NM_000463.3(UGT1A1):c.1184G>C (p.Gly395Ala)

UGT1A1 c.1184G>C (p.Gly395Ala) is a null/near-null Crigler-Najjar allele, so the cleanest disease-level approach is to replace bilirubin-conjugating activity through gene therapy while keeping transplant, phenobarbital, and precise editing in the mix for bridging and future fixes.

ClinVar counts c.1184G>C as a pathogenic Crigler-Najjar type I allele (VCV003391386). Liver-directed AAV-UGT1A1 programs (GNT0003) have achieved sustained bilirubin correction in preclinical models and early trials while remaining the most advanced path toward regulatory filings (PMID:27722180; PMID:29448836; PMID:37585628; NCT:NCT03466463). Whole-liver transplant (and even hepatocyte infusion) continues to rescue severe CNS patients with excellent survival and long-term graft function, so the surgical option anchors cases where gene therapy access is delayed (PMID:33544952; PMID:11065252). Type II patients remain alive on phenobarbital/phototherapy, illustrating that enzyme induction can stabilize bilirubin levels while definitive therapy is organized (PMID:38784231). Preclinical UGT1A1 correction via chimeric oligonucleotides, CRISPR/LV, or HDR in Gunn rats demonstrates that direct editing-based fixes can permanently restore enzyme expression and may eventually replace vector-based approaches (PMID:10468611; PMID:16581301; PMID:20546738).

These are disease-level modalities; there is no clinical dataset stratifying outcomes by p.Gly395Ala alone, and every pathway retains unique extrapolation risk (AAV immunity, transplant fibrosis, chronic phenobarbital toxicity, and editing off-targets). Treatments still demand careful bundle: early phototherapy/phenobarbital to avoid kernicterus, early transplant bridging in the acute neonatal phase, and, ideally, gene therapy/editing once vector availability, safety, and delivery logistics are settled.