Evo 2 Predicts Cardiomyopathy-Associated Variants and Elucidates Their Underlying Mechanisms

Background: Although advances in next-generation sequencing have accelerated the identification of genetic variants in cardiomyopathy, interpreting variants of uncertain significance (VUS) remains a clinical challenge. Evo 2 is a high-resolution genomic artificial intelligence model capable of predicting pathogenicity across large sequence contexts and enabling mechanistic interpretation; however, its application in cardiovascular genetics is limited. Here, we evaluated the utility of Evo 2 for assessing the pathogenicity and underlying mechanisms of cardiomyopathy-associated variants. Methods: We used Evo 2 to predict the pathogenicity of single-nucleotide variants in cardiomyopathy-related genes listed on ClinVar. We assessed the ability of the model to identify characteristic structural features in both coding and noncoding regions using internal representation such as embeddings, and to infer the molecular mechanisms of variants within these regions. Results: Evo 2 demonstrated high predictive accuracy for pathogenicity, achieving an AUROC of 0.983 and an AUPRC of 0.915. Notably, sparse autoencoders (SAEs) from embeddings identified features corresponding to higher-order structural features, including coiled-coil and actin-binding domains characteristic of cardiomyopathy-related proteins, and accurately detected mutations known to disrupt these domains. The model recognized the binding motif of the cardiac-enriched transcription factor TBX5 with SAEs and accurately predicted a single-nucleotide polymorphism affecting TBX5 binding affinity after supervised fine-tuning. Conclusions: Evo 2 demonstrated strong performance for both predicting pathogenicity and extracting biological features of cardiomyopathy-associated variants. It may represent a powerful emerging tool for evaluating VUS in cardiovascular medicine.