# Missense Constraint in Intrinsically Disordered Proteins Enhances Missense Variant Interpretation in Neurodevelopmental Disorders

## TL;DR

This study improves the interpretation of genetic variants in disordered proteins linked to neurodevelopmental disorders by integrating disorder annotations and genetic constraint measures.

## Contribution

The novel integration of disorder annotations and updated MTR profiles enhances missense variant interpretation in intrinsically disordered regions.

## Key findings

- MTR identifies localized low-tolerance subregions within intrinsically disordered regions (IDRs).
- Ordered and structural transition regions show the strongest depletion of missense variation.
- Constraint in NDD proteins is highly localized and context-dependent.

## Abstract

Background/Objectives: Interpreting missense variants in intrinsically disordered proteins (IDPs) remains a major challenge, as these proteins lack stable structure and are under-represented in experimental and clinical annotations. Variants occurring in IDPs are disproportionately classified as variants of uncertain significance (VUS), reflecting the absence of appropriate predictive tools rather than true biological neutrality. Here, we address this challenge using a curated dataset of neurodevelopmental disorder (NDD)-associated proteins. Methods: We integrated curated and predicted disorder annotations from DisProt and MobiDB to characterize the structural landscape of 339 NDD-associated proteins. To quantify a regional genetic constraint, we recalculated the Missense Tolerance Ratio (MTR) using a published framework adapted to the recent gnomAD release (v4.1.0). Integration with 33,124 ClinVar-reported missense variants revealed that, while mean constraint levels differ only modestly across structural states, ordered and structural transition regions show the strongest depletion of missense variation. Results: MTR identifies localized low-tolerance subregions within IDRs, indicating that these regions are not uniformly permissive and can harbor functionally essential elements. Conclusions: Overall, our results demonstrate that missense constraint in NDD proteins is highly localized and context-dependent, and that integrating high-quality disorder annotations with updated MTR profiles can improve the prioritization and interpretation of missense variants in IDRs and IDPs.