The prevalence of protein misfolding as a mechanism for hereditary deafness

Hearing loss is the most common sensory deficit impacting [~]5% of the worlds population. The Deafness Variation Database (DVD) is a public resource of deafness variants, containing over 380,000 missense variants across 224 genes, with 303,577 classified as a variant of uncertain significance (VUS). To address the challenge of evaluating each deafness associated VUS, we evaluate a family of probabilistic frameworks to quantify the strength of computational evidence based on ACMG/AMP recommendations. First, CADD and REVEL are compared using Bayesian models parameterized using either a ClinVar 2019 dataset or labeled DVD variants. The REVEL model built using the DVD dataset demonstrates the best accuracy, sensitivity, and specificity. Incorporation of (in)tolerance to missense variation based on sorting each gene into three bins (tolerant, average, intolerant) shows that intolerant DVD genes are consistent with a higher prior probability of being pathogenic (25.7%) than average (10.7%) or tolerant (8.7%) genes. Finally, the impact of protein folding stability was incorporated using a 2D likelihood, which surpassed the simpler models while also offering a biophysical rationale for the disease mechanism. The protein folding-informed Bayesian model results in 28,866 prioritized VUSs reaching a posterior probability of pathogenicity above 98% with a false positive rate of only 0.14%. Overall, 54,752 missense variants are predicted to cause protein folding destabilization of greater than 1.0 kcal/mol, while 18,706 of the 28,886 prioritized VUS (65%) surpass this threshold. From these VUSs, we identify twelve probands where the patients genetic diagnosis is upgraded to likely pathogenic/pathogenic. We highlight two variants that cause clear structural disruption, demonstrating the impact of biophysical characterization on variant evaluation. Author SummaryWe investigate the impacts of single amino acid changes on protein structure and folding in the context of hearing loss. Hearing loss is the most common impairment of the main senses affecting nearly 5% of the worlds population. About 45% of people with hearing loss receive a diagnosis after targeted genetic testing. Here, we integrate biophysical data that quantifies the effect of a change to protein sequence on protein folding in combination with genetic data to improve our ability to identify protein amino acid changes that are likely to impact hearing. Our work leads to 12 patients receiving an upgraded diagnosis with their variant disrupting protein stability. Although the method is applied to hearing loss, it can be used for interpreting protein sequence changes in other disease contexts.