

Woodford-Richens et al. (2000) [108]

Exon 4; Linker domain

Deletion; premature stop codon

c.517_527del

p.(Ser173Thrfs*12)

Pathogenic (unconfirmed)

12

JPS with > 50 sigmoid and recal polyps, FHx of CRC

 

Exon 8; MH2 domain

Substitution, missense

c.1083C > T

p.( =)

Unclassified

16

JPS with 4 colorectal polyps, FHx of CRC & JPS

 

Exon 11; MH2 domain

Deletion; premature stop codon

c.1564_1565del

p.(Pro522Leufs*4)

Pathogenic

N/A

JPS with FHx, > 100 gastric polyps, 8 colorectal polyps

 

Exon 11; MH2 domain

Deletion; premature stop codon

c.1564_1565del

p.(Pro522Leufs*4)

Pathogenic

N/A

JPS with FHx, gastric JPs

 

Exon 11; MH2 domain

Deletion

c.189_197del

p.(Asn64_Ala66del)

Pathogenic (unconfirmed)

N/A

JPS with FHx, extensive polyposis throughout GIT, colectomy at 45y

 

Exon 11; MH2 domain

Deletion

c.189_197del

p.(Asn64_Ala66del)

Pathogenic (unconfirmed)

N/A

JPS with FHx, colorectal juvenile polyps, coloectomy at 21y

 

Exon 10; MH2 domain

Substitution; nonsense

c.1333C > T

p.(Arg445*)

Pathogenic

39

JPS with FHx, colonic polyps with tubular adenoma

 

Exon 10; MH2 domain

Substitution; nonsense

c.1333C > T

p.(Arg445*)

Pathogenic

6

JPS with FHx, > 100 juvenile polyps throughout GIT

 

Aretz et al. (2007) [4]

Exon 9; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

41

Familial JPS with multiple juvenile colonic and gastric polyps

 

Exon 9; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

4

Familial JPS with numerous juvenile, hyperplastic and adenomatous colonic polyps

 

Exon 9; MH2 domain

Substitution, missense

c.1157G > A

p.(Gly386Asp)

Pathogenic/Likely pathogenic

10

JPS with > 50 colonic juvenile polyps

 

Exon 6; SMAD4 activation domain

Deletion

c.831_832del

p.(Pro278*)

Pathogenic

12

Familial JPS with > 50 colonic and gastric juvenile, hyperplastic polyps

 

Exon 6–11

Deletion

c.788-?_1659 + ?del

p.?

Unclassified

12

Familial JPS with numerous colonic and gastric juvenile/adenomatous polyps

 

Exon 10; MH2 domain

Substitution, nonsense

c.1342C > T

p.(Gln448*)

Pathogenic

12

JPS with massive juvenile and adenomatous colonic polyps

 

Exon 11; MH2 domain

Deletion

c.(?_-17093)_(*6575_?)del

p.0

Pathogenic (unconfirmed)

18

JPS with > 100 juvenile, adenomatous, hyperplastic colonic polyps

 

Exon 11; MH2 domain

Deletion, frameshift

c.1544del

p.(Arg515Asnfs*22)

Pathogenic

40

JPS with multiple juvenile colonic and gastric polyps

 

Exon 11; MH2 domain

Duplication, frameshift

c.1547_1550dup

p.(Ser517Argfs*11)

Pathogenic (unconfirmed)

24

Familial JPS with numerous juvenile and adenomatous colonic/gastric polyps

 

Exon 8; MH2 domain

Substitution

c.1139G > A

p.(Arg380Lys)

Likely pathogenic

38

JPS with 10 adenomatous colonic polyps with hundreds of gastric juvenile polyps

 

Exon 11; MH2 domain

Deletion

c.(?_-17093)_(*6575_?)del

p.0

Pathogenic (unconfirmed)

33

JPS with massive juvenile and adenomatous colonic polyps

 

Exon 3; Linker domain

Substitution

c.425-6A > G

p.( =)

Uncertain significance

10

Familial JPS with numerous colonic/gastric polyps

 

Exon 11; MH2 domain

Deletion

c.(?_-17093)_(*6575_?)del

p.0

Pathogenic (unconfirmed)

45

Familial JPS with > 30 juvenile, adenomatous and inflammatory colonic polyps and pronounced gastric polyps

 

Exon 9; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

48

Familial JPS with multiple colonic juvenile polyps and pronounced gastric polyposis

 

Exon 10; MH2 domain

Deletion, frameshift

c.1421del

p.(Ser474*)

Pathogenic

54

Familial JPS with several juvenile colonic and gastric polyps

 

Exon 5–11

Deletion

c.668-?_1659 + ?del

p.?

Unclassified

50

JPS with massive juvenile gastric polyposis with 2 colonic polyps

 

Exon 3; Linker domain

Substitution, nonsense

c.437 T > A

p.(Leu146*)

Pathogenic

48

Familial JPS with multiple juvenile gastric polyps and > 5 colonic polyps

 

Exon 9; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

23

JPS with > 20 colonic juvenile and inflammatory polyps

 

Exon 8; MH2 domain

Substitution, missense

c.1087 T > C

p.(Cys363Arg)

Pathogenic

5

JPS with multiple colonic polyps

 

Exon 8; MH2 domain

Substitution, missense

c.1082G > A

p.(Arg361His)

Pathogenic

11

JPS with > 50 colonic juvenile polyps

 

Exon 8; MH2 domain

Substitution, missense

c.1081C > T

p.(Arg361Cys)

Pathogenic

3

JPS with > 30 colonic juvenile polyps

 

Exon 11; MH2 domain

Deletion

c.(?_-17093)_(*6575_?)del

p.0

Pathogenic (unconfirmed)

12

JPS with massive juvenile colonic polyposis

 

Exon 2; MH1 domain

Substitution, nonsense

c.403C > T

p.(Arg135*)

Pathogenic

48

JPS with > 20 colonic juvenile polyps and pronounced gastric polyposis

 

Gallione et al. (2004) [36]

Exon 11; MH2 domain

Deletion

c.1612_1625del

p.(Glu538Hisfs*34)

Pathogenic

41

Caecal juvenile polyps, GI cancer

HHT features: telangiectasia, epistaxis, pulmonary and liver AVMs

Exon 11; MH2 domain

Deletion

c.1612_1625del

p.(Glu538Hisfs*34)

Pathogenic

8

Colorectal juvenile polyps

HHT features: telangiectasia, epistaxis, anaemia

Exon 8; MH2 domain

Substitution, missense

c.1054G > A

p.(Gly352Arg)

Pathogenic

9

Colorectal juvenile polyps

HHT features: telangiectasia, pulmonary AVM, anaemia, digital clubbing

Exon 8; MH2 domain

Substitution, missense

c.1054G > A

p.(Gly352Arg)

Pathogenic

5

Colorectal juvenile polyps, GI cancer

HHT features: pulmonary AVM, anaemia, digital clubbing, stroke with intracranial bleed

Exon 8; MH2 domain

Substitution, missense

c.1054G > A

p.(Gly352Arg)

Pathogenic

3

Colorectal juvenile polyps

HHT features: liver AVM, anaemia, digital clubbing

Exon 11; MH2 domain

Substitution, missense

c.1598 T > G

p.(Leu533Arg)

Pathogenic

15

Colorectal juvenile polyps

HHT features telangiectases, epistaxis, anaemia

Exon 11; MH2 domain

Substitution, missense

c.1598 T > G

p.(Leu533Arg)

Pathogenic

14

Colorectal juvenile polyps

HHT features: telangiectases, epistaxis, anaemia

Exon 11; MH2 domain

Substitution, missense

c.1598 T > G

p.(Leu533Arg)

Pathogenic

3

Colorectal juvenile polyps

HHT features: telangiectases, epistaxis, anaemia, digital clubbing, pulmonary & liver AVM

Exon 11; MH2 domain

Substitution, missense

c.1598 T > G

p.(Leu533Arg)

Pathogenic

N/A

Not examined

HHT features: pulmonary AVM, anaemia

Exon 8; MH2 domain

Substitution, missense

c.1081C > G

p.(Arg361Gly)

Likely pathogenic

14

Colorectal and gastric juvenile polyps

HHT features: telangiectases, epistaxis, anaemia

Exon 9; MH2 domain

Substitution, missense

c.1157G > A

p.(Gly386Asp)

Pathogenic/Likely pathogenic

10

Colorectal & duodenal juvenile polyps, GI cancer

HHT features: anaemia, pulmonary AVM, telangiectasia, epistaxis, stroke, digital clubbing, stroke, intracranial bleed

Exon 9; MH2 domain

Substitution, missense

c.1157G > A

p.(Gly386Asp)

Pathogenic/Likely pathogenic

4

Colorectal juvenile polyps

HHT features: anaemia, pulmonary AVM, digital clubbing, cyanosis

Exon 11; MH2 domain

Deletion

c.1594del

p.(Ala532Profs*5)

Pathogenic

11

Colorectal juvenile polyps

HHT features: anaemia, telangiectases, epistaxis

Exon 11; MH2 domain

Substitution, nonsense

c.1600C > T

p.(Gln534*)

Pathogenic

10

Upper GI especially duodenal juvenile polyps, GI cancer

HHT features: liver AVM, epistaxis, digital clubbing, mild seizures

Gallione et al. (2006) [37]

Exon 11; MH2 domain

Deletion-insertion Frameshift mutation

c.1596_1597delinsT

p.(Leu533Serfs*4)

Pathogenic

37

Multiple colonic juvenile polyps with GI bleeding

HHT features: telangiectases, epistaxis, AVMs in the lung and GIT, nil FHx

Exon 8; MH2 domain

Substitution, missense

c.1081C > T

p.(Arg361Cys)

Pathogenic

39

Unclassified regarding JP symptoms

HHT features: telangiectases, epistaxis, pulmonary AVM, liver shunts nil FHx

Exon 8; MH2 domain

Substitution, missense

c.1081C > T

p.(Arg361Cys)

Pathogenic

13

Mulitple hamartomatous polyps found in the ascending colon + duodenum; Signet ring cell type CRC (caecum)

HHT features: telangiectases, epistaxis, hepatic AVM, anaemia

Hattem et al. (2008) [104]

Exon 8; MH2 domain

Substitution, missense

c.970 T > C

p.(Cys324Arg)

Uncertain significance

N/A

JPS

(Juvenile polyposis registry)

Exon 8; MH2 domain

Substitution, missense

c.989A > G

p.(Glu330Gly)

Likely pathogenic

N/A

JPS

 

Exon 8; MH2 domain

Deletion – > frameshift

c.971del

p.(Cys324Phefs*12)

Pathogenic

N/A

JPS

 

Exon 9; MH2 domain

Substitution, nonsense

c.1193G > A

p.(Trp398*)

Pathogenic

N/A

JPS

 

Exon 10; MH2 domain

Deletion – > frameshift

c.1411_1435del

p.(Gly471Leufs*25)

Pathogenic

N/A

JPS

 

Exon 11; MH2 domain

Duplication – > frameshift

c.1586_1587dup

p.(His530Tyrfs*8)

Pathogenic

N/A

JPS

 

Exon 1–11

Hemizygous deletion

c.(?_-538)_(*6575_?)del

p.0

Pathogenic (unconfirmed)

N/A

JPS

 

Pyatt et al. (2006) [86]

Exon 2; MH1 domain

Substitution, missense

c.403C > T

p.(Arg135*)

Pathogenic

35

 > 20 juvenile polyps

 

Exon 3; Linker domain

Deletion, premature stop codon

c.430_431del

p.(Ser144Argfs*7)

Pathogenic

Infancy

 > 5 juvenile polyps in rectum, stomach

 

Exon 5; Linker domain

Insertion, premature stop codon

c.731_732insGCCC

p.(Gln245Profs*20)

Pathogenic (unconfirmed)

9

 > 140 juvenile polyps in colon, terminal ileum

 

Exon 7; Linker domain

Duplication, premature stop codon

c.925_928dup

p.(Phe310Cysfs*13)

Pathogenic

17

 > 10 juvenile polyps in transverse, descending, sigmoid & rectum

 

Exon 8; MH2 domain

Insertion, premature stop codon

c.982dup

p.(Tyr328Leufs*3)

Pathogenic

9.5

 > 9 juvenile polyps—hepatic flexure, rectum

 

Exon 8; MH2 domain

Deletion

c.1088_1090del

p.(Cys363del)

Pathogenic

11

Colonic polyps

HHT symptoms

Exon 8; MH2 domain

Substitution, missense

c.1091 T > G

p.(Leu364Trp)

Pathogenic

2.5

 > 15 juvenile colonic polyps

 

Exon 8; MH2 domain

Deletion, premature stop codon

c.1113del

p.(His371Glnfs*13)

Pathogenic

33

Multiple juvenile polyps in colon and stomach

 

Exon 9; MH2 domain

Deletion, premature stop codon

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

10

 > 6 juvenile polyps in sigmoid

 

Exon 9; MH2 domain

Deletion, premature stop codon

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

21

Innumerable juvenile polyps in colon & stomach

 

Exon 10; MH2 domain

Deletion, premature stop codon

c.1361_1364del

p.(Ala454Glufs*21)

Pathogenic

23

 > 20 juvenile polyps in caecum, ascending, descending, sigmoid

 

Intron 10

Intronic

c.1308 + 1G > A

p.( =)

Pathogenic/Likely pathogenic

30

 > 15 juvenile polyps with focal adenomatous changes in the colon

 

Exon 11; MH2 domain

Deletion, premature stop codon

c.1596del

p.(Leu533Serfs*4)

Pathogenic (unconfirmed)

7

Colectomy at 7yo

HHT symptoms

O'Malley et al. (2011) [80]

Exon 9; MH2 domain

Deletion

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

JPS

HHT features: telangiectasia, pulmonary AVM

Exon 9; MH2 domain

Deletion

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

JPS

HHT features: FHx, telangiectasia, cranial AVM

Exon 9; MH2 domain

Deletion

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

JPS

HHT features: FHx. GI AVM

Exon 9; MH2 domain

Deletion

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

JPS

HHT features: telangiectasia, epistaxis, asthma

Exon 9; MH2 domain

Deletion

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

JPS

HHT features: telangiectasia, epistaxis, pulmnary AVM, asthma

Exon 9; MH2 domain

Deletion

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

JPS

HHT features: FHx, telangiectasia, epistaxis, pulmonary AVM, asthma

Exon 9; MH2 domain

Deletion

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

JPS

HHT features: epistaxis, cranial/pulmonary AVM, asthma

Exon 9; MH2 domain

Deletion

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

JPS

HHT features: FHx, epistaxis, pulmonary AVM, asthma

Exon 3/4; Linker domain

Substitution; missense

c.1363C > A

p.(Gln455Lys)

Unclassified

N/A

JPS

HHT features: FHx, pulmonary AVM, asthma

Exon 3/4; Linker domain

Substitution; missense

c.1363C > A

p.(Gln455Lys)

Unclassified

N/A

JPS

HHT features: telangiectasia, epistaxis, pulmonary AVM

Exon 2/3; MH1/Linker

Deletion

c.430_431del

p.(Ser144Argfs*7)

Pathogenic

N/A

JPS

HHT features: N/A

Exon 8; MH2 domain

Duplication

c.956-?_1139 + ?dup

p.?

Unclassified

N/A

JPS

HHT features: telangiectasia, epistaxis, cranial/pulmonary AVM, asthma

Exon 8; MH2 domain

Duplication

c.956-?_1139 + ?dup

p.?

Unclassified

N/A

JPS

HHT features: FHx, telangiectasia, pulmonary AVM

Exon 9; MH2 domain

Deletion

c.1228_1229del

p.(Gln410Glufs*18)

Pathogenic

N/A

JPS

HHT features: telangiectasia, epistaxis, pulmonary AVM, asthma

Exon 9; MH2 domain

Deletion

c.1228_1229del

p.(Gln410Glufs*18)

Pathogenic

N/A

JPS

HHT features: FHx, telangiectasia, epistaxis, pulmonary AVM

Exon 9; MH2 domain

Deletion

c.1228_1229del

p.(Gln410Glufs*18)

Pathogenic

N/A

JPS

HHT features: FHx, telangiectasia, epistaxis, pulmonary AVM, asthma

Exon 9; MH2 domain

Deletion

c.1228_1229del

p.(Gln410Glufs*18)

Pathogenic

N/A

JPS

HHT features: FHx, epistaxis, cranial/pulmonary AVM

Exon 9; MH2 domain

Deletion

c.1228_1229del

p.(Gln410Glufs*18)

Pathogenic

N/A

JPS

HHT features: FHx, epistaxis, pulmonary AVM, asthma

Exon 9; MH2 domain

Deletion

c.1228_1229del

p.(Gln410Glufs*18)

Pathogenic

N/A

JPS

HHT features: FHx, epistaxis

Exon 9; MH2 domain

Deletion

c.1228_1229del

p.(Gln410Glufs*18)

Pathogenic

N/A

JPS

HHT features: FHx, epistaxis, GI AVM

Exon 9; MH2 domain

Unclassified

Exon 9

0

Unclassified

N/A

JPS

HHT features: telangiectasia, epistaxis, pulmonary/cranial/GI AVM

Gallione et al. (2010) [35]

Exon 2; MH1 domain

Substitution, nonsense

c.302G > A

p.(Trp101*)

Pathogenic

13.5

Colonic and rectal juvenile polyps; JPS

HHT features: pulmonary AVM. Other: Williams syndrome, dental caries, acanthosis nigricans

Exon 5; Linker domain

Duplication, frameshift

c.692dup

p.(Ser232Glnfs*3)

Pathogenic

22

Colonic, duodenal and gastric juvenile polyps; JPS with FHx

HHT features: pulmonary AVM, FHx of HHT Other: UC, mild HTN

Exon 8; MH2 domain

Substitution, missense

c.988G > A

p.(Glu330Lys)

Pathogenic

6.5

Colonic and caecal juvenile polyps; JPS with FHx

HHT features: FHx, anaemia, epistaxis

Exon 8; MH2 domain

Substitution, missense

c.1055G > A

p.(Gly352Glu)

Pathogenic

65

Colonic, duodenal and gastric juvenile polyps; JPS

HHT features: anaemia, pulmonary AVM, telangiectasia, epistaxis

Exon 8; MH2 domain

Substitution, missense

c.1081C > T

p.(Arg361Cys)

Pathogenic

9

Colonic and gastric juvenile polyps; JPS

HHT features: anaemia, pulmonary AVM, telangiectasia, epistaxis, asthma

Exon 8; MH2 domain

Substitution, missense

c.1081C > T

p.(Arg361Cys)

Pathogenic

17

GI juvenile polyps; JPS with FHx

HHT features: pulmonary AVM, epistaxis, digital clubbing, FHx of HHT, stroke

Exon 8; MH2 domain

Substitution, missense

c.1082G > T

p.(Arg361Leu)

Pathogenic

34

Colonic and rectal juvenile polyps; JPS with FHx of CRC (34y)

HHT features: pulmonary AVM, telangiectasia, epistaxis, digital clubbing, FHx of HHT; other: polycythaemia, dental caries, brain abscess (35y)

Exon 8; MH2 domain

Substitution, missense

c.1082G > A

p.(Arg361His)

Pathogenic

35

Colonic and caecal juvenile polyps; JPS with FHx of CRC (35y)

HHT features: anaemia, pulmonary AVM, telangiectasia, epistaxis; Other: hysterectomy/oophorectomy (36), died of metastatic CRC

Exon 8; MH2 domain

Substitution, missense

c.1091 T > G

p.(Leu364Trp)

Pathogenic

2.5

Colorectal and caecal juvenile polyps; JPS with FHx

HHT features: pulmonary and hepatic AVM, epistaxis, digital clubbing, FHx of HHT; Other: thrombosis, FTT

Exon 8; MH2 domain

Deletion, frameshift

c.1102_1103del

p.(Ser368Glnfs*9)

Pathogenic

17

Colonic juvenile polyps; JPS

HHT features: anaemia, telangiectases, epistaxis

Exon 9; MH2 domain

Substitution, missense

c.1148 T > A

p.(Ile383Lys)

Conflicting interpretations of pathogenicity

21

Colonic, ileal, duodenal juvenile polyps; JPS

HHT features: anaemia, pulmonary AVM, telangiectasia, epistaxis, digital clubbing; other: cyanosis, MV prolapse, asthma

Exon 9; MH2 domain

Substitution, missense

c.1157G > A

p.(Gly386Asp)

Pathogenic/Likely pathogenic

15

Colonic juvenile polyps; JPS with CRC (20y)

HHT features: anaemia, pulmonary AVM, telangiectasia, epistaxis

Exon 9; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

44

Colonic juvenile polyps; JPS with FHx

HHT features: pulmonary AVM, telangiectasia, epistaxis, FHx of HHT

Exon 11; MH2 domain

Duplication, frameshift

c.1586_1587dup

p.(His530Tyrfs*8)

Pathogenic

3

Colorectal juvenile polyps; JPS

HHT features: anaemia, pulmonary and cerebral AVM, telangiectasia, epistaxis, digital clubbing; other: asthma

Exon 11; MH2 domain

Substitution, missense

c.1598 T > C

p.(Leu533Pro)

Pathogenic

36

Colonic juvenile polyps; JPS

HHT features: anaemia, pulmonary AVM, telangiectasia, epistaxis, digital clubbing, FHx of HHT

Duan et al. (2019) [29]

Exon 2; MH1 domain

Substitution, missense

c.290G > T

p.(Arg97Leu)

Conflicting interpretations of pathogenicity

24

Nil JPS, HHT, Myhre syndrome

Heritable thoracic aortic disease (HTAD)—ascending aortic dissection at 24y, passed away with ovarian cancer at 44y

Exon 2; MH1 domain

Substitution, missense

c.290G > T

p.(Arg97Leu)

Conflicting interpretations of pathogenicity

41

Nil JPS, HHT, Myhre syndrome

HTAD—ascending aortic aneurysm at 41y with bicuspid aortic valve

Exon 1; MH1 domain

Substitution, missense

c.70A > G

p.(Met24Val)

Uncertain significance

37

Nil JPS, HHT, Myhre syndrome

Type A aortic dissection at 37y; DNA samples

Exon 5; Linker domain

Substitution, missense

c.736C > A

p.(Pro246Thr)

Uncertain significance

54

Nil JPS, HHT, Myhre syndrome

Type A aortic dissection at 54y

Rohlin et al. (2017) [88]

Exon 8; MH2 domain

Deletion, frameshift

c.1110_1114del

p.(His371Aspfs*5)

Pathogenic (unconfirmed)

N/A

Unexplained adenomatous polyposis Pathogenic variant for CRC

 

Calva-Cerqueira et al. (2009) [20]

Exon 2; MH1 domain

Insertion, frameshift

c.373_374insAT

p.(Ser125Asnfs*5)

Pathogenic

N/A

Sporadic JPS

 

Exon 4; Linker domain

Deletion, frameshift

c.608del

p.(Pro203Hisfs*38)

Pathogenic

N/A

Familial JPS

 

Exon 8; MH2 domain

Substitution, missense

c.989A > G

p.(Glu330Gly)

Likely pathogenic

N/A

Sporadic JPS

 

Exon 8; MH2 domain

Substitution, gene deletion

c.1139 + 1G > A

p.( =)

Pathogenic

N/A

Sporadic JPS

 

Exon 8; MH2 domain

Deletion, frameshift

c.1037del

p.(Pro346Leufs*38)

Pathogenic

N/A

Sporadic JPS

 

Exon 8; MH2 domain

Substitution, missense

c.1054G > A

p.(Gly352Arg)

Pathogenic

N/A

Familial JPS

 

Exon 8; MH2 domain

Substitution, missense

c.1081C > A

p.(Arg361Ser)

Pathogenic

N/A

Sporadic JPS

 

Exon 8; MH2 domain

Substitution, missense

c.1081C > G

p.(Arg361Gly)

Likely pathogenic

N/A

Sporadic JPS

 

Exon 9; MH2 domain

Substitution, nonsense

c.1162C > T

p.(Gln388*)

Pathogenic

N/A

Familial JPS

 

Exon 9; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

Sporadic JPS

 

Exon 9; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

Familial JPS

 

Exon 9; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

Familial JPS

 

Exon 9; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

Familial JPS

 

Exon 9; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

Sporadic JPS

 

Exon 9; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

Sporadic JPS

 

Exon 9; MH2 domain

Substitution, missense

c.1321C > A

p.(Arg441Ser)

Unclassified

N/A

Familial JPS

 

Exon 10; MH2 domain

Deletion, frameshift

c.1343_1365del

p.(Gln448Argfs*38)

Pathogenic

N/A

Sporadic JPS

 

Exon 11; MH2 domain

Substitution, missense

c.1525 T > A

p.(Trp509Arg)

Pathogenic

N/A

Sporadic JPS

 

Exon 11; MH2 domain

Substitution, missense

c.1529G > T

p.(Gly510Val)

Pathogenic

N/A

Sporadic JPS

 

Exon 11; MH2 domain

Deletion, frameshift

c.1588del

p.(His530Thrfs*7)

Pathogenic

N/A

Sporadic JPS

 

Sayed et al. (2002) [91]

Exon 4; Linker domain

Deletion

c.608del

p.(Pro203Hisfs*38)

Pathogenic

N/A

Familial JPS, > 10 LGI polyps, FHx of GI cancer, nil upper GI involvement

 

Exon 8; MH2 domain

Substitution

c.989A > G

p.(Glu330Gly)

Likely pathogenic

N/A

Familial JPS, FHx of GI cancer

 

Exon 8; MH2 domain

Deletion

c.1037del

p.(Pro346Leufs*38)

Pathogenic

N/A

Unclassified

 

Exon 8; MH2 domain

Substitution

c.1054G > A

p.(Gly352Arg)

Pathogenic

N/A

Familial JPS, > 10 LGI polyps, FHx GI cancer, upper GI involvement

 

Exon 9; MH2 domain

Substitution

c.1162C > T

p.(Gln388*)

Pathogenic

N/A

Familial JPS, > 10 LGI polyps, FHx GI cancer, upper GI involvement

 

Exon 9; MH2 domain

Deletion

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

Familial JPS, > 10 LGI polyps, FHx GI cancer, upper GI involvement

 

Exon 9; MH2 domain

Deletion

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

Familial JPS, > 10 LGI polyps, FHx GI cancer, upper GI involvement

 

Exon 9; MH2 domain

Deletion

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

Familial JPS, FHx GI cancer, nil upper GI involvement

 

Exon 11; MH2 domain

Deletion

c.1588del

p.(His530Thrfs*7)

Pathogenic

N/A

Familial JPS, > 10 LGI polyps, FHx GI cancer, nil upper GI involvement

 

Kim et al. (2000) [62]

Exon 8; MH2 domain

Substitution; missense

c.1082G > A

p.(Arg361His)

Pathogenic

16

Familial JPS with FHx, > 20 colorectal juvenile polyps, with polypectomy

 

Exon 9; MH2 domain

Substitution; nonsense

c.1162C > T

p.(Gln388*)

Pathogenic

20

JPS with nil FHx, many small bowel, colorectal juvenile polyps, with total colectomy with ileorectal anastomosis

 

Exon 9; MH2 domain

Substitution; missense

c.1168G > A

p.(Glu390Lys)

Pathogenic

16

JPS with nil FHx, 28 colorectal juvenile polyps, with restorative proctocolectomy with ileal pouch-anal anastomosis

 

Roth et al. (1999) [89]

Exon 4; Linker domain

Substitution; nonsense

c.533C > G

p.(Ser178*)

Pathogenic

38

Sporadic JPS with 10–50 juvenile polyps in stomach, small & large intestines

Congenital panhypopituitarism

Exon 9; MH2 domain

Substitution; missense

c.1058A > C

p.(Tyr353Ser)

Pathogenic

N/A

Familial JPS with FHx, < 10 colonic juvenile polyps; Colorectal (42) & pancreatic carcinoma (50)

 

Exon 9; MH2 domain

Substitution; missense

c.1058A > C

p.(Tyr353Ser)

Pathogenic

N/A

Familial JPS with FHx, 10–50 colonic juvenile polyps

 

Exon 10; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

Familial JPS with FHx, < 10 colonic juvenile polyps

Adenomatous changes

Exon 10; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

Familial JPS with FHx, > 50 colonic juvenile polyps

Adenomatous changes

Exon 10; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

Familial JPS with FHx, > 50 colonic juvenile polyps; Colorectal carcinoma (30y)

Adenomatous changes

Exon 10; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

Familial JPS with FHx, < 10 colonic juvenile polyps

Adenomatous changes

Exon 10; MH2 domain

Deletion, frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

Familial JPS with FHx, 10–50 juvenile polyps in stomach, small and large intestine

Adenomatous changes

Friedl et al. (1999) [33]

Exon 8; MH2 domain

Deletion; frameshift

c.831_832del

p.(Pro278*)

Pathogenic

12

Familial JP with > 50 juvenile polyps by age 12. Severe gastric polyposis at 28y. FHx of CRC (father, several paternal relatives)

 

Exon 10; MH2 domain

Deletion; frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

35

Familial JP with multiple juvenile polyps in colon and stomach (35-40y), colonic complications less pronounced. Massive gastric polyposis, requiring partial or total gastrectomy in family members

 

Exon 10; MH2 domain

Deletion; frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

4

Familial JP with multiple juvenile colonic polyps at age 4-5y in 2 brothers

 

Howe et al. (1998) [47]

Exon 6; SMAD4 activation domain

Deletion; frameshift

c.815_820del

p.(Arg272_Ala274delinsThr)

Pathogenic (unconfirmed)

6

30–40 colonic juvenile polyps (aged 6) with no FHx of JP

 

Exon 8; MH2 domain

Deletion; frameshift

c.1170_1171del

p.(Cys391*)

Pathogenic (unconfirmed)

N/A

Colonic and gastric juvenile polyps with FHx of GI symptoms

 

Exon 9; MH2 domain

Deletion; frameshift

c.1432_1434del

p.(Ile478del)

Pathogenic (unconfirmed)

N/A

JPS

 

Exon 9; MH2 domain

Deletion; frameshift

c.1432_1434del

p.(Ile478del)

Pathogenic (unconfirmed)

N/A

JPS

 

Exon 9; MH2 domain

Deletion; frameshift

c.1432_1434del

p.(Ile478del)

Pathogenic (unconfirmed)

N/A

JPS

 

Wain et al. (2014) [106]

Exon 2; MH1 domain

Deletion; frameshift

c.263_267del

p.(Lys88Ilefs*14)

Pathogenic (unconfirmed)

N/A

Mutation shared by 3 families including 6 individuals

 

Exon 2; MH1 domain

Deletion; frameshift

c.373_374insAT

p.(Ser125Asnfs*5)

Pathogenic

N/A

1 reported with JP phenotype

 

Exon 5; Linker domain

Deletion; frameshift

c.692dup

p.(Ser232Glnfs*3)

Pathogenic

N/A

3 individuals shared this mutation, reported with JP phenotype & JP-HHT

 

Exon 5; Linker domain

Deletion; frameshift

c.759del

p.(Phe253Leufs*83)

Pathogenic (unconfirmed)

N/A

1

 

N/A

Intronic

c.1308 + 1G > A

p.( =)

Unclassified

N/A

5 unrelated individuals shared this genotype

 

Exon 8; MH2 domain

Substitution; missense

c.1081C > T

p.(Arg361Cys)

Unclassified

N/A

2 individuals with same mutation, where one was reported with JP and the other JP-HHT

 

Exon 8; MH2 domain

Deletion; frameshift

c.1081del

p.(Arg361Alafs*23)

Pathogenic (unconfirmed)

N/A

1

 

Exon 8; MH2 domain

Substitution; missense

c.1082G > A

p.(Arg361His)

Pathogenic

N/A

3 individuals shared this mutation, some reported with JP, and others JP-HHT

 

Exon 8; MH2 domain

Substitution; nonsense

c.1096C > T

p.(Gln366*)

Pathogenic

N/A

1

 

Exon 9; MH2 domain

Substitution; nonsense

c.1193G > A

p.(Trp398*)

Pathogenic

N/A

1 individual reported with JP

 

Exon 9; MH2 domain

Deletion; frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

Mutation shared by 4 families in 6 individuals

 

Exon 10; MH2 domain

Deletion; frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

N/A

2 unrelated individuals shared this phenotype

 

Exon 11; MH2 domain

Substitution; missense

c.1525 T > A

p.(Trp509Arg)

Pathogenic

N/A

1 individual reported with JP

 

Exon 1–11

Multi-exonic deletion

c.(?_-538)_(1447 + 1_1448-1)del

p.?

Unclassified

N/A

1

 

CASE REPORTS

Sakurai et al. (2021) [90]

Exon 5; Linker domain

Substitution; nonsense

c.502G > T

p.(Gly168*)

Likely pathogenic

49

Multiple gastric hyperplastic polyps in all parts of the stomach. Gastric juvenile polyposis with adenocarcinoma treated with laparoscopic total gastrectomy

Presented with anaemia, Hx of appendicectomy at 7, FHx of breast cancer, nil FHx of GI cancer or polyposis

Poaty et al. (2021) [84]

Exon 9; MH2 domain

Deletion; frameshift

c.1231_1232del

p.(Ser411Leufs*17)

Pathogenic

25

 > 100 colonic juvenile polyps, underwent subtotal colectomy, FHx of colon cancer (paternal)

Presented with long medical history of recurrent diarrhoea since 15, associated with loss of weight, mild abdominal pain, rectal bleeding, anaemia, bloating and intestinal occlusion

Kopiec et al. (2021) [63]

Exon 8; MH2 domain

Substitution; missense

c.1082G > A

p.(Arg361His)

Pathogenic

11

¬40 juvenile polyps, mostly colorectal, but also gastric and small bowel, with JPS diagnosis. FHx of JPS and HHT (maternal)

Features of HHT: telangiectasias, cyanosis of lips/nails, pulmonary AVM, pulmonary artery dilatation and tricuspid valve regurgitation, epistaxis; Initially presented with rectal bleeding (first time when 4), recurrent nasal bleeding

Kang et al. (2021) [59]

Exon 9; MH2 domain

Deletion; frameshift

c.1146_1163del

p.(His382_Val387del)

Pathogenic

7

30–50 colonic juvenile polyps observed with annual polypectomy, ¬10 jejunal polyps and telangiectases

Features of HHT: telangiectasias, pulmonary AVM, epistaxis, digital clubbing

Hashimoto et al. (2020) [42]

Exon 8; MH2 domain

Substitution; missense

c.1081C > T

p.(Arg361Cys)

Pathogenic

9

Multiple colonic & numerous gastric juvenile polyps with FHx of maternal colonic & stomach polyps with early gastric cancer + symptoms of HHT

Features of HHT: epistaxis, telangiectasias, pulmonary, liver and mammary gland AVM, anaemia

Faisal et al. (2020) [31]

Not mentioned

Not mentioned

Not mentioned

0

#N/A

7

 > 20 colonic, gastric and small bowel juvenile polyps. Diagnosed with small bowel carcinoma at 24, passed away from metastatic disease

Hx of IBD on immunosuppressants (increased cancer risk)

Chang et al. (2020) [22]

Not mentioned

Not mentioned

Not mentioned

0

#N/A

32

 > 100 colonic, small bowel and gastric juvenile polyps, large fungating gastric mass (benign hyperplastic tissue) with no known family history. Underwent total gastrectomy

Presented with severe symptomatic anaemia

Aagaard et al. (2020) [1]

Intron b/n exons 5–6 Linker/MH2 domain (breakpoint)

Chromosomal translocation via chromosomal analysis

t(1;18)(p36.1;q21.1)

p.?

Pathogenic (unconfirmed)

N/A

2 juvenile polyps (gastric) with strong FHx of JPS & HHT (brother: multiple JPs, cousin: multiple JPs, CRC at 33y)

HHT features: epistaxis, telangiectasia, FHx of HHT (mother & brother with epistaxis, telangiectasia, PAVM)

Inoguchi et al. (2019) [50]

Exon 9; MH2 domain

Deletion; frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

40

Multiple colonic juvenile polyps with substantial gastric polyposis with FHx of gastric cancer

HHT features: epistaxis, telangiectasia, pulmonary AVM, clubbing; other: aortic aneurysm, fatty degeneration of LV, coronary aneurysm

Leon et al. (2019) [28]

Exon 9; MH2 domain

Duplication

c.1213dup

p.(His405Profs*24)

Pathogenic (unconfirmed)

24

 > 10 colonic juvenile hyperplastic polyps with massive juvenile polyposis of the stomach with high grade dysplasia with total gastrectomy (2017), with FHx of JPS

HHT features: epistaxis, pulmonary AVM

  

Duplication

c.1213dup

p.(His405Profs*24)

Pathogenic (unconfirmed)

47

 > 10 colonic juvenile polyps of adenomatous and hyperplastic nature with massive gastric polyposis with subtotal gastrectomy, with FHx of JPS

HHT features: epistaxis in adolescent years

  

Duplication

c.1213dup

p.(His405Profs*24)

Pathogenic (unconfirmed)

23

 > 20 colonic juvenile hamartomatous polyps, as well as massive gastric polyposis

HHT features: epistaxis in younger years, pulmonary AVM

O'Malley et al. (2019) [81]

Exon 9; MH2 domain

Deletion

c.1228_1229del

p.(Gln410Glufs*18)

Pathogenic

13

JPS-HHT syndrome, FHx of JPS

Ovarian mass with moderate ascites – > R) ovarian immature teratoma

Karnsakul et al. (2018) [61]

Exon 8; MH2 domain

Substitution; missense

c.1052A > T

p.(Asp351Val)

Uncertain significance

6

 > 100 colonic juvenile polyps removed via colonoscopy and polypectomy

Juvenile idiopathic arthritis: presented with fever, poor weight gain, upper and lower limb joint swelling & erythema. Features of HHT: digital clubbing, pulmonary and hepatic AVMs

Bruceta et al. (2018) [16]

Exon 9; MH2 domain

Deletion; frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

44

 > 100 gastric juvenile polyps, few colorectal polyps

Nil features of HHT; other: embolic strokes from atrial septal aneurysm and patent foramen ovale

Bishop et al. (2018) [9]

Exon 8; MH2 domain

Substitution; missense

c.1052A > T

p.(Asp351Val)

Uncertain significance

6

 > 50 colonic juvenile polyps with diagnosis of JPS-HHT syndrome

Systemic juvenile idiopathic arthritis: knee/ankle pain with swelling; Hx of being premature, Henoch-Schonlein purpura; HHT features: clubbing, pulmonary and hepatic AVM, aortic dilation

Wiener et al. (2017) [107]

Exon 10; MH2 domain

Substitution; nonsense

c.1333C > T

p.(Arg445*)

Pathogenic (unconfirmed)

N/A

Nil JPS, FHx of JPS (colonic polyps)

Aortic root dilation with surgical replacement, R) common iliac artery aneurysm; HHT features: epistaxis, telangiectasia

Ramos et al. (2016) [87]

Exon 11; MH2 domain

Substitution; missense

c.1561A > C

p.(Thr521Pro)

Uncertain significance

N/A

Duodenal sessile/pendunculated juvenile polyps throughout, tubular adenoma with low grade dysplasia, severe anaemia; FHx of gastric cancer

Hx of ulcerative colitis with total colectomy and ileostony, HHT features: FHx of HHT, epistaxis, telangiectasia, large angioectasia throughout the stomach (angiodysplasia)

Kadiyska et al. (2016) [57]

Exon 11; MH2 domain

Deletion; frameshift

c.?

p.(Arg531Glyfs*6)

Pathogenic (unconfirmed)

11

One hyperplastic colonic polyp (11y) w/ rectal bleeds, no GI symptoms since

Features of HHT: FHx of HHT, epistaxis, telangiectasia, pulmonary AVM; Other: embolic stroke (30y)

 

Exon 11; MH2 domain

Deletion; frameshift

c.?

p.(Arg531Glyfs*6)

Pathogenic (unconfirmed)

6

N/A

Features of HHT: clubbing, cyanosis, pulmonary AVM, FHx of HHT (maternal)

Burmester et al. (2016) [18]

Exon 9; MH2 domain

Deletion; frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

 

Family with 3 cases of JPS (colorectal polyps), 1 case of JPS-Menetrier's disease

5 cases of Menetrier's disease, 7 cases of asthma, 8 cases of epistaxis, 5 cases of GORD, 4 cases of gastritis, 14 cases of migraine headaches

Brosens et al. (2016) [15]

Not described

Not described

Not described

p.?

#N/A

30

 ~ 27 colorectal juvenile/inflammatory polyps and multiple gastric hyperplastic polyps

Neurofibromatosis-1 diagnosed at 2y with café-au-lait spots, axillary freckling, bilateral optic nerve gliomas and cutaneous neurofibromas, and FHx of NF-1

Soer et al. (2015) [98]

Not described

Deletion of SMAD4 gene

Not described

p.?

#N/A

40

Multiple gastric, small bowel and colonic adenomatous polyps (15) with low grade dysplasia, had gastrectomy, metastatic GI cancer; FHx of son with duodenal & rectal polyps

 
  

Deletion of exons 1–8

c.(?_-127–1)_(1139 + 1_1140-1)del

p.?

#N/A

48

Multiple gastric polyps, two colonic inflammatory polyps, with iron deficiency anaemia

 

Ngeow et al. (2015) [78]

SMAD9; MH1 domain

Substitution; missense

#N/A

#N/A

#N/A

38

 ~ 30 diffuse colonic polyposis (hamartomatous with adipose or ganglioneuroma proliferation) with family history of paternal diffuse polyposis, CRC with deaths in 40s

 

Lin et al. (2015) [70]

Exon 10; MH2 domain

Substitution

c.1342C > T

p.(Gln448*)

Pathogenic

14

15 pedunculated/sessile colonic juvenile polyps, integrated into bowel wall

HHT features: epistaxis, telangiectasia, FHx of pulmonary AVMs

Oliveira et al. (2014) [79]

 

Balanced translocation

c.(?_-538)_(*6575_?)del

p.0

Pathogenic (unconfirmed)

10

JPS with multiple colonic juvenile polyps with annual colonoscopies, with tubular adenomas by 11y, and multiple adenomatous colonic polyposis by 13y

Other: facial dysmorphism, intellectual disability, developmental delay, ADHD, corpus callosum agenesis HHT features: epistaxis, brain AVM, telangiectasia (JPS-HHT)

Teekakirikul et al. (2013) [103]

Exon 10; MH2 domain

Duplication; frameshift

c.1349_1376dup

p.(Ala460Glyfs*43)

Likely pathogenic

7

Multiple juvenile polyps throughout GI tract with low-grade dysplasia with total abdominal colectomy (11y)

Aortopathy: mild dilation of aortic annulus and aortic root; HHT features: pulmonary AVMs, epistaxis

 

Exon 9; MH2 domain

Deletion; frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

6

Colonic juvenile polyps, with partial colectomy and multiple polypectomies

Aortopathy: mild aortic root dilation, family history of sudden cardiac death (acute aortic dissection of father); HHT features: pulmonary and hepatic AVM, epistaxis, FHx of HHT; Other: Marfan syndrome, PFO, myclonic epilepsy, TIA, migraine, sleep apnoea, spondylolisthesis

Honda et al. (2013) [44]

Exon 11; MH2 domain

Substitution; nonsense

c.1421C > G

p.(Ser474*)

Pathogenic (unconfirmed)

29

Familial JPS with numerous gastric (predominant) + colonic juvenile polyps, necessitating gastrectomy, family history of gastric polyps and CRC

 
 

Exon 11; MH2 domain

Substitution; nonsense

c.1421C > G

p.(Ser474*)

Pathogenic (unconfirmed)

57

Familial and generalised JPS with multiple gastric (predominant) + small bowel + colonic juvenile polyps, with history of polypectomies

 

Jee et al. (2013) [52]

Exon 10; MH2 domain

Substitution; nonsense

c.1239C > G

p.(Tyr413*)

Pathogenic

21

Multiple juvenile polyps in stomach, small bowel & colon, with family history of mother with gastric polyposis & CRC (gastrectomy, right hemicolectomy)

 

Stadler et al. (2012) [99]

Exon 11; MH2 domain

Insertion

c.1507_1508insATCC

p.(Met503Asnfs*25)

Pathogenic (unconfirmed)

38

Diffuse, severe grape-like gastric hyperplastic polyps, and many large colonic polyps, with total gastrectomy + right hemicolectomy with family history of early onset gastric cancer (death of sister/father in 40s)

 

Schwetz et al. (2012) [95]

Exon 4; Linker domain

Deletion

c.543del

p.(Ile182Serfs*20)

Pathogenic (unconfirmed)

8

Ileocolic intussusception with massive colonic polyposis w/ total colectomy

Family history: grandmother (52y massive polyposis of stomach with total gastrectomy), 7/9 family members with gastric manifestations, 2/9 gallbladder polyps, 3/9 GI AVMs ?JP-HHT

Piepoli et al. (2012) [82]

Exon 9; MH2 domain

Deletion; frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

4

Familial JPS with several colonic polyps with tubular adenoma & gastric hyperplastic polyps (with H.pylori infection)

 
 

Exon 9; MH2 domain

Deletion; frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

13

Familial JPS with numerous colonic juveile polyps with tubular adenoma & gastric polyps (with H.pylori infection)

 
 

Exon 9; MH2 domain

Deletion; frameshift

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

17

Familial JPS with innumerable gastric polyps (with H.pylori infection), few rectal hyperplastic polyps

Menetrier's gastropathy

Zimmer et al. (2011) [110]

Exon 9; MH2 domain

Substitution; missense

c.1157G > A

p.(Gly386Asp)

Pathogenic/Likely pathogenic

10

Diffuse colorectal juvenile polyposis, several gastric polyps, large duodenal juvenile polyps

HHT: Ileal AVM, digital clubbing, pulmonary AVM

Andrabi et al. (2011) [2]

Exon 10; MH2 domain

Substitution; nonsense

c.1333C > T

p.(Arg445*)

Pathogenic

7

Some colonic hamartomatous polyps

Mild mitral regurgitation, family history of sudden cardiac death, Marfan's syndrome; HHT: epistaxis

   

Not tested

Not tested

Not tested

21

5–10 colonic juvenile polyps

Mild aortic dilatation, severe mitral regurgitation, mitral valve prolapse with "Marfan-like CTD" (passed away at 21—arrhythmia precipitated by mitral valve prolapse with underlying marfanoid features)

 

Exon 10; MH2 domain

Substitution; nonsense

c.1333C > T

p.(Arg445*)

Pathogenic

27

Colonic polyps

Normal echocardiogram in adulthood

 

Exon 10; MH2 domain

Substitution; nonsense

c.1333C > T

p.(Arg445*)

Pathogenic

5

Mulitple juvenile colonic polyps with total colectomy (19y)

Mild aortic dilatation, mitral valve prolapse

   

Not tested

Not tested

Not tested

43

Multiple colonic juvenile and some adenomatous polyps with metastatic colorectal cancer (pulmonary metastases)

Aortic dilatation, severe mitral regurgitation (passed away at 43)

Poletto et al. (2010) [85]

  

Not tested

Not tested

Not tested

9

Multiple juvenile polyps throughout the colon with family history of JPS (mother)

HHT: epistaxis, digital clubbing, pulmonary AVM, left-to-right shunt, family history of HHT (epistaxis, haemoptysis, telangiectasia, pulmonary AVM)

Iyer et al. (2010) [51]

Exon 9; MH2 domain

Deletion

c.1228_1229del

p.(Gln410Glufs*18)

Pathogenic

24

JPS diagnosed given multiple harmatomatous polyps throughout the colon, with total colectomy

HHT: epistaxis, telangiectasia, pulmonary AVM, brain AVM—HHT

Pitiliciuc et al. (2008) [83]

Exon 11; MH2 domain

Substitution; nonsense

c.1527G > A

p.(Trp509*)

Pathogenic

31

Generalised juvenile polyposis: Gastric polyps of hypertrophic and polypoid nature with foveolar hyperplasia, nil colorectal/SB polyps, with family history of CRC and gastric cancer

 
 

Exon 9; MH2 domain

Deletion

c.1245_1248del

p.(Asp415Glufs*20)

Pathogenic

38

Generalised juvenile polyposis: Multiple colonic hyperplastic polyps w/ hypertrophic and polypoid gastropathy, on the background of villous caecal tumour & right hemicolectomy

Menetrier's disease; Hx of R) ovarian teratoma, uterine fibroma, autoimmune hyperthyroidism, lobular breast carcinoma, FHx of brain and breast cancer

Shikata et al. (2005) [97]

Exon 5; Linker domain

Insertion; frameshift

c.692dup

p.(Ser232Glnfs*3)

Pathogenic

24

GJP: Profuse gastric polyposis with small areas of adenocarcinoma, nil intestinal polyps, treated with gastrectomy

HHT: pulmonary AVM; other: paroxysmal VT with cardio defibrillator

Lamireau et al. (2005) [64]

Exon 11; MH2 domain

Substitution; nonsense

c.1236C > G

p.(Tyr412*)

Pathogenic

5

Several colonic juvenile polyps with adenomatous component, large ileal juvenile polyp caussing intussesception

Hypertrophic osteoarthropathy: digital clubbing of finger and toes (acro-osteolysis of distal phalanges of toes with soft-tissue swelling)

 

Exon 11; MH2 domain

Substitution; nonsense

c.1236C > G

p.(Tyr412*)

Pathogenic

3

Several colonic juvenile polyps

Hypertrophic osteoarthropathy: digital clubbing of finger and toes (acro-osteolysis of distal phalanges of toes with soft-tissue swelling)

Burger et al. (2002) [17]

Exon 9; MH2 domain

Substitution; missense

c.1157G > A

p.Gly386Asp

Pathogenic/Likely pathogenic

11

70 colonic juvenile polyps

HHT: pulmonary AVM, digital clubbing

Baert et al. (1983) [7]

  

#N/A

#N/A

#N/A

15

Juvenile intestinal polyposis involving duodenum and colon

Hypertrophic osteoarthropathy: finger clubbing, pretibial swelling – > extensive bilateral laminated new bone formation of ulna and right radius, hands and feet; HHT: pulmonary AVM