The c.227T>C is a missense variant in GJB2 predicted to cause substitution of leucine to proline at amino acid 76. The highest population minor allele frequency in gnomAD v4.1 is 0.0006779% (8/1180042) in the European (non-Finnish) population, which is a low enough frequency to apply PM2_Supporting based on the thresholds defined by the ClinGen Hearing Loss Expert Panel for autosomal recessive hearing loss (PM2_Supporting). The variant has been detected in 4 probands with hearing loss (3.0 PM3 points). For two of those patients, a pathogenic variant was observed in trans (PMID: 17666888, 19274344), in a third the variant was observed in a homozygous state (ARUP Laboratories internal data, SCV001158697.1), and in the last patient the variant was observed with another pathogenic variant although with unknown phase (Partners LMM internal data, SCV000061486.5) (PM3_Strong). The variant has been reported to segregate with hearing loss in one affected family member (PP1, PMID: 19274344). The REVEL computational prediction tool produced a score of 0.976, which is above the threshold necessary to apply PP3. In summary, this variant meets criteria to be classified as likely pathogenic for autosomal recessive nonsyndromic hearing loss based on the ACMG/AMP criteria applied as specified by the ClinGen Hearing Loss Expert Panel : PM3_Strong, PM2_Supporting, PP1, PP3. (The ClinGen Hearing Loss VCEP Specifications Version 2, 04/17/2024)