Carnitine-Acylcarnitine Translocase (CACT) Deficiency​


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Introduction

The SLC25A20 gene, solute carrier family 25 member 20, is located on chromosome 3p21.31 and has 9 exons spanning ~16.5kb (1). It encodes a 302 amino acid protein that is one of several closely related mitochondrial-membrane carrier proteins shuttling substrates between cytosol and the intramitochondrial matrix space.

The SLC25A20 protein mediates the transport of acylcarnitines into mitochondrial matrix for oxidation by the mitochondrial fatty acid-oxidation pathway (2). It also mediates the electroneutral exchange of acylcarnitines (O-acyl-(R)-carnitine or L-acylcarnitine) of different acyl chain lengths (ranging from O-acetyl-(R)-carnitine to long-chain O-acyl-(R)-carnitines) with free carnitine ((R)-carnitine or L-carnitine) across the mitochondrial inner membrane (3,4).

​Variations in this gene are associated with carnitine-acylcarnitine translocase deficiency, which can cause a variety of pathological conditions such as hypoglycemia, cardiac arrest, hepatomegaly, hepatic dysfunction and muscle weakness, and is usually lethal in newborns and infants (1). The protein is expressed in liver, duodenum and other tissues (5).

More than 58 disease-causing variants in the SLC25A20 gene have been identified in patients and are represented in this database. The variants occur across the entire length of the gene and include frameshift, splice site, copy-number, nonsense and missense variants (6).

Variant List

To see more information, click on the Variant in the table. Hover on the Variant in the table to see its location on the gene. For more information on table headers, HGVS nomenclature, and ACMG classification please use the following links here.

Gene Structure
Variant IDVariantAmino Acid ChangeGene SymbolVariant TypeEffect TypeDisplay ACMG CallDisease SubtypeTimes ObservedPhenotypePMIDLocationPresent in ClinVar
SLC25A20_0060c.?Deletion (Exon 5-9)SLC25A20CNVDeletionPathogenicCACT<5Hyperammonemia, Hypoglycemia21605995Unknown
SLC25A20_0061c.906A>Gp.*302Trpext*2SLC25A20SNVMissenseUncertain SignificanceCACT<5Elevated circulating creatine kinase concentration, Liver abnormality, Other, Peripheral neuropathyExon 9Yes
SLC25A20_0002c.897dupp.Asn300Glnfs*24SLC25A20DuplicationFrameshiftPathogenicCACT5-10Cardiac arrest, Cardiomyopathy, Cyanosis, Dehydration, Hypoglycemia, Liver abnormality, Muscle weakness, Seizure11162577, 36109795, 9399886Exon 9Yes
SLC25A20_0003c.868G>Ap.Ala290ThrSLC25A20SNVMissenseUncertain SignificanceCACT<5Exon 9Yes
SLC25A20_0004c.843+4_843+50delIntronicSLC25A20DeletionSplice regionLikely PathogenicCACT<5Abnormality of metabolism/homeostasis, Anorexia, Arrhythmia, Cardiomyopathy, Gas....10472533, 15365988Intron 8Yes
SLC25A20_0005c.843+4A>GIntronicSLC25A20SNVSplice regionUncertain SignificanceCACT<5Liver abnormalityIntron 8Yes
SLC25A20_0006c.842C>Tp.Ala281ValSLC25A20SNVMissensePathogenicCACT<5Cardiac-other, Coma, Feeding refusal, Hyperammonemia, Hypoglycemia, Liver abnormality15365988Exon 8Yes
SLC25A20_0007c.824G>Ap.Arg275GlnSLC25A20SNVMissenseLikely PathogenicCACT5-10Arrhythmia, Cardiac arrest, Cardiomyopathy, Decreased body weight, Developmental....32337051Exon 8Yes
SLC25A20_0008c.823C>Tp.Arg275*SLC25A20SNVNonsensePathogenicCACT<5Hyperammonemia, Hypoglycemia21605995Exon 8Yes
SLC25A20_0009c.804delp.Phe269Serfs*4SLC25A20DeletionFrameshiftPathogenicCACT5-10Abnormality of metabolism/homeostasis, Encephalopathy, Hypertension, Hypoglycemi....12559850, 21605995, 24088670, 31156707, 35360862Exon 8Yes
SLC25A20_0010c.673_782delp.Ala225Serfs*27SLC25A20Copy Number LossDeletionLikely PathogenicCACT<5Abnormality of metabolism/homeostasis, Arrhythmia, Cardiomyopathy, Liver abnormality, Muscle weakness21605995, 9686371Exon 7-8, Intron 7No
SLC25A20_0011c.779_781delp.Glu260delSLC25A20DeletionDeletionUncertain SignificanceCACT<5Abnormality of metabolism/homeostasis, Cardiac-other, Hyperbilirubinemia, Hypoglycemia, Lethargy, Liver abnormality21605995Exon 8Yes
SLC25A20_0012c.752_761delp.Asp251Glyfs*3SLC25A20DeletionFrameshiftPathogenicCACT<5Abnormality of metabolism/homeostasis, Arrhythmia, Hypoglycemia21605995Exon 8No
SLC25A20_0013c.719-9_719-1dupIntronicSLC25A20InsertionIntronicUncertain SignificanceCACT<5Arrhythmia, Cardiomyopathy, Coma, Hyperammonemia, Hypoglycemia, Hypotonia, Lethargy, Liver abnormality, Pulmonary/respiratory, Seizure31108048, 33194920Intron 7No
SLC25A20_0014c.718+1G>CIntronicSLC25A20SNVSplice donorPathogenicCACT<5Arrhythmia, Gastrointestinal-other, Hyperammonemia, Hypoglycemia, Hypotonia, Liver abnormality, Pulmonary/respiratory15365988Intron 7Yes
SLC25A20_0015c.715A>Cp.Thr239ProSLC25A20SNVMissenseUncertain SignificanceCACT<531319225Exon 7Yes
SLC25A20_0016c.713A>Gp.Gln238ArgSLC25A20SNVMissensePathogenicCACT21-30Arrhythmia, Cardiomyopathy, Hyperammonemia, Hypoglycemia, Hypothermia, Low blood pressure, Microcephaly, Pulmonary/respiratory15057979, 23867825, 32906206Exon 7Yes
SLC25A20_0017c.706C>Tp.Arg236*SLC25A20SNVNonsensePathogenicCACT<534626609Exon 7Yes
SLC25A20_0018c.691G>Cp.Asp231HisSLC25A20SNVMissensePathogenicCACT<5Hyperammonemia, Hypoglycemia, Liver abnormality12559850, 15365988Exon 7Yes
SLC25A20_0019c.689C>Gp.Pro230ArgSLC25A20SNVMissenseLikely PathogenicCACT<512559850Exon 7No
SLC25A20_0020c.658G>Ap.Gly220ArgSLC25A20SNVMissenseUncertain SignificanceCACT<5Cardiomyopathy, Encephalopathy, Hyperammonemia, Seizure32905135Exon 7Yes
SLC25A20_0021c.609-1G>AIntronicSLC25A20SNVSplice acceptorPathogenicCACT<512559850Intron 6No
SLC25A20_0022c.609-3C>GIntronicSLC25A20SNVSplice regionPathogenicCACT<5Abnormal muscle tone, Abnormality of metabolism/homeostasis, Arrhythmia, Hypogly....16919490, 25604974Intron 6No
SLC25A20_0023c.576G>Ap.Trp192*SLC25A20SNVNonsensePathogenicCACT<5Asphyxia, Cardiac arrest, Hypoglycemia, Hypotonia, Irritability, Liver abnormality, Oliguria, Pulmonary/respiratory, Rhabdomyolysis24088670Exon 6Yes
SLC25A20_0024c.536A>Gp.Asp179GlySLC25A20SNVMissenseUncertain SignificanceCACT<5Abnormality of metabolism/homeostasis, Cardiac arrest, Gastrointestinal-other, H....25614308Exon 6Yes
SLC25A20_0025c.533G>Ap.Arg178GlnSLC25A20SNVMissensePathogenicCACT<512559850Exon 5Yes
SLC25A20_0026c.532C>Tp.Arg178*SLC25A20SNVNonsensePathogenicCACT5-10Abnormality of metabolism/homeostasis, Apnoea, Arrhythmia, Cardiomyopathy, Hyper....12559850, 12801121, 15365988, 25614308Exon 5Yes
SLC25A20_0027c.528delp.Met177Cysfs*12SLC25A20DeletionFrameshiftPathogenicCACT<521605995Exon 5Yes
SLC25A20_0028c.516T>Cp.Thr172=SLC25A20SNVSilentUncertain SignificanceCACT<524088670Exon 5Yes
SLC25A20_0029c.496C>Tp.Arg166*SLC25A20SNVNonsensePathogenicCACT<5Abnormality of metabolism/homeostasis, Arterial hypertension, Cardiac-other, Com....10384384, 10653336, 12559850, 21605995Exon 5Yes
SLC25A20_0030c.463T>Cp.Cys155ArgSLC25A20SNVMissenseLikely PathogenicCACT<5Discoloured stools, Jaundice31561269Exon 5No
SLC25A20_0031c.417+1G>TIntronicSLC25A20SNVSplice donorPathogenicCACT<523322164, 23850792Intron 4No
SLC25A20_0032c.397C>Tp.Arg133TrpSLC25A20SNVMissensePathogenicCACT<5Abnormality of metabolism/homeostasis, Arrhythmia, Cardiac-other, Cardiomyopathy....15365988, 21605995, 32905135Exon 4Yes
SLC25A20_0033c.261_388delp.Val88Trpfs*53SLC25A20Copy Number LossDeletionPathogenicCACT<5Abnormality of metabolism/homeostasis, Arrhythmia, Cardiomyopathy, Liver abnormality, Muscle weakness21605995, 9686371Exon 3-4, Intron 3No
SLC25A20_0034c.383T>Ap.Met128LysSLC25A20SNVMissenseUncertain SignificanceCACT<526589311Exon 4No
SLC25A20_0035c.364G>Ap.Val122IleSLC25A20SNVMissenseUncertain SignificanceCACT<5Cardiomyopathy, Elevated circulating creatine kinase concentration, Myopathy, Other, Peripheral neuropathyExon 4Yes
SLC25A20_0036c.326+1delIntronicSLC25A20DeletionSplice donorPathogenicCACT5-10Abnormal muscle tone, Abnormality of metabolism/homeostasis, Attention deficit h....11592821, 15365988, 16919490, 25604974, 32070364, 36109795, 9290607Intron 3Yes
SLC25A20_0037c.270delp.Phe91Leufs*38SLC25A20DeletionFrameshiftPathogenicCACT<5Abnormality of metabolism/homeostasis, Circulatory failure, Coma, Hypoglycemia, ....11592821, 35360862, 8450053Exon 3Yes
SLC25A20_0038c.269T>Gp.Phe90CysSLC25A20SNVMissenseLikely PathogenicCACT<5Hypoglycemia36109795Exon 3No
SLC25A20_0062c.254T>Ap.Met85LysSLC25A20SNVMissenseUncertain SignificanceCACT<5Exon 3Yes
SLC25A20_0039c.241G>Ap.Gly81ArgSLC25A20SNVMissensePathogenicCACT<523322164, 23850792Exon 3Yes
SLC25A20_0040c.226G>Cp.Ala76ProSLC25A20SNVMissenseUncertain SignificanceCACT<5Retinal/choroid disorderExon 3Yes
SLC25A20_0041c.199-10T>GIntronicSLC25A20SNVIntronicLikely PathogenicCACT30+Abnormality of metabolism/homeostasis, Anemia, Arrhythmia, Asphyxia, Cardiac arr....11592821, 12559850, 1598097, 24088670, 25459972, 25604974, 26117549, 27066551, 29137068, 31108048, 33194920, 34626609, 35314707, 35360862, 36419912, 8739960, 9290607Intron 2Yes
SLC25A20_0042c.198+4G>AIntronicSLC25A20SNVSplice regionUncertain SignificanceCACT<5Intron 2Yes
SLC25A20_0043c.160_163delinsTGGGp.Gly54_Thr55delinsTrpAlaSLC25A20DelinsMissensePathogenicCACT5-10Abnormality of metabolism/homeostasis, Cardiac-other, Encephalopathy, Hypoglycem....15365988, 21605995, 25614308Exon 2Yes
SLC25A20_0044c.110G>Cp.Arg37ProSLC25A20SNVMissenseLikely PathogenicCACT<5Hyperaminoaciduria31575911Exon 2No
SLC25A20_0045c.109C>Tp.Arg37*SLC25A20SNVNonsensePathogenicCACT<534626609Exon 2Yes
SLC25A20_0046c.106-2A>TIntronicSLC25A20SNVSplice acceptorPathogenicCACT<5Cardiac arrest24088670Intron 1Yes
SLC25A20_0047c.94G>Ap.Asp32AsnSLC25A20SNVMissenseLikely PathogenicCACT<512559850Exon 1No
SLC25A20_0048c.84delp.His29Thrfs*100SLC25A20DeletionFrameshiftPathogenicCACT<5Arrhythmia, Cardiac-other, Coma, Hypoglycemia, Hypotension, Lethargy, Liver abno....11592821, 1598097Exon 1Yes
SLC25A20_0049c.82G>Tp.Gly28CysSLC25A20SNVMissensePathogenicCACT5-10Abnormality of metabolism/homeostasis, Developmental delay, Hypoglycemia, Microcephaly12559850, 33123633, 34374989, 9544911Exon 1Yes
SLC25A20_0050c.67T>Cp.Cys23ArgSLC25A20SNVMissenseLikely PathogenicCACT<5Cardiomyopathy, Hypoglycemia21605995Exon 1No
SLC25A20_0051c.65_69dupp.Leu24Cysfs*107SLC25A20InsertionFrameshiftPathogenicCACT<512559850Exon 1No
SLC25A20_0052c.59G>Ap.Gly20AspSLC25A20SNVMissenseUncertain SignificanceCACT<5Cardiomyopathy, Hyperammonemia, Hypoglycemia, Hypothermia, Hypotonia, Liver abnormality, Respiratory tract infection25614308Exon 1No
SLC25A20_0053c.50G>Cp.Gly17AlaSLC25A20SNVMissenseUncertain SignificanceCACT<5Attention deficit hyperactivity disorder, Cardiac-other, Encephalopathy, Hypogly....32070364Exon 1No
SLC25A20_0054c.47C>Tp.Ala16ValSLC25A20SNVMissenseUncertain SignificanceCACT<5Discoloured stools, Jaundice31561269Exon 1Yes
SLC25A20_0055c.10C>Tp.Gln4*SLC25A20SNVNonsensePathogenicCACT<5Abnormality of metabolism/homeostasis, Cardiac arrest, Hypoglycemia, Hypotonia36109795Exon 1Yes
SLC25A20_0056c.3G>AIntronicSLC25A20SNVMissensePathogenicCACT<523322164, 23850792Exon 1No
SLC25A20_0063c.1A>Gp.Met1ValSLC25A20SNVMissensePathogenicCACT<529137068, 35360862Exon 1Yes
    Notes:
  • * Click the PMID number to go to the corresponding publication.
  • * All variants are referencing NM_000387.6 and there is no change between these versions with respect to the coding sequence.
  • * Genomic coordinates are calculated based on variant data provided: in some cases coordinates are estimated in order to allow users to sort the variants linearly, by approximation.
  • * Click the Present in ClinVar link to go to the corresponding ClinVar VariationID.
    Definition of acronyms:
  • "*": Referenced a stop codon insertion when listed under amino acid change.
  • ACMG: American College of Medical Genetics and Genomics
  • CNV: Copy number variant which here describes a change 100 DNA nucleotides or larger.
  • SNV: Single DNA nucleotide variant
  • del: Deletion
  • dup: Duplication
  • fs: Frameshift
  • ins: Insertion

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