#10
Case10: Male, 14 years onset, 37 years diagnosis
CaseAddInfo: Late-Onset Pompe Disease
#10
Case10: Male, 14 years onset, 37 years diagnosis
CaseAddInfo: Late-Onset Pompe Disease
#16
Case16: Female, 9 years onset, 11 years diagnosis
CaseAddInfo: Late-Onset Pompe Disease
c.1629C>G
Variant: NM_000152.4:c.1629C>G (p.Tyr543Ter)
CAID: CA401367368 https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_000152.3%3Ac.1629C%3EG
gnomAD: Not in gnomAD
VariantAddInfo: This variant was declared as novel and found in a patient, but no further information was given.
T
CaseA1: 26 years onset
CaseAddInfo: Late-Onset Pompe Disease, Sibling of A2
c.1212C>G
Variant: NM_000152.4:c.1212C>G (p.Asp404Glu)
CAID: CA401365194 https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_000152.3%3Ac.1212C%3EG
gnomAD: Not in gnomAD
VariantAddInfo: This variant was declared as novel and found in a patient, but no further information was given.
#22
Case22: Male, 16 years onset, 41 years diagnosis
CaseAddInfo: Late-Onset Pompe Disease
c.2109del
Variant: NM_000152.4:c.2109del (p.Tyr703Ter)
CAID: CA891862616 https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_000152.3%3Ac.2109del
gnomAD: Not in gnomAD
VariantAddInfo: This variant was declared as novel and found in a patient, but no further information was given.
#13
Case13: Male, 9 years onset, 19 years diagnosis
CaseAddInfo: Late-Onset Pompe Disease
Case10: Male, 80 years report
HPOsFreeText: 7 years of ERT completed, 6 Minute Walking Test at 220 meters, Forced Vital Capacity at 44%
GenotypingMethod: GAA Gene Sequencing
Variant1: NM_000152.4:c.-32-13T>G
ClinVar: 4027 http://www.ncbi.nlm.nih.gov/clinvar/variation/4027
gnomAD: Ashkenazi Jewish 5.541e-3, Overall 3.401e-3 http://gnomad.broadinstitute.org/variant/17-78078341-T-G
Variant2: NM_000152.4:c.1927G>A (p.Gly643Arg)
ClinVar: 4023 https://www.ncbi.nlm.nih.gov/clinvar/variation/4023/
gnomAD: European (Non-Finnish) 3.667e-5, Overall 2.479e-5 http://gnomad.broadinstitute.org/variant/17-78086713-G-A
CaseAddInfo: Late Onset Pompe Disease
Case29: Female, 50 years report
HPOsFreeText: ERT not started, 6 Minute Walking Test at 354 meters, Forced Vital Capacity at 116%
GenotypingMethod: GAA Gene Sequencing
Variant1: NM_000152.4:c.-32-13T>G
ClinVar: 4027 http://www.ncbi.nlm.nih.gov/clinvar/variation/4027
gnomAD: Ashkenazi Jewish 5.541e-3, Overall 3.401e-3 http://gnomad.broadinstitute.org/variant/17-78078341-T-G
Variant2: NM_000152.4:c.2481+102_2646+31del (p.Gly828_Asn882del) (exon 18 del)
ClinVar: 4031 https://www.ncbi.nlm.nih.gov/clinvar/variation/4031/
gnomAD: Not in gnomAD
CaseAddInfo: Late Onset Pompe Disease
Case37: Female, 62 years report
HPOsFreeText: ERT not started, 6 Minute Walking Test at 475 meters, Forced Vital Capacity at 94%
GenotypingMethod: GAA Gene Sequencing
Variant1: NM_000152.4:c.-32-13T>G
ClinVar: 4027 http://www.ncbi.nlm.nih.gov/clinvar/variation/4027
gnomAD: Ashkenazi Jewish 5.541e-3, Overall 3.401e-3 http://gnomad.broadinstitute.org/variant/17-78078341-T-G
Variant2: NM_000152.4:c.2481+102_2646+31del (p.Gly828_Asn882del) (exon 18 del)
ClinVar: 4031 https://www.ncbi.nlm.nih.gov/clinvar/variation/4031/
gnomAD: Not in gnomAD
CaseAddInfo: Late Onset Pompe Disease
Case33: Female, 79 years report
HPOsFreeText: ERT not started, 6 Minute Walking Test at 312 meters, Forced Vital Capacity at 113%
GenotypingMethod: GAA Gene Sequencing
Variant1: NM_000152.4:c.-32-13T>G
ClinVar: 4027 http://www.ncbi.nlm.nih.gov/clinvar/variation/4027
gnomAD: Ashkenazi Jewish 5.541e-3, Overall 3.401e-3 http://gnomad.broadinstitute.org/variant/17-78078341-T-G
Variant2: NM_000152.4:c.1560C>G (p.Asn520Lys)
CAID: CA401367200 http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_000152.4%3Ac.1560C%3EG
gnomAD: Not in gnomAD
CaseAddInfo: Late Onset Pompe Disease
Case16: Female, 61 years report
HPOsFreeText: 7 years of ERT completed, 6 Minute Walking Test at 392 meters, Forced Vital Capacity at 52%
GenotypingMethod: GAA Gene Sequencing
Variant1: NM_000152.4:c.-32-13T>G
ClinVar: 4027 http://www.ncbi.nlm.nih.gov/clinvar/variation/4027
gnomAD: Ashkenazi Jewish 5.541e-3, Overall 3.401e-3 http://gnomad.broadinstitute.org/variant/17-78078341-T-G
Variant2: NM_000152.4:c.693-1G>C
CAID: CA401362948 http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_000152.4%3Ac.693-1G%3EC
gnomAD: Not in gnomAD
CaseAddInfo: Late Onset Pompe Disease
Alglucosidase alfa enzyme replacement therapy as a therapeutic approach for a patient presenting with a PRKAG2 mutation
PMID: 27692944
Gene: GAA
Disease: Glycogen Storage Disease II
MonDO: 0009290
InheritancePattern: autosomal recessive
NoEvidence: Case report of individual incorrectly diagnosed with Pompe carrying the NM_000152.4(GAA):c.-32-13T>G variant, he was eventually diagnosed correctly with PRKAG2 syndrome via a pathogenic variant.
PD07
Patient7: Female, Southern China
CasePresentingHPOs:
HPOsFreeText: IOPD
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo:
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant1: NM_000152.4(GAA):c.1432G>A (p.Gly478Arg)
ClinVar: 551295, https://www.ncbi.nlm.nih.gov/clinvar/variation/551295/
gnomAD: 8.525e-06, http://exac.broadinstitute.org/variant/17-78083849-G-A
Variant2: NM_000152.4(GAA):c.1802C>T (p.Ser601Leu)
ClinVar: 194154, https://www.ncbi.nlm.nih.gov/clinvar/variation/194154/
gnomAD: n/a
PD15
Patient15: Male, Northern China
CasePresentingHPOs:
HPOsFreeText: IOPD
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo:
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant1: NM_000152.4(GAA):c.2662G>T (p.Glu888Ter)
ClinVar: 578595, https://www.ncbi.nlm.nih.gov/clinvar/variation/578595/
gnomAD: 1.65e-05, http://exac.broadinstitute.org/variant/17-78092467-G-T
Variant2: NM_000152.3:c.1298A>C
CAID: CA401365381, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA401365381
gnomAD: n/a
PD02
Patient2: Female, northern China
CasePresentingHPOs:
HPOsFreeText: IOPD
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo:
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant1: NM_000152.4(GAA):c.2662G>T (p.Glu888Ter)
ClinVar: 578595, https://www.ncbi.nlm.nih.gov/clinvar/variation/578595/
gnomAD: 1.65e-05, http://exac.broadinstitute.org/variant/17-78092467-G-T
Variant2: NM_000152.3:c.859-2A>T
CAID: CA401363789, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA401363789
gnomAD: n/a
In the present study, we describe the clinical course and provide a molecular analysis of another 25 mainland Chinese patients with IOPD, and we identified c.2662G > T (p.Glu888X) as the most common mutation in northern Chinese patients.
GroupPresentingHPOs: HP:0001324, HP:0001270, HP:0002205, HP:0002098, HP:0001635, HP:0001640, HP:0011968
HPOsFreeText: IOPD, reduced GAA activity, paucity of movements
GroupNotHPOs:
NumberMales: 14
NumberFemales: 11
CountryOrigin: mainland China; 12 patients from southern China, 13 from northern China
Ethnicity: Chinese
Race: Chinese
AgeRange: median age at symptom onset = 3.4mo, median age at diagnosis = 4.9mo
TotalNumber: 25
FamilyInfo: Parents of those individuals with mutations were sequenced
NoFamily: n/a
GroupAddInfo: all patients diagnosed with IOPD between 2013 and 2016 at Shanghai Children's Medical Center. Of the 24 untreated patients, non survived beyond 1.5yrs, only surviving (Patient 25) was 7mo at last follow-up.
GroupPreviousTesting: IOPD diagnosed via reduced GAA enzyme activity in leukocytes or DBS (PMID: 16702880)
GroupGenotypingMethod: DNA isolated from blood samples, coding exons (2-20) and intron/exon boundaries of GAA gene amplified via PCR (primers: PMID: 10338092), resulting DNA was sequenced with ABI3730XL sequencer then was analyzed with Mutation Survey or DNA Variant Analysis software, novel mutations were screened in 60 normal individuals (120 alleles) via direct sequencing and no novel variants were found among these suggesting those found in study patients are uncommon polymorphisms.
fragments containing a mutation in the patients were amplified and sequenced for the corresponding parents
Phylogenetic conservation of missense mutations analyzed with ClustalX program, and pathogenicity of novel variants predicited with MutationTaster, sorting intolerant from tolerant (SIFT), and PolyPhen-2
Variant: NM_000152.4(GAA):c.2662G>T (p.Glu888Ter)
this was identified (by present study) as the most common variant in northern Chinese patients, heterozygous for 5 patients, homozygous for one patient
ClinVar: 578595, https://www.ncbi.nlm.nih.gov/clinvar/variation/578595/
gnomAD: 1.65e-05, http://exac.broadinstitute.org/variant/17-78092467-G-T
PD09
Patient9: Female, Northern China
CasePresentingHPOs:
HPOsFreeText: IOPD
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo:
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant1: NM_000152.4(GAA):c.796C>T (p.Pro266Ser)
ClinVar: 556117, https://www.ncbi.nlm.nih.gov/clinvar/variation/556117/
gnomAD: n/a
Variant2: NM_000152.3:c.1602_1605delinsAGG
CAID: CA913184733, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA913184733
gnomAD: n/a
PD01
Patient1: Female, northern China
CasePresentingHPOs:
HPOsFreeText: IOPD
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo:
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant1: NM_000152.4(GAA):c.2662G>T (p.Glu888Ter)
ClinVar: 578595, https://www.ncbi.nlm.nih.gov/clinvar/variation/578595/
gnomAD: 1.65e-05, http://exac.broadinstitute.org/variant/17-78092467-G-T
Variant2: NM_000152.4(GAA):c.1927G>A (p.Gly643Arg)
ClinVar: 4023, https://www.ncbi.nlm.nih.gov/clinvar/variation/4023/
PD21
Patient21: Female, Northern China
CasePresentingHPOs:
HPOsFreeText: IOPD
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo:
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant1: NM_000152.4(GAA):c.1802C>T (p.Ser601Leu)
ClinVar: 194154, https://www.ncbi.nlm.nih.gov/clinvar/variation/194154/
gnomAD: n/a
Variant2: NM_000152.3:c.1844G>T
CAID: CA401369601, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA401369601
gnomAD: n/a
PD24
Patient24: Female, Northern China
CasePresentingHPOs:
HPOsFreeText: IOPD
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo:
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant1: c.1151 + 2T > G no ClinVar or CAID, intronic position inside exon
Variant2: NM_000152.3:c.1562A>T
CAID: CA401367205, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA401367205
gnomAD: 0.000003980, http://gnomad.broadinstitute.org/variant/17-78084750-A-T
c.1195-19_2190-17del(p.Asp399fs*6)
Case2
HPOsFreeText: See Group Phenotypes
CasePreviousTesting: Sanger sequencing
CaseMethod1: Sanger sequencing and PCR Amplification
CaseMethod2: Whole Exome Sequencing (WES)
CaseGenotypingMethod: Patients were previously confirmed with Pompe disease by Sanger sequencing to capture the pathogenic variants. The process was repeated as part of the study taking care to amplify the coding regions and exon/intron boundaries to compare with the WES results afterwards.
Variant: NM_000152.4:c.1195-19_2190-17del (p.Asp399fs*6)
CAID: CA658795244 https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_000152.4%3Ac.1195-19_2190-17del
gnomAD: Not in gnomAD
CaseAddInfo: Infantile Onset Pompe Disease, Patient is homozygous for this variant
c.2560C > T(p.Arg854*)
Case22
HPOsFreeText: See Group Phenotypes
CasePreviousTesting: Sanger sequencing
CaseMethod1: Sanger sequencing and PCR Amplification
CaseMethod2: Whole Exome Sequencing (WES)
CaseGenotypingMethod: Patients were previously confirmed with Pompe disease by Sanger sequencing to capture the pathogenic variants. The process was repeated as part of the study taking care to amplify the coding regions and exon/intron boundaries to compare with the WES results afterwards.
Variant1: NM_000152.4:c.2560C>T (p.Arg854*)
ClinVar: 4034 https://www.ncbi.nlm.nih.gov/clinvar/variation/4034/
gnomAD: African 1.891e-3, Overall 2.090e-4 http://gnomad.broadinstitute.org/variant/17-78092070-C-T
Variant2: NM_000152.4:c.1710C>G (p.Asn570Lys)
ClinVar: 555153 https://www.ncbi.nlm.nih.gov/clinvar/variation/555153/
gnomAD: African 1.149e-4, Overall 3.187e-5 http://gnomad.broadinstitute.org/variant/17-78085855-C-G
CaseAddInfo: Infantile Onset Pompe Disease
c.2481+102_2646+31del (p.Gly828_Asn882del)
Case36
HPOsFreeText: See Group Phenotypes
CasePreviousTesting: Sanger sequencing
CaseMethod1: Sanger sequencing and PCR Amplification
CaseMethod2: Whole Exome Sequencing (WES)
CaseGenotypingMethod: Patients were previously confirmed with Pompe disease by Sanger sequencing to capture the pathogenic variants. The process was repeated as part of the study taking care to amplify the coding regions and exon/intron boundaries to compare with the WES results afterwards.
Variant1: NM_000152.4:c.2481+102_2646+31del (p.Gly828_Asn882del) (exon 18 del)
ClinVar: 4031 https://www.ncbi.nlm.nih.gov/clinvar/variation/4031/
gnomAD: Not in gnomAD
Variant2: NM_000152.4:c.437delT (p.Met146Argfs*7)
ClinVar: 554096 https://www.ncbi.nlm.nih.gov/clinvar/variation/554096/
gnomAD: Not in gnomAD
CaseAddInfo: Infantile Onset Pompe Disease
c.836G > A(p.Trp279*)
Case88
HPOsFreeText: See Group Phenotypes
CasePreviousTesting: Sanger sequencing
CaseMethod1: Sanger sequencing and PCR Amplification
CaseMethod2: Whole Exome Sequencing (WES)
CaseGenotypingMethod: Patients were previously confirmed with Pompe disease by Sanger sequencing to capture the pathogenic variants. The process was repeated as part of the study taking care to amplify the coding regions and exon/intron boundaries to compare with the WES results afterwards.
Variant1: NM_000152.4:c.836G>A (p.Trp279*)
CAID: CA401363637 https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_000152.4%3Ac.836G%3EA
gnomAD: Not in gnomAD
Variant2: NM_000152.4:c.-32-13T>G
ClinVar: 4027 https://www.ncbi.nlm.nih.gov/clinvar/variation/4027/
gnomAD: Ashkenazi Jewish 5.541e-3, Overall 3.401e-3 http://gnomad.broadinstitute.org/variant/17-78078341-T-G
CaseAddInfo: Adult Late Onset Pompe Disease
c.2560C > T(p.Arg854*)
Case12
HPOsFreeText: See Group Phenotypes
CasePreviousTesting: Sanger sequencing
CaseMethod1: Sanger sequencing and PCR Amplification
CaseMethod2: Whole Exome Sequencing (WES)
CaseGenotypingMethod: Patients were previously confirmed with Pompe disease by Sanger sequencing to capture the pathogenic variants. The process was repeated as part of the study taking care to amplify the coding regions and exon/intron boundaries to compare with the WES results afterwards.
Variant1: NM_000152.4:c.2560C>T (p.Arg854*)
ClinVar: 4034 https://www.ncbi.nlm.nih.gov/clinvar/variation/4034/
gnomAD: African 1.891e-3, Overall 2.090e-4 http://gnomad.broadinstitute.org/variant/17-78092070-C-T
Variant2: NM_000152.4:c.1654delC (p.Leu552Serfs*26)
CAID: CA658795262 https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_000152.4%3Ac.1654delC
gnomAD: Not in gnomAD
CaseAddInfo: Infantile Onset Pompe Disease
c.1798C > T(p.Arg600Cys)
Case65
HPOsFreeText: See Group Phenotypes
CasePreviousTesting: Sanger sequencing
CaseMethod1: Sanger sequencing and PCR Amplification
CaseMethod2: Whole Exome Sequencing (WES)
CaseGenotypingMethod: Patients were previously confirmed with Pompe disease by Sanger sequencing to capture the pathogenic variants. The process was repeated as part of the study taking care to amplify the coding regions and exon/intron boundaries to compare with the WES results afterwards.
Variant1: NM_000152.4:c.1798C>T (p.Arg600Cys)
CAID: CA8815481 https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_000152.4%3Ac.1798C%3ET
gnomAD: South Asian 3.267e-5, Overall 4.025e-6 http://gnomad.broadinstitute.org/variant/17-78086420-C-T
Variant2: NM_000152.4:c.-32-13T>G
ClinVar: 4027 https://www.ncbi.nlm.nih.gov/clinvar/variation/4027/
gnomAD: Ashkenazi Jewish 5.541e-3, Overall 3.401e-3 http://gnomad.broadinstitute.org/variant/17-78078341-T-G
CaseAddInfo: Adult Late Onset Pompe Disease
c.525delT(p.Glu176Argfs*45)
Case51
HPOsFreeText: See Group Phenotypes
CasePreviousTesting: Sanger sequencing
CaseMethod1: Sanger sequencing and PCR Amplification
CaseMethod2: Whole Exome Sequencing (WES)
CaseGenotypingMethod: Patients were previously confirmed with Pompe disease by Sanger sequencing to capture the pathogenic variants. The process was repeated as part of the study taking care to amplify the coding regions and exon/intron boundaries to compare with the WES results afterwards.
Variant1: NM_000152.4:c.525delT (p.Glu176Argfs*45)
ClinVar: 4033 https://www.ncbi.nlm.nih.gov/clinvar/variation/4033/
gnomAD: European (Non-Finnish) 1.880e-4, Overall 9.959e-5 http://gnomad.broadinstitute.org/variant/17-78078909-CT-C
Variant2: NM_000152.4:c.-32-13T>G
ClinVar: 4027 https://www.ncbi.nlm.nih.gov/clinvar/variation/4027/
gnomAD: Ashkenazi Jewish 5.541e-3, Overall 3.401e-3 http://gnomad.broadinstitute.org/variant/17-78078341-T-G
CaseAddInfo: Infantile Onset Pompe Disease
PD15
Patient15: Male, Northern China
CasePresentingHPOs:
HPOsFreeText: IOPD
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo:
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant1: NM_000152.4(GAA):c.2662G>T (p.Glu888Ter)
ClinVar: 578595, https://www.ncbi.nlm.nih.gov/clinvar/variation/578595/
gnomAD: 1.65e-05, http://exac.broadinstitute.org/variant/17-78092467-G-T
Variant2: NM_000152.3:c.1298A>C
CAID: CA401365381, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA401365381
gnomAD: n/a
PD20
Patient20: Female, Northern China
CasePresentingHPOs:
HPOsFreeText: IOPD
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo:
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant1: NM_000152.4(GAA):c.1320_1322del (p.Met440del)
ClinVar: 526518, https://www.ncbi.nlm.nih.gov/clinvar/variation/526518/
gnomAD: n/a
Variant2: NM_000152.4(GAA):c.2560C>T (p.Arg854Ter)
ClinVar: 4034, https://www.ncbi.nlm.nih.gov/clinvar/variation/4034/
gnomAD: 0.0002146, http://exac.broadinstitute.org/variant/17-78092070-C-T
11
Case#: Subject number 11(L)
DiseaseAssertion: Late Onset Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: N/A
CaseHPOFreeText: N/A
CaseNotHPOs: N/A
CaseNotHPOFreeText: N/A
CasePreviousTesting: CK testing: 421 U/L (60-305 U/L is normal)
glucosidase activity: GAA activity (NBS) 0.63 in dried blood spots (>2.10 micromole/L/h is normal). 3.00 in confirmatory testing (>3.88 is normal).
Variant 1: NM_000152.5(GAA):c.-32-13T>G
Variant 1 ClinVarID: 4027
Variant 1 CAid: CA116606
Variant 2: NM_000152.5(GAA):c.2560C>T
Variant 2 ClinVarID: 4034
Variant 2 CAid: CA340130
Zygosity: compound heterozygous
ParentalGenotype: N/A
PreviouslyPublished: N/A
13
Case#: Subject number 13(L)
DiseaseAssertion: Late Onset Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: N/A
CaseHPOFreeText: N/A
CaseNotHPOs: N/A
CaseNotHPOFreeText: N/A
CasePreviousTesting: CK testing: 122 U/L (60-305 U/L is normal), AST: 78 U/L (20-64 U/L is normal), ALT: 42 U/L (12-42 U/L is normal), Hex4: 4.8 mmol/mol Creatinine (≤20 mmol/mol Creatinine is normal), BNP 71.8 pg/mL (0.0–100.0 pg/mL is normal)
glucosidase activity: GAA activity #1 was 0.56 micromole/L/h and GAA activity #2 (NBS) 0.62 in dried blood spots (>2.10 micromole/L/h is normal). 3.80 in confirmatory testing (>3.88 is normal).
Variant 1: NM_000152.5(GAA):c.-32-13T>G
Variant 1 ClinVarID: 4027
Variant 1 CAid: CA116606
Variant 2: NM_000152.5(GAA):c.-32-13T>G
Variant 2 ClinVarID: 4027
Variant 2 CAid: CA116606
Zygosity: homozygous
ParentalGenotype: N/A
PreviouslyPublished: N/A
5
Case#: Subject number 5(L)
DiseaseAssertion: Late Onset Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: N/A
CaseHPOFreeText: N/A
CaseNotHPOs: N/A
CaseNotHPOFreeText: N/A
CasePreviousTesting: CK testing: 333 U/L (28-300 U/L is normal), AST: 52 U/L (24-72 U/L is normal), ALT: 46 U/L (17-63 U/L is normal), Hex4: 4.4 mmol/mol Creatinine (≤20 mmol/mol Creatinine is normal)
glucosidase activity: GAA activity #1 was 1.82 micromole/L/h and GAA activity #2 (NBS) 0.94 in dried blood spots (>2.10 micromole/L/h is normal). 6.9 in confirmatory testing (>6.7 is normal).
Variant 1: NM_000152.5(GAA):c.-32-13T>G
Variant 1 ClinVarID: 4027
Variant 1 CAid: CA116606
Variant 2: NM_000152.5(GAA):c.-32-13T>G
Variant 2 ClinVarID: 4027
Variant 2 CAid: CA116606
Zygosity: homozygous
ParentalGenotype: N/A
PreviouslyPublished: N/A
4
Case#: Subject number 4(L)
DiseaseAssertion: Late Onset Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: N/A
CaseHPOFreeText: N/A
CaseNotHPOs: N/A
CaseNotHPOFreeText: N/A
CasePreviousTesting: CK testing: 361 U/L (28-300 U/L is normal), AST: 66 U/L (24-72 U/L is normal), ALT: 52 U/L (17-63 U/L is normal), Hex4: 3.9 mmol/mol Creatinine (≤20 mmol/mol Creatinine is normal)
glucosidase activity: GAA activity #1 was 1.24 micromole/L/h and GAA activity #2 (NBS) 0.67 in dried blood spots (>2.10 micromole/L/h is normal). 2.4 in confirmatory testing (>6.7 is normal).
Variant 1: NM_000152.5(GAA):c.-32-13T>G
Variant 1 ClinVarID: 4027
Variant 1 CAid: CA116606
Variant 2: NM_000152.5(GAA):c.-32-13T>G
Variant 2 ClinVarID: 4027
Variant 2 CAid: CA116606
Zygosity: homozygous
ParentalGenotype: N/A
PreviouslyPublished: N/A
27
Case#: Subject number 27(L)
DiseaseAssertion: Late Onset Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: N/A
CaseHPOFreeText: N/A
CaseNotHPOs: N/A
CaseNotHPOFreeText: N/A
CasePreviousTesting: CK testing: 108 U/L (60-305 U/L is normal), AST: 32 U/L (22-71 U/L is normal), ALT: 29 U/L (7-50 U/L is normal), Hex4: 3.3 mmol/mol Creatinine (≤20 mmol/mol Creatinine is normal), BNP 35.7 pg/mL (0.0–100.0 pg/mL is normal)
glucosidase activity: GAA activity #1 (NBS) is 1.1 micromole/L/h and GAA activity #2 (NBS) 0.42 in dried blood spots (>2.10 micromole/L/h is normal). 2.40 in confirmatory testing (>3.88 is normal).
Variant 1: NM_000152.5(GAA):c.1441T>C
Variant 1 ClinVarID: 189007
Variant 1 CAid: CA274247
Variant 2: NM_000152.5(GAA):c.2238G>C
Variant 2 ClinVarID: 265160
Variant 2 CAid: CA8815665
Variant 3: NM_000152.5(GAA):c.2065G>A
Variant 3 ClinVarID: 4030
Variant 3 CAid: CA116612
Zygosity: compound heterozygous
ParentalGenotype: N/A
PreviouslyPublished: N/A
15
Case#: Subject number 15(L)
DiseaseAssertion: Late Onset Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: N/A
CaseHPOFreeText: N/A
CaseNotHPOs: N/A
CaseNotHPOFreeText: N/A
CasePreviousTesting: CK testing: 68 U/L (60-305 U/L is normal), AST: 49 U/L (20-64 U/L is normal), ALT: 27 U/L (12-42 U/L is normal), Hex4: 2.8 mmol/mol Creatinine (≤20 mmol/mol Creatinine is normal)
glucosidase activity: GAA activity #1 was 1.11 micromole/L/h and GAA activity #2 (NBS) 0.5 in dried blood spots (>2.10 micromole/L/h is normal). 1.60 in confirmatory testing (>3.88 is normal).
Variant 1: NM_000152.5(GAA):c.2238G>C
Variant 1 ClinVarID: 265160
Variant 1 CAid: CA8815665
Variant 2: NM_000152.5(GAA):c.-32-13T>G
Variant 2 ClinVarID: 4027
Variant 2 CAid: CA116606
Variant 3: NM_000152.5(GAA):c.2065G>A
Variant 3 ClinVarID: 4030
Variant 3 CAid: CA116612
Zygosity: compound heterozygous
ParentalGenotype: N/A
PreviouslyPublished: N/A
24
Case#: Subject number 24(L)
DiseaseAssertion: Late Onset Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: N/A
CaseHPOFreeText: N/A
CaseNotHPOs: N/A
CaseNotHPOFreeText: N/A
CasePreviousTesting: CK testing: 197 U/L (60-305 U/L is normal)
glucosidase activity: GAA activity #2 (NBS) 0.43 in dried blood spots (>2.10 micromole/L/h is normal).
Variant 1: NM_000152.5(GAA):c.1856G>A
Variant 1 ClinVarID: 370146
Variant 1 CAid: CA8815500
Variant 2: NM_000152.5(GAA):c.2238G>C
Variant 2 ClinVarID: 265160
Variant 2 CAid: CA8815665
Zygosity: compound heterozygous
ParentalGenotype: N/A
PreviouslyPublished: N/A
21
Case#: Subject number 21(L)
DiseaseAssertion: Late Onset Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: N/A
CaseHPOFreeText: N/A
CaseNotHPOs: N/A
CaseNotHPOFreeText: N/A
CasePreviousTesting: CK testing: 155 U/L (60-305 U/L is normal), AST: 71 U/L (22-71 U/L is normal), ALT: 60 U/L (7-50 U/L is normal), Hex4 12.6 mmol/mol Creatine (≤20 is normal)
glucosidase activity: GAA activity #1 was 1.77 micromole/L/h and GAA activity #2 (NBS) 0.84 in dried blood spots (>2.10 micromole/L/h is normal).
Variant 1: NM_000152.5(GAA):c.-32-13T>G
Variant 1 ClinVarID: 4027
Variant 1 CAid: CA116606
Variant 2: NM_000152.5(GAA):c.-32-13T>G
Variant 2 ClinVarID: 4027
Variant 2 CAid: CA116606
Zygosity: homozygous
ParentalGenotype: N/A
PreviouslyPublished: N/A
19
Case#: Subject number 19(L)
DiseaseAssertion: Late Onset Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: N/A
CaseHPOFreeText: N/A
CaseNotHPOs: N/A
CaseNotHPOFreeText: N/A
CasePreviousTesting: CK testing: 510 U/L (60-305 U/L is normal), AST: 158 U/L (22-71 U/L is normal), ALT: 39 U/L (7-50 U/L is normal), Hex4: 8.1 mmol/mol Creatinine (≤20 mmol/mol Creatinine is normal), BNP <10.0 pg/mL (0.0–100.0 pg/mL is normal)
glucosidase activity: GAA activity #1 was 1.07 micromole/L/h and GAA activity #2 (NBS) 0.38 in dried blood spots (>2.10 micromole/L/h is normal). 1.10 in confirmatory testing (>3.88 is normal).
Variant 1: NM_000152.5(GAA):c.456_458insGA
Variant 1 ClinVarID: ?
Variant 1 CAid: ?
Variant 2: NM_000152.5(GAA):c.-32-13T>G
Variant 2 ClinVarID: 4027
Variant 2 CAid: CA116606
Zygosity: compound heterozygous
ParentalGenotype: N/A
PreviouslyPublished: N/A
18
Case#: Subject number 18(L)
DiseaseAssertion: Late Onset Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: N/A
CaseHPOFreeText: N/A
CaseNotHPOs: N/A
CaseNotHPOFreeText: N/A
CasePreviousTesting: CK testing: 542 U/L (60-305 U/L is normal), AST: 152 U/L (22-71 U/L is normal), ALT: 55 U/L (7-50 U/L is normal), Hex4: 7.6 mmol/mol Creatinine (≤20 mmol/mol Creatinine is normal), BNP 16.5 pg/mL (0.0–100.0 pg/mL is normal)
glucosidase activity: GAA activity #1 was 0.7 micromole/L/h and GAA activity #2 (NBS) 0.34 in dried blood spots (>2.10 micromole/L/h is normal). 1.40 in confirmatory testing (>3.88 is normal).
Variant 1: NM_000152.5(GAA):c.-32-13T>G
Variant 1 ClinVarID: 4027
Variant 1 CAid: CA116606
Variant 2: NM_000152.5(GAA):c.2560C>T
Variant 2 ClinVarID: 4034
Variant 2 CAid: CA340130
Zygosity: compound heterozygous
ParentalGenotype: N/A
PreviouslyPublished: N/A
9
Case#: Subject number 9(L)
DiseaseAssertion: Late Onset Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: N/A
CaseHPOFreeText: N/A
CaseNotHPOs: N/A
CaseNotHPOFreeText: N/A
CasePreviousTesting: CK testing: 145 U/L (60-305 U/L is normal), AST: 72 U/L (22-71 U/L is normal), ALT: 43 U/L (7-50 U/L is normal), Hex4: 5.3 mmol/mol Creatinine (≤20 mmol/mol Creatinine is normal), BNP 13.0 pg/mL (0.0–100.0 pg/mL is normal)
glucosidase activity: GAA activity #1 was 0.97 micromole/L/h and GAA activity #2 (NBS) 0.33 in dried blood spots (>2.10 micromole/L/h is normal). 0.93 in confirmatory testing (>3.88 is normal).
Variant 1: NM_000152.5(GAA):c.2238G>C
Variant 1 ClinVarID: 265160
Variant 1 CAid: CA8815665
Variant 2: NM_000152.5(GAA):c.2281delGinsAT
Variant 2 ClinVarID: 370993
Variant 2 CAid: CA16041905
Variant 3: NM_000152.5(GAA):c.2065G>A
Variant 3 ClinVarID: 4030
Variant 3 CAid: CA116612
Zygosity: compound heterozygous
ParentalGenotype: N/A
PreviouslyPublished: N/A
CaseOPOPD-75: Female, Taiwan, Birth diagnosis
HPOsFreeText: GAA (MS/MS) enzyme activity at 0.83 umol/hr/L
GenotypingMethod: GAA Gene Sequencing and PCR Amplification
Variant1: NM_000152.4:c.1726G>A (p.Gly576Ser)
ClinVar: 92467 https://www.ncbi.nlm.nih.gov/clinvar/variation/92467/
gnomAD: East Asian 0.1427, Overall 0.01700 http://gnomad.broadinstitute.org/variant/17-78085871-G-A
Variant2: NM_000152.4:c.2815_2816delGT (p.Val939Leufs)
ClinVar: 371481 https://www.ncbi.nlm.nih.gov/clinvar/variation/371481/
gnomAD: East Asian 1.631e-4, Overall 1.194e-5 http://gnomad.broadinstitute.org/variant/17-78093082-CTG-C
CaseAddInfo: One Pompe Mutation allele and One Pseudodeficency Mutation allele, 2 other patients have the same genotype
CaseLP2-11: Male, Taiwan, Birth diagnosis
HPOsFreeText: GAA (MS/MS) enzyme activity at 0.46 umol/hr/L, Serum CK at 86 U/L
GenotypingMethod: GAA Gene Sequencing and PCR Amplification
Variant1: NM_000152.4:c.752C>T (p.Ser251Leu)
ClinVar: 325781 https://www.ncbi.nlm.nih.gov/clinvar/variation/325781/
gnomAD: East Asian 2.760e-3, Overall 3.540e-4 http://gnomad.broadinstitute.org/variant/17-78081415-C-T
Variant2: NM_000152.4:c.761C>T (p.Ser254Leu)
ClinVar: 325782 https://www.ncbi.nlm.nih.gov/clinvar/variation/325782/
gnomAD: East Asian 2.759e-3, Overall 1.947e-4 http://gnomad.broadinstitute.org/variant/17-78081424-C-T
Variant3: NM_000152.4:c.1935C>A (p.Asp645Glu)
ClinVar: 4029 https://www.ncbi.nlm.nih.gov/clinvar/variation/4029/
gnomAD: East Asian 1.729e-3, Overall 1.240e-4 http://gnomad.broadinstitute.org/variant/17-78086721-C-A
Variant4: NM_000152.4:c.1726G>A (p.Gly576Ser)
ClinVar: 92467 https://www.ncbi.nlm.nih.gov/clinvar/variation/92467/
gnomAD: East Asian 0.1427, Overall 0.01700 http://gnomad.broadinstitute.org/variant/17-78085871-G-A
CaseAddInfo: Late Onset Pompe Disease, Nomenclature indicates Variants 1 and 2 and Variants 3 and 4 are in cis
CaseOPOPD-70: Male, Taiwan, Birth diagnosis
HPOsFreeText: GAA (MS/MS) enzyme activity at 0.47 umol/hr/L
GenotypingMethod: GAA Gene Sequencing and PCR Amplification
Variant1: NM_000152.4:c.1726G>A (p.Gly576Ser)
ClinVar: 92467 https://www.ncbi.nlm.nih.gov/clinvar/variation/92467/
gnomAD: East Asian 0.1427, Overall 0.01700 http://gnomad.broadinstitute.org/variant/17-78085871-G-A
Variant2: NM_000152.4:c.2238G>T (p.Trp746Cys)
CAID: CA401324771 https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_000152.4%3Ac.2238G%3ET
gnomAD: Not in gnomAD
CaseAddInfo: One Pompe Mutation allele and One Pseudodeficency Mutation allele
CasePDC-9: Female, Taiwan, Birth diagnosis
HPOsFreeText: 4MU enzyme activity at 0.98, MS/MS ennzyme activity at 0.83
GenotypingMethod: GAA Gene Sequencing and PCR Amplification
Variant1: NM_000152.4:c.1726G>A (p.Gly576Ser)
ClinVar: 92467 https://www.ncbi.nlm.nih.gov/clinvar/variation/92467/
gnomAD: East Asian 0.1427, Overall 0.01700 http://gnomad.broadinstitute.org/variant/17-78085871-G-A
Variant2: NM_000152.4:c.2815_2816delGT (p.Val939Leufs)
ClinVar: 371481 https://www.ncbi.nlm.nih.gov/clinvar/variation/371481/
gnomAD:East Asian 1.631e-4, Overall 1.194e-5 http://gnomad.broadinstitute.org/variant/17-78093082-CTG-C
CaseAddInfo: Patient is either a carrier or has a pseudodeficency allele
CaseOPTPD-6: Female, Taiwan, Birth diagnosis
HPOsFreeText: GAA (MS/MS) enzyme activity at 0.50 umol/hr/L
GenotypingMethod: GAA Gene Sequencing and PCR Amplification
Variant1: NM_000152.4:c.1726G>A (p.Gly576Ser)
ClinVar: 92467 https://www.ncbi.nlm.nih.gov/clinvar/variation/92467/
gnomAD: East Asian 0.1427, Overall 0.01700 http://gnomad.broadinstitute.org/variant/17-78085871-G-A
Variant2: NM_000152.4:c.1935C>A (p.Asp645Glu)
ClinVar: 4029 https://www.ncbi.nlm.nih.gov/clinvar/variation/4029/
gnomAD: East Asian 1.729e-3, Overall 1.240e-4 http://gnomad.broadinstitute.org/variant/17-78086721-C-A
CaseAddInfo: One Pompe Mutation allele and Two Pseudodeficency Mutation alleles, Nomenclature indicates patient is homozygous for Variant 1 and Variant 2 is in cis with one copy, 70 other patients have the same genotype
CaseOPOPD-11: Male, Taiwan, Birth diagnosis
HPOsFreeText: GAA (MS/MS) enzyme activity at 0.98 umol/hr/L
GenotypingMethod: GAA Gene Sequencing and PCR Amplification
Variant1: NM_000152.4:c.701C>T (p.Thr234Met)
ClinVar: CA8814994 https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_000152.4%3Ac.701C%3ET
gnomAD: South Asian 3.266e-5, Overall 1.196e-5 http://gnomad.broadinstitute.org/variant/17-78081364-C-T
Variant2: NM_000152.4:c.1726G>A (p.Gly576Ser)
ClinVar: 92467 https://www.ncbi.nlm.nih.gov/clinvar/variation/92467/
gnomAD: East Asian 0.1427, Overall 0.01700 http://gnomad.broadinstitute.org/variant/17-78085871-G-A
CaseAddInfo: One Pompe Mutation and One Pseudodeficency Mutation
CaseLP-1: Female, Taiwan, Birth diagnosis
HPOsFreeText: 4MU enzyme activity at 0.44, MS/MS ennzyme activity at 0.08
GenotypingMethod: GAA Gene Sequencing and PCR Amplification
Variant1: NM_000152.3:c.424_440del (p.Ser142Leufs*29)
CAID: CA658795228 https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_000152.4%3Ac.424_440del17
gnomAD: Not in gnomAD
Variant2: NM_000152.4:c.1958C>A (p.Thr653Asn)
CAID: CA8815557 https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_000152.4%3Ac.1958C%3EA
gnomAD: East Asian 2.548e-4, Overall 1.825e-5 http://gnomad.broadinstitute.org/variant/17-78086744-C-A
CaseAddInfo: Suspected Late Onset Pompe Disease
CaseIP2-2: Male, Taiwan, Birth diagnosis
HPOsFreeText: GAA (MS/MS) enzyme activity at 0.09 umol/hr/L, Serum CK at 458 U/L
GenotypingMethod: GAA Gene Sequencing and PCR Amplification
Variant1: NM_000152.4:c.872T>C (p.Leu291Pro)
CAID: CA401363854 https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_000152.4%3Ac.872T%3EC
gnomAD: Not in gnomAD
Variant2: NM_000152.4:c.1935C>A (p.Asp645Glu)
ClinVar: 4029 https://www.ncbi.nlm.nih.gov/clinvar/variation/4029/
gnomAD: East Asian 1.729e-3, Overall 1.240e-4 http://gnomad.broadinstitute.org/variant/17-78086721-C-A
Variant3: NM_000152.4:c.1726G>A (p.Gly576Ser)
ClinVar: 92467 https://www.ncbi.nlm.nih.gov/clinvar/variation/92467/
gnomAD: East Asian 0.1427, Overall 0.01700 http://gnomad.broadinstitute.org/variant/17-78085871-G-A
CaseAddInfo: Infantile Onset Pompe Disease, Nomenclature indicates Variant 1 and 2 are in trans, also that Variant 3 is in cis with only one of them
CasePDC-1: Female, Taiwan, Birth diagnosis
HPOsFreeText: 4MU enzyme activity at 1.15, MS/MS ennzyme activity at 1.2
GenotypingMethod: GAA Gene Sequencing and PCR Amplification
Variant1: NM_000152.4:c.1726G>A (p.Gly576Ser)
ClinVar: 92467 https://www.ncbi.nlm.nih.gov/clinvar/variation/92467/
gnomAD: East Asian 0.1427, Overall 0.01700 http://gnomad.broadinstitute.org/variant/17-78085871-G-A
CaseAddInfo: Patient is either a carrier or has a pseudodeficency allele, Second allele is wildtype
CaseLP-2: Female, Taiwan, Birth diagnosis
HPOsFreeText: 4MU enzyme activity at 0.85, MS/MS ennzyme activity at 0.42
GenotypingMethod: GAA Gene Sequencing and PCR Amplification
Variant1: NM_000152.4:c.671G>A (p.Arg224Gln)
CAID: CA8814958 https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_000152.4%3Ac.671G%3EA
gnomAD: African 8.060e-5, Overall 2.549e-5 http://gnomad.broadinstitute.org/variant/17-78079672-G-A
Variant2: NM_000152.4:c.752C>T (p.Ser251Leu)
ClinVar: 325781 https://www.ncbi.nlm.nih.gov/clinvar/variation/325781/
gnomAD: East Asian 2.760e-3, Overall 3.540e-4 http://gnomad.broadinstitute.org/variant/17-78081415-C-T
Variant3: NM_000152.4:c.761C>T (p.Ser254Leu)
ClinVar: 325782 https://www.ncbi.nlm.nih.gov/clinvar/variation/325782/
gnomAD: East Asian 2.759e-3, Overall 1.947e-4 http://gnomad.broadinstitute.org/variant/17-78081424-C-T
CaseAddInfo: Suspected Late Onset Pompe Disease, Nomenclature indicates Variants 2 and 3 are in cis
CaseOPOPD-5: Female, Taiwan, Birth diagnosis
HPOsFreeText: GAA (MS/MS) enzyme activity at 0.97 umol/hr/L
GenotypingMethod: GAA Gene Sequencing and PCR Amplification
Variant1: NM_000152.4:c.503G>C (p.Arg168Pro)
CAID: CA401361673 https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_000152.4%3Ac.503G%3EC
gnomAD: Not in gnomAD
Variant2: NM_000152.4:c.1726G>A (p.Gly576Ser)
ClinVar: 92467 https://www.ncbi.nlm.nih.gov/clinvar/variation/92467/
gnomAD: East Asian 0.1427, Overall 0.01700 http://gnomad.broadinstitute.org/variant/17-78085871-G-A
CaseAddInfo: One Pompe Mutation and One Pseudodeficency Mutation
5
Case5: Male, 18 years diagnosis, 13 years onset
CasePresentingHPOs: HP:0009073, HP:0003198, HP:0003236, HP:0003327 (Progressive proximal muscle weakness, Myopathy, Increased serum CK, Axial muscle weakness)
HPOsFreeText: Electromyography showed myogenic damage, Vacuolar myopathy, Serum CK is 586.2 U/L
4
Case4: Female, 16 years diagnosis, 13 years onset
CasePresentingHPOs: HP:0009073, HP:0003198, HP:0003236, HP:0003327, HP:0008994 (Progressive proximal muscle weakness, Myopathy, Increased serum CK, Axial muscle weakness, Proximal muscle weakness in lower limbs)
HPOsFreeText: Electromyography showed myogenic damage, Vacuolar myopathy, Serum CK is 1652.0 U/L
recently Van Capele et al. evidenced that a second mutation (defined as severe, less severe or potentially less severe) did not seem to have an effect on the age of onset of the disease [22]. A homozygous status for this mutation has been shown to have a low frequency (maybe explained by a reduced or incomplete penetrance); however, patients homozygous for this mutation do not seem to differ, in their clinical phenotype variation, from heterozygotes [19].
NM_000152.4(GAA):c.-32-13T>G
P2
Case#: Subject number 2, male, 20 months (onset), 24 months (first admission)
DiseaseAssertion: Pompe disease
FamilyInfo: Patients 2 and 3 are full siblings
CasePresentingHPOs: HP:0002355 (difficulty walking), HP:0002205 (recurrent respiratory infections), HP:0004887 (respiratory failure requiring assisted ventilation)
CaseHPOFreeText: on BiPAP, ambulatory (transport ventilator), juvenile-onset, assistive device (wheelchair)
CaseNotHPOs:
CaseNotHPOFreeText: no dysphagia at baseline, no tracheostomy
CasePreviousTesting: “GAA activity in peripheral blood leukocytes lower than normal”; on enzyme replacement therapy
PMID: 31392189
Gene: GAA
Disease: Pompe disease
Inheritance: Autosomal recessive
Pearls & Oy-sters: Clues to the diagnosis of adult-onset acid maltase deficiency
PMID: 24590251
Gene: GAA
11
Case11: Female, 48 years onset, 54 years diagnosis, Italy
HPOsFreeText: See Group Phenotypes, ERT started at 54, GAA Activity at ~8.5 pmol/min/mg before ERT and ~9 after
GroupGenotypingMethod: PCR Amplification and GAA Gene Sequencing
Variant1: NM_000152.4:c.-32-13T>G
ClinVar: 4027 https://www.ncbi.nlm.nih.gov/clinvar/variation/4027/
gnomAD: Ashkenazi Jewish 5.541e-3, Overall 3.401e-3 http://gnomad.broadinstitute.org/variant/17-78078341-T-G
Variant2: NM_000152.4:c.525delT (p.Glu176Argfs*45)
ClinVar: 4033 https://www.ncbi.nlm.nih.gov/clinvar/variation/4033/
gnomAD: European (Non-Finnish) 1.880e-4, Overall 9.959e-5 http://gnomad.broadinstitute.org/variant/17-78078909-CT-C
CaseAddInfo: Late Onset Pompe Disease
10
Case10: Male, 50 years onset, 52 years diagnosis, Italy
HPOsFreeText: See Group Phenotypes, ERT started at 53, GAA Activity at ~13 pmol/min/mg before ERT and ~15 after
GroupGenotypingMethod: PCR Amplification and GAA Gene Sequencing
Variant1: NM_000152.4:c.-32-13T>G
ClinVar: 4027 https://www.ncbi.nlm.nih.gov/clinvar/variation/4027/
gnomAD: Ashkenazi Jewish 5.541e-3, Overall 3.401e-3 http://gnomad.broadinstitute.org/variant/17-78078341-T-G
Variant2: NM_000152.4:c.784G>A (p.Glu262Lys)
ClinVar: 188806 https://www.ncbi.nlm.nih.gov/clinvar/variation/188806/
gnomAD: East Asian 5.016e-5, Overall 1.417e-5 http://gnomad.broadinstitute.org/variant/17-78081447-G-A
CaseAddInfo: Late Onset Pompe Disease
5
Case5: Male, 65 years onset, 72 years diagnosis, Italy
HPOsFreeText: See Group Phenotypes, ERT started at 72, GAA Activity at ~6 pmol/min/mg before ERT and ~10.5 after
GroupGenotypingMethod: PCR Amplification and GAA Gene Sequencing
Variant1: NM_000152.4:c.-32-13T>G
ClinVar: 4027 https://www.ncbi.nlm.nih.gov/clinvar/variation/4027/
gnomAD: Ashkenazi Jewish 5.541e-3, Overall 3.401e-3 http://gnomad.broadinstitute.org/variant/17-78078341-T-G
Variant2: NM_000152.4:c.525delT (p.Glu176Argfs*45)
ClinVar: 4033 https://www.ncbi.nlm.nih.gov/clinvar/variation/4033/
gnomAD: European (Non-Finnish) 1.880e-4, Overall 9.959e-5 http://gnomad.broadinstitute.org/variant/17-78078909-CT-C
CaseAddInfo: Late Onset Pompe Disease
Supplement Table 1)
Patient4: 3yo
CasePresentingHPOs: HP:0001638
HPOsFreeText: rhGAA dosage = 20 QW, independent walker
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo: homozygous variant, 6days old at ERT start
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant1: NM_000152.4(GAA):c.1935C>A (p.Asp645Glu)
ClinVar: 4029, https://www.ncbi.nlm.nih.gov/clinvar/variation/4029/
gnomAD: 0.0001721, http://exac.broadinstitute.org/variant/17-78086721-C-A
Supplement Table 1)
Patient13: 6yo
CasePresentingHPOs:
HPOsFreeText: rhGAA dosage = 20 EOW, independent walker
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo: 37mo at ERT start
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant1: NM_000152.4(GAA):c.1935C>A (p.Asp645Glu)
ClinVar: 4029, https://www.ncbi.nlm.nih.gov/clinvar/variation/4029/
gnomAD: 0.0001721, http://exac.broadinstitute.org/variant/17-78086721-C-A
Variant2: NM_000152.3:c.1781G>A
CAID: CA8815477, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA8815477
gnomAD: 1.729e-05, http://exac.broadinstitute.org/variant/17-78086403-G-A
Supplement Table 1)
Patient5: 12yo
CasePresentingHPOs: HP:0001638
HPOsFreeText: rhGAA dosage = 20 EOW, ventilator dependent
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo: 6mo at ERT start
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant1: NM_000152.4(GAA):c.1935C>A (p.Asp645Glu)
ClinVar: 4029, https://www.ncbi.nlm.nih.gov/clinvar/variation/4029/
gnomAD: 0.0001721, http://exac.broadinstitute.org/variant/17-78086721-C-A
Variant2: NM_000152.3:c.2023_2025del
CAID: CA274244, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA274244
gnomAD: 2.105e-05, http://exac.broadinstitute.org/variant/17-78086806-CACA-C
Supplement Table 1)
Patient9: 2yo
CasePresentingHPOs: HP:0001638
HPOsFreeText: rhGAA dosage = 40 EOW, independent walker
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo: 14days old at ERT start
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant1: NM_000152.4(GAA):c.1935C>A (p.Asp645Glu)
ClinVar: 4029, https://www.ncbi.nlm.nih.gov/clinvar/variation/4029/
gnomAD: 0.0001721, http://exac.broadinstitute.org/variant/17-78086721-C-A
Variant2: NM_000152.4(GAA):c.2815_2816delGT (p.Val939Leufs)
ClinVar: 371481, https://www.ncbi.nlm.nih.gov/clinvar/variation/371481/
gnomAD: 1.653e-05, http://exac.broadinstitute.org/variant/17-78093082-CTG-C
Supplement Table 1)
Patient8: 2yo
CasePresentingHPOs: HP:0001638
HPOsFreeText: rhGAA dosage = 40 EOW, independent walker
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo: 16 days old at ERT start
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant1: NM_000152.4(GAA):c.1935C>A (p.Asp645Glu)
ClinVar: 4029, https://www.ncbi.nlm.nih.gov/clinvar/variation/4029/
gnomAD: 0.0001721, http://exac.broadinstitute.org/variant/17-78086721-C-A
Variant2:NM_000152.3:c.1197_1208del
CAID: CA658795246, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA658795246
gnomAD: n/a
84
Case#: 84, Gender N/A, 6 months old when diagnosed, Asian
DiseaseAssertion: Pompe disease
FamilyInfo: Both parents were tested for variants in GAA
CasePresentingHPOs: N/A
CaseHPOFreeText:N/A
CaseNotHPOs: N/A
CaseNotHPOFreeText: The patient did not present any symptoms, diagnosed was made based on the predicted impact of the variant by PolyPhen-2
CasePreviousTesting: The GAA gene was sequenced using NGS and resequenced for confirmation using Sanger.
Dried Blood spot test found an GAA activity of 3.8 pmol/h/disk with a reference value of 6.5 pmol/h/disk
enzyme activity in fibroblast was recorded to be 3.0 nmol/h/mg protein.
Variants: Variant1: (Two mutated alleles with heterozygous mutations)
Variant1.1: NM_000152.5(GAA):c.752C>T (p.Ser251Leu)
ClinVar: 346310
CAID: CA8815007
gnomAD: Highest population MAF = 0.002234 (East Asian)
Variant1.2: NM_000152.5(GAA):c.761C>T (p.Ser254Leu)
ClinVar: 330447
CAID: CA8815009
gnomAD: Highest popu;ation MAF= 0.002235 (East Asians)
Variant2: C.1244C>T
ClinVar: N/A
CAID: N/A
gnomAD: N/A
ParentalGenotype: The c.752C>T+c.761C>T and c.1244C>T of subject ID 84 were derived from mother and father, respectively
PreviouslyPublished:N/A
93
Case#: 93, gender N/A, 6months old when diagnosed, Asian
DiseaseAssertion: Pompe disease
FamilyInfo: Both parents were carriers of mutations in the GAA gene. The patient inherited the mutations.
CasePresentingHPOs: N/A
CaseHPOFreeText: Symptoms were noted at the age of 2.7 months old
CaseNotHPOs: N/A
CaseNotHPOFreeText: The patient showed no symptoms but LOPD was diagnosed based on the predicted impact of the variants by PolyPhen-2
CasePreviousTesting: The GAA gene was sequenced using NGS and resequenced for confirmation using Sanger.
Dried Blood spot test found an GAA activity of 0.25 pmol/h/disk with a reference value of 6.5 pmol/h/disk
Variant1: NM_000152.5(GAA):c.317G>A (p.Arg106His)
ClinVar: 286481
CAID: CA8814849
gnomAD: MAF=0.0001094 in East Asian
Variant2: (COMBINATION OF MUTATIONS IN THIS ALLELE, DOUBT HERE)
Variant2.1: NM_000152.5(GAA):c.752C>T (p.Ser251Leu)
ClinVar: 346310
CAID: CA8815007
gnomAD: Highest population MAF = 0.002234 (East Asian)
Variant2.2: NM_000152.5(GAA):c.761C>T (p.Ser254Leu)
ClinVar: 330447
CAID: CA8815009
gnomAD: Highest population MAF= 0.002235 (East Asians)
ParentalGenotype: Father is heterozygous for c.317G>A (p.Arg106His).
Mother carries both mutations of c.[752C>T,761C>T].
PreviouslyPublished:N/A
19
Patient19: 55yo
CasePresentingHPOs: HP:0003325, HP:0002093, HP:0002315, HP:0004887
HPOsFreeText: morning headache, GAA = 6%, BMI = 25, normal CTA, temporo-insular lacunes
CaseNotHPOs:
NotHPOsFreeText: No cardiovascular risk
CaseAddInfo: 3yr disease duration, variants in cis
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant1: NM_000152.4(GAA):c.-32-13T>G
Clinvar: 4027, https://www.ncbi.nlm.nih.gov/clinvar/variation/4027/
gnomAD: 0.003582, http://exac.broadinstitute.org/variant/17-78078341-T-G
Variant2: NM_000152.3:c.2530_2541del
CAID: CA658795292, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA658795292
gnomAD: n/a
10
Patient10: 50yo
CasePresentingHPOs: HP:0003325, HP:0004944, HP:0020038
HPOsFreeText: GAA = 3.6%, BMI = 22.4, MCA M1 4mm aneurysm, normal CT
CaseNotHPOs:
NotHPOsFreeText: No cardiovascular risk factor
CaseAddInfo: 13yr disease duration, variants in cis
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant: NM_000152.4(GAA):c.-32-13T>G
Clinvar: 4027, https://www.ncbi.nlm.nih.gov/clinvar/variation/4027/
gnomAD: 0.003582, http://exac.broadinstitute.org/variant/17-78078341-T-G
Variant2: NM_000152.4(GAA):c.1551+1G>C
ClinVar: 554983, https://www.ncbi.nlm.nih.gov/clinvar/variation/554983/
gnomAD: n/a
The most common mutation observed in PDJ-A patients, including Brazilians, is the intronic alteration c.-32-13 T > G (IVS1-13T > G), which is observed in more than two-thirds of the patients worldwide
Variant: NM_000152.4(GAA):c.-32-13T>G
Clinvar: 4027, https://www.ncbi.nlm.nih.gov/clinvar/variation/4027/
gnomAD: 0.003582, http://exac.broadinstitute.org/variant/17-78078341-T-G
7
Case7: 0.1 years diagnosis, Germany
CasePresentingHPOs: HP:0001635, HP:0001252, HP:0001324, HP:0003236, HP:0001639 (Cardiac failure, Muscular hypotonia, Muscle weakness, Increased serum CK, Hypertrophic cardiomyopathy)
HPOsFreeText: 56 BNP (pg/ml), 6.01 IVS (d) z score, 6.45 IVS (s) z score, Heart Failure at NYHA Class 1, Left-ventricular outflow tract obstruction
CaseAddInfo: Infantile-Onset Pompe Disease
LOPD-3
CaseLOPD-3: 2 weeks diagnosis
HPOsFreeText: GAA activity 2.7 (nmol · h−1 · mg−1), Mean percentage of normal 3.7%
GenotypingMethod: Newborn Screening Panels
Variant: NM_000152.4:c.2647-7G>A
ClinVar: 551106 https://www.ncbi.nlm.nih.gov/clinvar/variation/551106/
gnomAD: South Asian 3.266e-5, Overall 1.780e-5 http://gnomad.broadinstitute.org/variant/17-78092445-G-A
CaseAddInfo: Late Onset Pompe Disease, Patient is homozygous for the above variant
LOPD-7
CaseLOPD-7: 24 years diagnosis
CasePresentingHPOs: HP:0003236, HP:0012378, HP:0002910 (Increased serum CK, Fatigue, Elevated transaminases)
HPOsFreeText: GAA activity 4.0 (nmol · h−1 · mg−1), Mean percentage of normal 5.6%
GenotypingMethod: Newborn Screening Panels
Variant1: NM_000152.4:c.-32-13T>G
ClinVar: 4027 http://www.ncbi.nlm.nih.gov/clinvar/variation/4027
gnomAD: Ashkenazi Jewish 5.541e-3, Overall 3.401e-3 http://gnomad.broadinstitute.org/variant/17-78078341-T-G
Variant2: NM_000152.4:c.2481+102_2646+31del (p.Gly828_Asn882del) (exon 18 del)
ClinVar: 4031 https://www.ncbi.nlm.nih.gov/clinvar/variation/4031/
gnomAD: Not in gnomAD
CaseAddInfo: Late Onset Pompe Disease
LOPD-11
CaseLOPD-11: 8.3 years diagnosis
HPOsFreeText: GAA activity 2.0 (nmol · h−1 · mg−1), Mean percentage of normal 2.8%
GenotypingMethod: Newborn Screening Panels
Variant1: NM_000152.4:c.-32-13T>G
ClinVar: 4027 http://www.ncbi.nlm.nih.gov/clinvar/variation/4027
gnomAD: Ashkenazi Jewish 5.541e-3, Overall 3.401e-3 http://gnomad.broadinstitute.org/variant/17-78078341-T-G
Chromosomal code not provided
Variant2: NP_000143.2:p.Q743∗
ClinVar: N/A
gnomAD: N/A
CaseAddInfo: Late Onset Pompe Disease
PD/VOUS-5
CasePD/VOUS-5: 1.7 years diagnosis
HPOsFreeText: GAA activity 9.16 (nmol · h−1 · mg−1), Mean percentage of normal 12.9%
GenotypingMethod: Newborn Screening Panels
Variant1: NM_000152.4:c.1726G>A (p.Gly576Ser)
ClinVar: 92467 https://www.ncbi.nlm.nih.gov/clinvar/variation/92467/
gnomAD: East Asian 0.1427, Overall 0.01700 http://gnomad.broadinstitute.org/variant/17-78085871-G-A
Variant2: NM_000152.4:c.2065G>A (p.Glu689Lys)
ClinVar: 4030 https://www.ncbi.nlm.nih.gov/clinvar/variation/4030/
gnomAD: East Asian 0.2355, Overall 0.05524 http://gnomad.broadinstitute.org/variant/17-78087041-G-A
Variant3: NM_000152.4:c.1424C>T (p.Pro475Leu)
CAID: CA8815314 https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_000152.3:c.1424C%3ET
gnomAD: South Asian 1.307e-4, Overall 2.009e-5 http://gnomad.broadinstitute.org/variant/17-78083841-C-T
CaseAddInfo: Patient has one pseudodeficency allele and one allele of uncertain significance, Nomenclature claims Variant 1 and 2 are in cis
PD/VOUS-7
CasePD/VOUS-7: 3 weeks diagnosis
HPOsFreeText: GAA activity 3.43 (nmol · h−1 · mg−1), Mean percentage of normal 4.8%
GenotypingMethod: Newborn Screening Panels
Variant1: NM_000152.4:c.1726G>A (p.Gly576Ser)
ClinVar: 92467 https://www.ncbi.nlm.nih.gov/clinvar/variation/92467/
gnomAD: East Asian 0.1427, Overall 0.01700 http://gnomad.broadinstitute.org/variant/17-78085871-G-A
Variant2: NM_000152.4:c.2065G>A (p.Glu689Lys)
ClinVar: 4030 https://www.ncbi.nlm.nih.gov/clinvar/variation/4030/
gnomAD: East Asian 0.2355, Overall 0.05524 http://gnomad.broadinstitute.org/variant/17-78087041-G-A
Multiple interpretations of p.G615R possible
Variant3: NP_000143.2:p.G615R
CAID: PA113309 https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NP_000143.2%3Ap.G615R
gnomAD: N/A
CaseAddInfo: Patient has one pseudodeficency allele and one allele of uncertain significance, Nomenclature claims Variant 1 and 2 are in cis
Reevaluating the pathogenicity of the mutation c.1194 +5 G>A in GAA gene by functional analysis of RNA in a 61-year-old woman diagnosed with Pompe disease by muscle biopsy
PMID: 30770309 Gene: GAA
The patient, a 61‐year-old woman,
Case#: Patient, female, 61 years old, ethnicity unknown
DiseaseAssertion: Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: HP:0040213, HP:0010535, HP:0003326, HP:0002273, HP:0002877 (Hypopnea, Sleep Apnea, Myalgia, Tetraparesis, Nocturnal hypoventilation)
CaseHPOFreeText: Sleep Apnea-Hypopnea Syndrome (SAHS), predominantly proximal tetraparesis
CaseNotHPOs: N/A
CaseNotHPOFreeText: Serum measurements were normal, includind Creatine Phosphokinase levels (CPK)
CasePreviousTesting: GAA enzyme level 0.72 µkat/kg was significantly reduced in lymphocytes with a reference range of 4.8–13.3 µkat/kg protein. This test was done with maltase-glucoamylase inhibitor acarbose
All exons and flanking introns were bidirectionally sequenced after PCR amplification. "sequence-analysis of GAA transcripts"
Variant: c.1194+5G>A
ClinVar:
CAID:CA658795243
gnomAD:
ParentalGenotype:
PreviouslyPublished: N/A
These results were confirmed in a fibroblast cell line from patient 2
Patient2: concentration-dependent effects of AONs 3 and 4 confirmed in a fibroblast cell line from this patient, this concluded that these AONs show in vitro activities sufficient to elevate canonical GAA pre-mRNA splicing and thus enzymatic activity
CasePresentingHPOs:
HPOsFreeText:
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo:
CasePMIDs:
CasePreviousTesting: n/a
CaseGenotypingMethod: n/a
Variant1: NM_000152.4(GAA):c.-32-13T>G
Clinvar: 4027, https://www.ncbi.nlm.nih.gov/clinvar/variation/4027/
gnomAD: 0.003582, http://exac.broadinstitute.org/variant/17-78078341-T-G
Variant2: NM_000152.3:c.923A>C
CAID: CA401364056, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA401364056
gnomAD: n/a
To validate the U7 snRNA vector, a control experiment was performed on primary fibroblasts derived from a patient with adult Pompe disease (patient 1), who carried the IVS1 variant on one allele and the c.525delT on the second allele.
Patient1: control experiment performed on patient's primary fibroblasts to validate U7 snRNA vector, screen showed multiple U7 snRNA-based AONs that modulate inclusion of exon 2 in GAA mRNA
CasePresentingHPOs:
HPOsFreeText: LOPD
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo:
CasePMIDs:
CasePreviousTesting: n/a
CaseGenotypingMethod: n/a
Variant1: NM_000152.4(GAA):c.-32-13T>G
Clinvar: 4027, https://www.ncbi.nlm.nih.gov/clinvar/variation/4027/
gnomAD: 0.003582, http://exac.broadinstitute.org/variant/17-78078341-T-G
Variant2: NM_000152.4(GAA):c.525delT (p.Glu176Argfs)
ClinVar: 4033, https://www.ncbi.nlm.nih.gov/clinvar/variation/4033/
gnomAD: 7.041e-05, http://exac.broadinstitute.org/variant/17-78078909-CT-C
4
Case4: Male, 0.8 yr onset, 2 yr diagnosis, 2.4 yr report
HPOsFreeText: 1353 CK U/l, 13 GAA activity (nmol/h/mg)^h from cultured fibroblasts
NotHPOsFreeText: No wheelchair used, no respiratory support
13
Case13: Male, 5 yr onset, 2 yr diagnosis, 7.6 yr report
HPOsFreeText: Respiratory support at night, FVC z-score sitting -1.77 (78% pred), FVC z-score supine -1.72 (79% pred), 100% MRC Scale, 436 CK U/l, Deficent GAA activity (nmol/h/mg)^h from cultured fibroblasts
NotHPOsFreeText: No wheelchair used
16
Case#: Subject number 16, male, 22 years (baseline visit)
DiseaseAssertion: Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: HP:0003236 (Elevated circulating creatine kinase concentration)
CaseHPOFreeText:
CaseNotHPOs: HP:0001324 (Muscle Weakness), HP:0002098 (respiratory distress), HP:0002870 (obstructive sleep apnea)
CaseNotHPOFreeText: no mechanical ventilation at Baseline Visit, no mechanical ventilation at last visit
CasePreviousTesting: "reduced enzymatic activity on fibroblasts, blood leukocytes or skeletal muscle and/or the presence of two known mutations in the GAA gene"
PreviouslyPublished: N/A
6
Case#: Subject number 6, female, 36 years (diagnosis), 51 years (baseline visit), 47 years (ERT)
DiseaseAssertion: Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: HP:0001324 (Muscle Weakness)
CaseHPOFreeText:
CaseNotHPOs: HP:0003236 (Elevated circulating creatine kinase concentration), HP:0002870 (obstructive sleep apnea), HP:0002098 (respiratory distress)
CaseNotHPOFreeText: no mechanical ventilation at Baseline Visit, no mechanical ventilation at last visit
CasePreviousTesting: "reduced enzymatic activity on fibroblasts, blood leukocytes or skeletal muscle and/or the presence of two known mutations in the GAA gene"
PreviouslyPublished: N/A
28
Case#: Subject number 28, male, 20 years (diagnosis), 43 years (baseline visit), 43 (ERT)
DiseaseAssertion: Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: HP:0001324 (Muscle Weakness)
CaseHPOFreeText:
CaseNotHPOs: HP:0003236 (Elevated circulating creatine kinase concentration), HP:0002870 (obstructive sleep apnea), HP:0002098 (respiratory distress)
CaseNotHPOFreeText: no mechanical ventilation at Baseline Visit, no mechanical ventilation at last visit
CasePreviousTesting: "reduced enzymatic activity on fibroblasts, blood leukocytes or skeletal muscle and/or the presence of two known mutations in the GAA gene"
PreviouslyPublished: N/A
23
Case#: Subject number 23, male, 2 years (diagnosis), 8 years (baseline visit)
DiseaseAssertion: Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: HP:0003236 (Elevated circulating creatine kinase concentration)
CaseHPOFreeText:
CaseNotHPOs: HP:0002870 (obstructive sleep apnea), HP:0001324 (Muscle Weakness), HP:0002098 (respiratory distress)
CaseNotHPOFreeText: no mechanical ventilation at Baseline Visit, no mechanical ventilation at last visit
CasePreviousTesting: "reduced enzymatic activity on fibroblasts, blood leukocytes or skeletal muscle and/or the presence of two known mutations in the GAA gene"
PreviouslyPublished: N/A
33
Case#: Subject number 33, female, 16 years (diagnosis), 20 years (baseline visit)
DiseaseAssertion: Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: HP:0003236 (Elevated circulating creatine kinase concentration)
CaseHPOFreeText:
CaseNotHPOs: HP:0002098 (respiratory distress), HP:0002870 (obstructive sleep apnea), HP:0001324 (Muscle Weakness)
CaseNotHPOFreeText: no mechanical ventilation at Baseline Visit, no mechanical ventilation at last visit
CasePreviousTesting: "reduced enzymatic activity on fibroblasts, blood leukocytes or skeletal muscle and/or the presence of two known mutations in the GAA gene"
PreviouslyPublished: N/A
6
Case#: Patient 6, Gender N/A, Onset at 5-6 months. Death around 2 years old, Southeast Asian
DiseaseAssertion: Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: P:0001639. HP:0005165, HP:0001270, HP:0011968
(Dyspnea, Shortened PR interval, Motor delay, Feeding difficulties,
CaseHPOFreeText: FTT, BVH, Severe MR)
CaseNotHPOs: N/A
CaseNotHPOFreeText: N/A
CasePreviousTesting: GAA activity in leukocytes was 0.43% of normal control value.
PCR of all exons was performed and subsequently subjected to capillary Sanger sequencing in both directions
Variant: NM_000152.5(GAA):c.781G>A (p.Ala261Thr)
ClinVar: 456438
CAID: CA8815016
gnomAD: Highest population MAF = 0.00009799 (South Asian)
ParentalGenotype: Father and Mother were carriers of the variant c.781G>A (p.Ala261Thr)
PreviouslyPublished: N/A
10
Case#: Patient 10, Gender N/A, Onset at 1-2 months. Death at 10 months, Southeast Asian
DiseaseAssertion:Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: HP:0001639. HP:0005165, HP:0002100
(Dyspnea, Shortened PR interval, Recurrent aspiration pneumonia)
CaseHPOFreeText: BVH, SDD
CaseNotHPOs: N/A
CaseNotHPOFreeText: N/A
CasePreviousTesting GAA enzyme activity is not available.
PCR of all exons was performed and subsequently subjected to capillary Sanger sequencing in both directions
Variant: NM_000152.5(GAA):c.876C>G (p.Tyr292Ter)
ClinVar: 637958
CAID: CA500127534
gnomAD: N/A
ParentalGenotype: Both parents are carriers of the variant c.876C>G (p.Tyr292Ter)
PreviouslyPublished: N/A
Patient 1 was a 22-year old Caucasian female
Patient1: female, 22 yo, Caucasian
CasePresentingHPOs: HP:0003710, HP:0003326, HP:0040081, HP:0045040, HP:0002910
HPOsFreeText: CK = 571 U/l, LDH = 301 U/l, ASAT = 85 U/l, ALAT = 84 U/l, GAA activity = 0.31nmol/spot x21hrs, small droplet lipid deposits in the muscle fibres of vastus lateralis
CaseNotHPOs: HP:0003457, HP:0009051, HP:0001639, HP:0002111, HP:0002093
NotHPOsFreeText: MRI of thigh muscles showed no abnormalities, no changes in the PAS positive inclusions
CaseAddInfo: 14yo at symptom onset, no family history of neuromuscular disease
CasePreviousTesting: EMG, MRI, muscle biopsy of mm. vastus lateralis, hematoxylin and eosin stain, Peri acid-Schiff reaction, Acid phosphatase staining,transthoracic echocardiogram, respiratory function test
CaseGenotypingMethod: Sanger Sequencing
Variant: NM_000152.4(GAA):c.-32-13T>G
Clinvar: 4027, https://www.ncbi.nlm.nih.gov/clinvar/variation/4027/
gnomAD: 0.003582, http://exac.broadinstitute.org/variant/17-78078341-T-G
2
Case#: P 2, Female, 4.7 months old when started ERT (113.7 months old at publication date), ethnicity unknown
DiseaseAssertion: Pompe disease
FamilyInfo: Table 1 includes parental genotype
CasePresentingHPOs: HP:0001639 , HP:0001252 , HP:0003701, HP:0002090
(Hypertrophic cardiomyopathy, Muscular hypotonia, Proximal muscle weakness, Pneumonia)
CaseHPOFreeText: Aspiration pneumonia was a complication during ERT.
Patient requires tube feeding.
Patient's best and current motor status is being able to sit.
CaseNotHPOs: N/A
CaseNotHPOFreeText: Patient has not required ventilation
CasePreviousTesting: CRIM status is positive in patient
Antibody titer is 1:1.200
Variant 1: NM_000152.5(GAA):c.1799G>A (p.Arg600His)
ClinVar: 370130
CAID: CA8815482
gnomAD: Highest population MAF= 0.00003267 in South Asians
Variant 2: c.1859G>A
ClinVar: N/A
CAID: N/A
gnomAD: N/A
ParentalGenotype: Mother is the carrier of the c.1799G>A (p.Arg600His) Variant
Father is the carrier of the c.1859G>A variant
PreviouslyPublished: N/A
14
Case#: P 14, Male, 1.5 months old when started ERT (Died at 41.8 months old), German
DiseaseAssertion: Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: HP:0001639 , HP:0001252 , HP:0003701, HP:0002090
(Hypertrophic cardiomyopathy, Muscular hypotonia, Proximal muscle weakness, Pneumonia)
CaseHPOFreeText: Pneumonia and deterioration were complications during ERT
Required ventilation
CaseNotHPOs: N/A
CaseNotHPOFreeText: Did not required tube feeding
CasePreviousTesting: CRIM Status and Antibody titer are unknown
Variant: NM_000152.5(GAA):c.1978C>T (p.Arg660Cys)
ClinVar:<br /> 558604
CAID: CA8815561
gnomAD: MAF=0.00005554 in East Asian
ParentalGenotype: Both the paternal and maternal allele carry the variant c.1978C>T (p.Arg660Cys)
PreviouslyPublished: N/A
5
Case#: P 5, Male, 0.9 months old when started ERT (76.9 months old at publication date), Ethnicity unknown
DiseaseAssertion: Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: HP:0001639 , HP:0001252 , HP:0003701, HP:0006532
(Hypertrophic cardiomyopathy, Muscular hypotonia, Proximal muscle weakness, Recurrent pneumonia)
CaseHPOFreeText: Recurrent pneumonia was a complication during ERT.
AR III
Patient requires tube feeding and is ventilated
CaseNotHPOs: N/A
CaseNotHPOFreeText: N/A
CasePreviousTesting: CRIM status is unknown
Antibody titer is 1:12,000
Variant: NM_000152.5(GAA):c.2662G>T (p.Glu888Ter)
ClinVar: 578595
CAID: CA8815829
gnomAD: Highest population MAF= 0.0002719 (East asian)
ParentalGenotype: Both the paternal and maternal allele carry the c.2662G>T (p.Glu888Ter) Variant
PreviouslyPublished: N/A
3
Case3: Female, Swedish, 64 years report, 48 years onset
CasePresentingHPOs: HP:0008956 (Thigh muscle atrophy)
HPOsFreeText: 6-min walk test achieved 369 m, MRC score is 4/5 (thigh/calf), Forced vital capacity sitting/supine is 2.8/2.7 (L), On the medications Zopiklon and Ketoprofen
NotHPOsFreetext: Not on ERT
GroupGenotypingMethod: Mutation Analysis on the GAA Gene
Variant1: NM_000152.4:c.2560C>T (p.Arg854Ter)
ClinVar: 4034 https://www.ncbi.nlm.nih.gov/clinvar/variation/4034/
gnomAD: African 1.891e-3, Overall 2.090e-4 http://gnomad.broadinstitute.org/variant/17-78092070-C-T
Variant2: NM_000152.4:c.-32-13T>G
ClinVar: 4027 https://www.ncbi.nlm.nih.gov/clinvar/variation/4027/
gnomAD: Ashkenazi Jewish 5.541e-3, Overall 3.401e-3 http://gnomad.broadinstitute.org/variant/17-78078341-T-G
CaseAddInfo: Late Onset Pompe Disease
6
Case6: Female, French, 26 years report, 21 years onset
CasePresentingHPOs: HP:0008956 (Thigh muscle atrophy)
HPOsFreeText: 6-min walk test achieved 496 m, MRC score is 3/5 (thigh/calf), Forced vital capacity sitting/supine is 2.2/1.9 (L), Has started ERT,On the medication Perindopril
GroupGenotypingMethod: Mutation Analysis on the GAA Gene
Variant1: NM_000152.4:c.-32-13T>A
CAID: CA913184742 https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA913184742
gnomAD: Not in gnomAD
Variant2: NM_000152.4:c.525delT (p.Glu176Argfs)
ClinVar: 4033 https://www.ncbi.nlm.nih.gov/clinvar/variation/4033/
gnomAD: European (Non-Finnish) 1.880e-4, Overall 9.959e-5 http://gnomad.broadinstitute.org/variant/17-78078909-CT-C
CaseAddInfo: Late Onset Pompe Disease
Ten patients received concomitant immunomodulation (detailed in Supplementary Table S4); six were genotype-predicted as CRIM-negative, three were CRIM-positive, and one lacked genotype data.
Patient 5
Variant1: NM_000152.3:c.1396del
CAID: CA658795256, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA658795256
gnomAD: n/a
Variant2: NM_000152.3:c.1705dup
CAID: CA658795264, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_000152.3%3Ac.1705dup
gnomAD: n/a
3.1 Description of the study population
Patient5: IOPD Group, 12days old
CasePresentingHPOs:
HPOsFreeText: LDH = 464 U/L, CK = 380 U/L, ALT = 58 U/L, AST = 100 U/L, Mann-Whitney Test = 2
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo:
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant: NM_000152.4(GAA):c.1935C>A (p.Asp645Glu)
ClinVar: 4029, https://www.ncbi.nlm.nih.gov/clinvar/variation/4029/
gnomAD: 0.0001240, https://gnomad.broadinstitute.org/variant/17-78086721-C-A
3.1 Description of the study population
Patient3: IOPD Group, 11days old
CasePresentingHPOs:
HPOsFreeText: LDH = 664 U/L, CK = 809 U/L, ALT = 48 U/L, AST = 117 U/L, Mann-Whitney Test = 3
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo:
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant: NM_000152.4(GAA):c.1935C>A (p.Asp645Glu)
ClinVar: 4029, https://www.ncbi.nlm.nih.gov/clinvar/variation/4029/
gnomAD: 0.0001240, https://gnomad.broadinstitute.org/variant/17-78086721-C-A
3.1 Description of the study population
Patient9: IOPD Group, 14days old
CasePresentingHPOs:
HPOsFreeText: LDH = 597 U/L, CK = 998 U/L, ALT = 43 U/L, AST = 102 U/L, Mann-Whitney Test = 3
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo:
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant: NM_000152.4(GAA):c.1935C>A (p.Asp645Glu)
ClinVar: 4029, https://www.ncbi.nlm.nih.gov/clinvar/variation/4029/
gnomAD: 0.0001240, https://gnomad.broadinstitute.org/variant/17-78086721-C-A
4
Case#: Patient 4
DiseaseAssertion: Pompe Disease
FamilyInfo: None given
CasePresentingHPOs: None
CaseHPOFreeText: None
CaseNotHPOs: None
CaseNotHPOFreeText: None
CasePreviousTesting: Single gene sequencing with Ion Torrent Persional Genome Machine
Glucosidase activity: 0.0 nmol 5MU/hr/mL
Variant 1: NM_000152.5:c.596A>G
Variant 1 ClinVarID: 92486
Variant 1 CAid: CA145785
Variant 2: NM_000152.5:c.668G>A
Variant 2 ClinVarID: 92488
Variant 2 CAid: CA145791
ParentalGenotype: Not provided
8
Case#: Patient 8
DiseaseAssertion: Pompe Disease
FamilyInfo: None given
CasePresentingHPOs: None
CaseHPOFreeText: None
CaseNotHPOs: None
CaseNotHPOFreeText: None
CasePreviousTesting: Single gene sequencing with Ion Torrent Persional Genome Machine
Glucosidase activity: 0.05 nmol 5MU/hr/mL
Variant 1: NM_000152.5:c.596A>G
Variant 1 ClinVarID: 92486
Variant 1 CAid: CA145785
Variant 2: NM_000152.5:c.472A>G
Variant 2 ClinVarID:
Variant 2 CAid: CA401361595
Variant 3: NM_000152.5:c.668G>A
Variant 3 ClinVarID: 92488
Variant 3 CAid: CA145791
Variant 4: NM_000152.5:c.503G>T
Variant 4 ClinVarID:
Variant 4 CAid: CA8814883
ParentalGenotype: Not provided
5
Case#: Patient 5
DiseaseAssertion: Pompe Disease
FamilyInfo: None given
CasePresentingHPOs: None
CaseHPOFreeText: None
CaseNotHPOs: None
CaseNotHPOFreeText: None
CasePreviousTesting: Single gene sequencing with Ion Torrent Persional Genome Machine
Glucosidase activity: 0.0 nmol 5MU/hr/mL
Variant 1: NM_000152.5:c.2560C>T
Variant 1 ClinVarID: 4034
Variant 1 CAid: CA340130
Variant 2: NM_000152.5:c.2446G>A
Variant 2 ClinVarID: 92477
Variant 2 CAid: CA145772
ParentalGenotype: Not provided
7
Case#: Patient 7
DiseaseAssertion: Pompe Disease
FamilyInfo: None given
CasePresentingHPOs: None
CaseHPOFreeText: None
CaseNotHPOs: None
CaseNotHPOFreeText: None
CasePreviousTesting: Single gene sequencing with Ion Torrent Persional Genome Machine
Glucosidase activity: 0.05 nmol 5MU/hr/mL
Variant 1: NM_000152.5:c.2560C>T
Variant 1 ClinVarID: 4034
Variant 1 CAid: CA340130
Variant 2: NM_000152.5:c.596A>G
Variant 2 ClinVarID: 92486
Variant 2 CAid: CA145785
Variant 3: NM_000152.5:c.668G>A
Variant 3 ClinVarID: 92488
Variant 3 CAid: CA145791
ParentalGenotype: Not provided
9
Patient9: Male, <1 year onset
CaseAddInfo: LOPD
7
Patient7: Female, 1 year onset
CasePresentingHPOs: HP:0002240 (Hepatomegaly)
HPOsFreeText: GAA activity 1% from leukocyte
CaseNotHPOs: HP:0002098, HP:0001324, HP:0001640 (Respiratory distress, Muscle weakness, Cardiomegaly)
NotHPOsFreeText: No wheelchair needed, Respiratory Assistance not needed
CaseAddInfo: LOPD
3
Patient3: Female, 6 years report, birth onset
CasePresentingHPOs: HP:0001640, HP:0002240, HP:0001324 (Cardiomegaly, Hepatomegaly, Muscle weakness)
HPOsFreeText: GAA activity 2.1% from leukocyte
CaseNotHPOs: HP:0002098 (Respiratory distress)
NotHPOsFreeText: No wheelchair needed, Respiratory Assistance not needed
CaseAddInfo: IOPD
Case 2A 50-day-old male infant was diagnosed with IOPD (Table 1)
Case#: Case 2, male, 50 days old when diagnosed, ethnicity unknown
DiseaseAssertion: Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: HP:0001638, HP:0001252, HP:0000282 (cardiomyopathy, muscular hypotonia, facial edema)
CaseHPOFreeText:(Associated to Pompe disease) increased serum CK.
CaseHPOFreeText: (Infussion associated reactions) Generalized rash, cough and bronchospasm
CaseNotHPOs: N/A
CaseNotHPOFreeText: Infusion associated reactions are not associated with an IgE mediated mechanism.
CasePreviousTesting: See Table 1 for reports on GAA metabolic activity.
GAA activity in dried blood spots is 0 μmol/l/h with a reference range of 1.86–21.9 μmol/l/h
GAA activity on lymphocytes is 0.5 nmol 4 Mu/mg prot/h with a reference range of 21.4 ± 6.2 nmol 4 Mu/mg prot/h
Variant: c1124G>T (p.R375L)
ClinVar: N/A
CAID: N/A
gnomAD: N/A
ParentalGenotype: N/A
PreviouslyPublished: N/A
35
Patient35: male, Caucasian
CasePresentingHPOs: HP:0003676, HP:0003236, HP:0003325, HP:0008994, HP:0003458, HP:0003560, HP:0030121
HPOsFreeText: CK < 10x increase, difficulty ascending stairs, inability to stand without aid, treated with ERT
CaseNotHPOs: HP:0002093
CaseAddInfo: onset as young adult. Older sister also affected with onset at 21 yo. She now exhibits scoliosis, fatigability, paraspinal muscle atrophy, proximal upper limp atrophy, and weakness. Calpain deficiency detected via immunoblot could be connected to CAPN3 variants (p.Gly333Asp [c.998G > A] and p.Ala726Ser [c.2176G > T]).
CasePreviousTesting: same as group, EMG, muscle biopsy, immunoblot analysis
CaseGenotypingMethod: same as group
Variant1: NM_000152.4(GAA):c.569G>A (p.Arg190His)
ClinVar: 188809, https://www.ncbi.nlm.nih.gov/clinvar/variation/188809/
gnomAD: 8.276e-06, http://exac.broadinstitute.org/variant/17-78079570-G-A
Variant2: NM_000152.3:c.2020C>G
CAID: CA401370092, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA401370092
gnomAD: n/a
10
Case#: Subject number 10, male, 70 years (report), 58 years (onset), 65 years (diagnosis)
DiseaseAssertion: Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: HP:0000365 (hearing loss)
CaseHPOFreeText: on BiPAP, ambulatory, assistive device (walking stick occasionally)
CaseNotHPOs: HP:0000360, HP:0000821, HP:0002650, HP:0002617, HP:0000939, HP:0009830, HP:0100647, HP:0010788, HP:0001638 (tinnitus, hypothyroidism, scoliosis, aneurysm, osteoporosis, peripheral neuropathy, Graves disease, Testicular cancer, cardiomyopathy)
CaseNotHPOFreeText: no infusion reaction, no tracheostomy
CasePreviousTesting: “documented deficiency of acid alpha-glucosidase enzyme activity”; on enzyme replacement therapy
Variant 1: NM_000152.5(GAA):c.-32-13T>G (p.Tyr766Ser)
Variant 1 ClinVarID: 4027
Variant 1 CAid: CA116606
Variant 2: NM_000152.5(GAA):c.2655_2656delCG (p.Val886GlufsTer2)
Variant 2 ClinVarID: 597005
Variant 2 CAid: CA913191011
Zygosity: Compound heterozygous
ParentalGenotype: N/A
PreviouslyPublished: N/A
18
Case#: Subject number 18, male, 65 years (report), 40 years (onset), 62 years (diagnosis)
DiseaseAssertion: Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: HP:0000365 (hearing loss), HP:0000939 (osteoporosis), HP:0001638 (cardiomyopathy)
CaseHPOFreeText: ambulatory, on BiPAP
CaseNotHPOs: HP:0000360, HP:0000821, HP:0002650, HP:0002617, HP:0009830, HP:0100647, HP:0010788 (tinnitus, hypothyroidism, scoliosis, aneurysm, peripheral neuropathy, Graves disease, Testicular cancer)
CaseNotHPOFreeText: no tracheostomy, no infusion reaction
CasePreviousTesting: “documented deficiency of acid alpha-glucosidase enzyme activity”; on enzyme replacement therapy
Variant 1: NM_000152.5(GAA):c.-32-13T>G (p.Tyr766Ser)
Variant 1 ClinVarID: 4027
Variant 1 CAid: CA116606
Variant 2: NM_000152.5(GAA):c.1051delG
Variant 2 ClinVarID: 188841
Variant 2 CAid: CA274024
Zygosity: Compound heterozygous
ParentalGenotype: N/A
6
Case#: Subject number 6, female, 57 years (report), 20s years (onset), 31 years (diagnosis)
DiseaseAssertion: Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: HP:0002650 (scoliosis)
CaseHPOFreeText: on BiPAP, ambulatory, assistive device (walker)
CaseNotHPOs: HP:0000360, HP:0000365, HP:0002617, HP:0000939, HP:0009830, HP:0100647, HP:0010788, HP:0000821, HP:0001638 (tinnitus, hearing loss, aneurysm, osteoporosis, peripheral neuropathy, Graves disease, Testicular cancer, hypothyroidism, cardiomyopathy)
CaseNotHPOFreeText: No infusion reaction, no tracheostomy
CasePreviousTesting: “documented deficiency of acid alpha-glucosidase enzyme activity”; on enzyme replacement therapy
Variant 1: NM_000152.5(GAA):c.-32-13T>G (p.Tyr766Ser)
Variant 1 ClinVarID: 4027
Variant 1 CAid: CA116606
Variant 2: NM_000152.5(GAA):c.925G>A (p.Gly309Arg)
Variant 2 ClinVarID: 188797
Variant 2 CAid: CA273972
Zygosity: Compound heterozygous
ParentalGenotype: N/A
PreviouslyPublished: N/A
2
Case#: Subject number 2, male, 48 years (report), 39 years (onset), 43 years (diagnosis)
DiseaseAssertion: Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: HP:0002617 (aneurysm)
CaseHPOFreeText: on BiPap, ambulatory
CaseNotHPOs: HP:0000365, HP:0000360, HP:0000939, HP:0009830, HP:0100647, HP:0010788, HP:0000821, HP:0002650, HP:0001638 (hearing loss, tinnitus, osteoporosis, peripheral neuropathy, Graves disease, Testicular cancer, hypothyroidism, scoliosis, cardiomyopathy)
CaseNotHPOFreeText: No infusion reaction, no tracheostomy
CasePreviousTesting: “documented deficiency of acid alpha-glucosidase enzyme activity”; on enzyme replacement therapy
20 mg/kg (N = 16)
Case16HPOsFreeText: 20 mg/kg GAA treatment, GAA activity at 0.1 umol/h/L, GAA activity at 33% lower limit of normal
CaseAddInfo: Late Onset Pompe Disease
CaseGenotypingMethod: Method not described, only that the diagnosis was "confirmed … based on 2 GAA gene mutations"
Variant1: NM_000152.4:c.-32-13T>G
ClinVar: 4027 https://www.ncbi.nlm.nih.gov/clinvar/variation/4027/
gnomAD: Ashkenazi Jewish 5.541e-3, Overall 3.401e-3 https://gnomad.broadinstitute.org/variant/17-78078341-T-G
Variant2: NM_000152.4:c.722_723delTT (p.Phe241Cysfs*?)
CAID: CA658795235 https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_000152.4%3Ac.722_723delTT
gnomAD: Not in gnomAD
CaseAddInfo:
20 mg/kg (N = 16)
Case15HPOsFreeText: 20 mg/kg GAA treatment, GAA activity at 8.3 pmol/spot/hr, GAA activity at 35% lower limit of normal
CaseAddInfo: Late Onset Pompe Disease
CaseGenotypingMethod: Method not described, only that the diagnosis was "confirmed … based on 2 GAA gene mutations"
Variant1: NM_000152.4:c.-32-13T>G
ClinVar: 4027 https://www.ncbi.nlm.nih.gov/clinvar/variation/4027/
gnomAD: Ashkenazi Jewish 5.541e-3, Overall 3.401e-3 https://gnomad.broadinstitute.org/variant/17-78078341-T-G
Variant2: NM_000152.4:c.2482_2646del165 (p.Gly828_Asn882del) (Exon 18 del)
ClinVar: 4031 https://www.ncbi.nlm.nih.gov/clinvar/variation/4031/
gnomAD: Not in gnomAD
CaseAddInfo:
20 mg/kg (N = 16)
Case21HPOsFreeText: 20 mg/kg GAA treatment, GAA activity at 0.8 U/g, GAA activity at 8.9% lower limit of normal
CaseAddInfo: Late Onset Pompe Disease
CaseGenotypingMethod: Method not described, only that the diagnosis was "confirmed … based on 2 GAA gene mutations"
Variant1: NM_000152.4:c.-32-13T>G
ClinVar: 4027 https://www.ncbi.nlm.nih.gov/clinvar/variation/4027/
gnomAD: Ashkenazi Jewish 5.541e-3, Overall 3.401e-3 https://gnomad.broadinstitute.org/variant/17-78078341-T-G
No information given to identify where the variant is
Variant2: NM_000152.4: IVS15+2T>A
ClinVar:
gnomAD:
CaseAddInfo:
20 mg/kg (N = 16)
Case12HPOsFreeText: 20 mg/kg GAA treatment, GAA activity at 4 nmol/punch/hr, GAA activity at 15% lower limit of normal
CaseAddInfo: Late Onset Pompe Disease
CaseGenotypingMethod: Method not described, only that the diagnosis was "confirmed … based on 2 GAA gene mutations"
Variant1: NM_000152.4:c.-32-13T>G
ClinVar: 4027 https://www.ncbi.nlm.nih.gov/clinvar/variation/4027/
gnomAD: Ashkenazi Jewish 5.541e-3, Overall 3.401e-3 https://gnomad.broadinstitute.org/variant/17-78078341-T-G
Variant2: NM_000152.4:c.546+1G>T
CAID: CA401361913 https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_000152.4%3Ac.546%2B1G%3ET
gnomAD: Not in gnomAD
CaseAddInfo:
#10
Case#: Subject number 10, male, 46 years (report)
DiseaseAssertion: Pompe disease
FamilyInfo: No known family member with PD
CasePresentingHPOs: HP:0001324 (muscle weakness), HP:0003546 (Exercise intolerance), HP:0001252 (Hypotonia)
CaseHPOFreeText:
CaseNotHPOs: HP:0001638 (cardiomyopathy), HP:0002098 (respiratory distress), HP:0002153 (hyperkalemia), HP:0003326 (Myalgia), HP:0002015 (dysphagia), HP:0002094 (dyspnoea)
CaseNotHPOFreeText: no biopsy, not asymptomatic
CasePreviousTesting: "Enzymatic activity was detected by fluorometric techniques" "The GAA sequence was performed in all patients whose enzyme activity measured in DBS and lymphocytes was decreased."
glucosidase activity: GAA activity was 0.36 mol/Lh in dried blood spots (normal range >0.75).
Variant 1: NM_000152.5(GAA):c.-32-13T>C
Variant 1 ClinVarID: 4027
Variant 1 CAid: CA116606
Variant 2: NM_000152.5(GAA):c.236_246delCCACACAGTGC (p.Pro79ArgfsTer13)
Variant 2 ClinVarID: 371302
Variant 2 CAid: CA16041880
Zygosity: Compound heterozygous
ParentalGenotype: N/A
PreviouslyPublished: N/A
#8
Case#: Subject number 8, female, 32 years (report)
DiseaseAssertion: Pompe disease
FamilyInfo: No known family member with PD
CasePresentingHPOs: HP:0002153 (hyperkalemia), HP:0001324 (muscle weakness)
CaseHPOFreeText:
CaseNotHPOs: HP:0001638 (cardiomyopathy), HP:0003546 (Exercise intolerance), HP:0001252 (Hypotonia), HP:0003326 (Myalgia), HP:0002015 (dysphagia), HP:0002098 (respiratory distress), HP:0002094 (dyspnoea)
CaseNotHPOFreeText: no biopsy, not asymptomatic
CasePreviousTesting: "Enzymatic activity was detected by fluorometric techniques" "The GAA sequence was performed in all patients whose enzyme activity measured in DBS and lymphocytes was decreased."
glucosidase activity: GAA activity was 0.3 mol/Lh in dried blood spots (normal range >0.75).
Variant 1: NM_000152.5(GAA):c.-32-13T>C
Variant 1 ClinVarID: 4027
Variant 1 CAid: CA116606
Variant 2: NM_000152.5(GAA):c.925G>A (p.Gly309Arg)
Variant 2 ClinVarID: 188797
Variant 2 CAid: CA273972
Zygosity: Compound heterozygous
ParentalGenotype: N/A
PreviouslyPublished: N/A
#13
Case#: Subject number 13, female, 57 years (report)
DiseaseAssertion: Pompe disease
FamilyInfo: No known family member with PD
CasePresentingHPOs: HP:0001324 (muscle weakness), HP:0003546 (Exercise intolerance), HP:0002094 (dyspnoea)
CaseHPOFreeText:
CaseNotHPOs: HP:0001252 (Hypotonia), HP:0001638 (cardiomyopathy), HP:0003326 (Myalgia), HP:0002015 (dysphagia), HP:0002153 (hyperkalemia), HP:0002098 (respiratory distress)
CaseNotHPOFreeText: no biopsy, not asymptomatic
CasePreviousTesting: "Enzymatic activity was detected by fluorometric techniques" "The GAA sequence was performed in all patients whose enzyme activity measured in DBS and lymphocytes was decreased."
glucosidase activity: GAA activity was 0.37 mol/Lh in dried blood spots (normal range >0.75).
Variant 1: NM_000152.5(GAA):c.-32-13T>C
Variant 1 ClinVarID: 4027
Variant 1 CAid: CA116606
Variant 2: NM_000152.5(GAA):c.2237G>C (p.Trp746Ser)
Variant 2 ClinVarID: 188484
Variant 2 CAid: CA198797
Zygosity: Compound heterozygous
ParentalGenotype: N/A
PreviouslyPublished: N/A
20
Case20: Male, 8 years onset, 11 years diagnosis, 11 years report
CasePresentingHPOs: HP:0003236 (Increased serum CK)
HPOsFreeText: Asymptomatic hyperCKemia
CaseAddInfo: Late-Onset Pompe Disease
12
Case12: Female, Unknown years onset, Unknown years diagnosis, 50 years report
CasePresentingHPOs: HP:0003325, HP:0003327, HP:0003236, HP:0002747 (Limb-girdle muscle weakness, Axial muscle weakness, Increased serum CK, Respiratory muscle weakness)
CaseAddInfo: Late-Onset Pompe Disease
PD02
Patient2: Female, northern China
CasePresentingHPOs:
HPOsFreeText: IOPD
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo:
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant1: NM_000152.4(GAA):c.2662G>T (p.Glu888Ter)
ClinVar: 578595, https://www.ncbi.nlm.nih.gov/clinvar/variation/578595/
gnomAD: 1.65e-05, http://exac.broadinstitute.org/variant/17-78092467-G-T
Variant2: NM_000152.3:c.859-2A>T
CAID: CA401363789, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA401363789
gnomAD: n/a
16
Patient16: Male
CasePresentingHPOs: HP:0004887, HP:0002194, HP:0001522
HPOsFreeText: ERT dosage = 29mg/kg/2w
CaseNotHPOs:
NotHPOsFreeText: No HCM reversal
CaseAddInfo: Symptom onset at 2days, diagnosis and ERT at 10mo, ERT lasted for 6mo, required ventilation at 11mo, died at 16mo
CasePMIDs: 14695532
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant: NM_000152.3:c.1431del
CAID: CA502178465, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA502178465
gnomAD: n/a
9
Patient9: Male
CasePresentingHPOs: HP:0004887, HP:0002194, HP:0001522
HPOsFreeText: ERT dosage = 20 mg/kg/2 w, CRIM negative
CaseNotHPOs:
NotHPOsFreeText: no HCM reversal
CaseAddInfo: Symptom onset at 2mo, diagnosis at 4mo, ERT at 4.5mo, ERT lasted for 4mo, ventilation required at 7mo, died at 10mo
CasePMIDs: 22252923, 27629047
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant: NM_000152.3:c.1657C>T
CAID: CA401368835, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_000152.3%3Ac.1657C%3ET
gnomAD: n/a
Patient 3
Case#: Patient 3, female, symptoms began at birth, diagnosed at 5 weeks
DiseaseAssertion: Pompe Disease
FamilyInfo: N/A
CasePresentingHPOs: HP:0001639, HP:0003712 (hypertrophic cardiomyopathy, hypertrophy of calves)
CaseHPOFreeText: N/A
CaseNotHPOs: N/A
CaseNotHPOFreeText: N/A
CasePreviousTesting: <1% normal GAA expression in fibroblast; after ERT treatment had 100% enzyme activity in cell lysates; unclear how patient was diagnosed
Variant 1: NM_000152.5:c.525delT
Variant 1 ClinVarID: 4033
Variant 1 CAid: CA220406
Variant 2: NM_000152.5:c.525delT
Variant 2 ClinVarID: 4033
Variant 2 CAid: CA220406
ParentalGenotype: Not provided
The mutation c.(1837T>G) results in substitution of glycine in the position of tryptophan in the enzyme structure, which can lead to accelerated tissue damage due to loss of function
NM_000152.3:c.1837T>G
P7a
Patient7: Male, 59yo
CasePresentingHPOs: HP:0000822, HP:0000819, HP:0003077, HP:0001513
HPOsFreeText: LOPD
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo: 5yr follow-up MRI, 14yr disease duration, ERT lasted for 135mo
CasePMIDs: PMID: 25614309
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant1: NM_000152.4(GAA):c.-32-13T>G
Clinvar: 4027, https://www.ncbi.nlm.nih.gov/clinvar/variation/4027/
gnomAD: 0.003582, http://exac.broadinstitute.org/variant/17-78078341-T-G
Variant2: NM_000152.4(GAA):c.307T>G (p.Cys103Gly)
ClinVar: 92483, https://www.ncbi.nlm.nih.gov/clinvar/variation/92483/
gnomAD: n/a
P1a
Patient1: Female 26yo
CasePresentingHPOs: HP:0003077
HPOsFreeText: LOPD
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo: 5year follow-up MRI, 15yr disease duration, ERT lasted for 67mo
CasePMIDs: PMID: 25614309
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant1: NM_000152.4(GAA):c.-32-13T>G
Clinvar: 4027, https://www.ncbi.nlm.nih.gov/clinvar/variation/4027/
gnomAD: 0.003582, http://exac.broadinstitute.org/variant/17-78078341-T-G
Variant2: IVS9 G > C no ClinVar or CAID
P12
Patient12: Female, 66yo
CasePresentingHPOs: HP:0003077, HP:0000822
HPOsFreeText: LOPD
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo: 7yr disease duration, ERT lasted 33mo
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant1: NM_000152.4(GAA):c.-32-13T>G
Clinvar: 4027, https://www.ncbi.nlm.nih.gov/clinvar/variation/4027/
gnomAD: 0.003582, http://exac.broadinstitute.org/variant/17-78078341-T-G
Variant2: NM_000152.4(GAA):c.525delT (p.Glu176Argfs)
ClinVar: 4033, https://www.ncbi.nlm.nih.gov/clinvar/variation/4033/
gnomAD: 0.00009959, http://gnomad.broadinstitute.org/variant/17-78078909-CT-C
3
Case#: Patient 3, Female, 2 months old at diagnosis, Caucasian
DiseaseAssertion: Pompe disease
FamilyInfo: N/A
CasePresentingHPOs: HP:0001252, HP:0001638
(Muscular hypotonia, Cardiomyopathy)
CaseHPOFreeText: floppy baby, no head or neck control
NG tube feeds started at age 1.4 months, currently the patient orally feeds.
Before ERT patient needed oxygen, currently the patient does not need respiratory support.
CaseNotHPOs:
CaseNotHPOFreeText:
Patient ambulates independently
No infusion associated reactions to ERT
CasePreviousTesting: No GAA measurement
Variant: NM_000152.5(GAA):c.236_246del (p.Pro79fs)
ClinVar: 371302
CAID: CA16041880
gnomAD: N/A
ParentalGenotype: N/A
PreviouslyPublished: N/A
At-Risk Testing for Pompe Disease Using Dried Blood Spots: Lessons Learned for Newborn Screening
PMID: PMC7780922
Gene: GAA
Disease: Pompe Disease
Inheritance: Autosomal Recessive
For GAA (Pompe disease) screening
CaseP3-GAA: male, ethnicity = European, country origin = Italy
CasePresentingHPOs:
HPOsFreeText: enzyme activity = 1.97
CaseNotHPOs: HP:0010899, HP:0010916, HP:0003236
CaseAddInfo: known psuedodeficiency alleles (c.1726G>A and c.2065G>A)
CasePreviousTesting: initial and confirmatory DBS, biochemical tests
CaseGenotypingMethod: mutation analyses
Variant1: NM_000152.4(GAA):c.-32-13T>G
Clinvar: 4027, https://www.ncbi.nlm.nih.gov/clinvar/variation/4027/
gnomAD: n/a
3
Patient3: Female, 4.5yo, Family B (fig. 2)
CasePresentingHPOs: HP:0001733 (pancreatitis)
HPOsFreeText: acute neonatal IVA, treated with IVA special formula and vegetarian diet, stopped formula at 2yo and remained on vegetarian diet. Urinary organic acid analysis showed elevated lactic acid, 3-hydroxy-isovaleric acid, and isovalerylglycine, C5-carnitine = 10.8 µmol/l, fluctuating levels of serum ammonia which were eventually normalized with oral sodium benzoate treatment, admitted to hospital 2 times for gastroenteritis with metabolic acidosis and then for recurrent vomiting due to acute pancreatitis. sat unsupported at 6mo, walked and spoke first word at 12mo. As last physical, height = 105cm, weight = 18kg, and had unremarkable neurologic, chest, cardiovascular, and abdominal exams
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo: diagnosed at birth via NBS, consanguineous family
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant1: c.ins386T (p.Tyr129fs) no ClinVar or CAID
Variant2: NM_002225.3(IVD):c.732C>T (p.Asp244=)
ClinVar: 94057, https://www.ncbi.nlm.nih.gov/clinvar/variation/94057/
gnomAD: n/a
Variant3: NC_000015.9:g.40699940T>C (NM_002225.4(IVD):c.234+14C=)
CAID: CA147572, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NC_000015.9%3Ag.40699940T%3EC
ClinVar: 94053, https://www.ncbi.nlm.nih.gov/clinvar/variation/94053/
gnomAD: 0.6830, https://gnomad.broadinstitute.org/variant/15-40699940-T-C
8
Patient8: Male, 6yo, Family C (fig. 2)
CasePresentingHPOs: HP:0000486, HP:0000651 (squint, diplopia)
HPOsFreeText: acute neonatal IVA, treated with IVA special formula and oral L-carnitine, elevated isovalerylglycine, C5-carnitine = 6.8 µmol/l, normal development for age, weight = 128cm, weight = 28kg, normal chest, cardiovascular, and abdominal exams
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo: diagnosed at 3do via NBS, consanguineous family, family history and multiple sibling deaths
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant1: NM_002225.3:c.1207T>A
CAID: CA391724509, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA391724509
gnomAD: n/a
Variant2: NC_000015.9:g.40699940T>C (NM_002225.4(IVD):c.234+14C=)
CAID: CA147572, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NC_000015.9%3Ag.40699940T%3EC
ClinVar: 94053, https://www.ncbi.nlm.nih.gov/clinvar/variation/94053/
gnomAD: 0.6830, https://gnomad.broadinstitute.org/variant/15-40699940-T-C
2
CaseGM01565: Female, 16 years report, Caucasian, Europe
CasePresentingHPOs: HP:0003153 (Cystathioninuria)
HPOsFreeText: N/A
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: Proband is a homozygote for this variant.
CasePreviousTesting: N/A
CaseGenotypingMethod: Primers were developed and the CTH exons 1-12 and exon-intron boundaries were PCR amplified and sequenced. All sequence variations were verified by restriction enzyme analysis and/or repeat sequencing.
Variant: NM_001902.5:c.200C>T (p.Thr67Ile)
ClinVar: 2939 https://www.ncbi.nlm.nih.gov/clinvar/variation/2939/
gnomAD: Ashkenazi Jewish 9.934e-3, Overall 6.308e-3 https://gnomad.broadinstitute.org/variant/1-70881670-C-T
11.
CaseDII-2: N/A
CasePresentingHPOs: N/A
HPOsFreeText: Pretreatment phenylalanine level at 970 umol/L
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: N/A
Variant1: NM_000277.3(PAH):c.561G>A (p.Trp187Ter)
ClinVar: 102736 https://www.ncbi.nlm.nih.gov/clinvar/variation/102736/
gnomAD: 0.00001760, https://gnomad.broadinstitute.org/variant/12-103249059-C-T
Variant2: NM_000277.3(PAH):c.782G>C (p.Arg261Pro)
ClinVar: 102832 https://www.ncbi.nlm.nih.gov/clinvar/variation/102832/
gnomAD: Not in gnomAD
I1.4
CaseAII-4: N/A
CasePresentingHPOs: N/A
HPOsFreeText: Pretreatment phenylalanine level at 2085 umol/L
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: Proband for Family A
Variant1: NM_000277.3(PAH):c.165del (p.Phe55fs)
ClinVar: 611 https://www.ncbi.nlm.nih.gov/clinvar/variation/611/
gnomAD: 0.00002639, https://gnomad.broadinstitute.org/variant/12-103306571-CA-C?dataset=gnomad_r3
Variant2: NM_000277.3(PAH):c.143T>C (p.Leu48Ser)
ClinVar: 608 https://www.ncbi.nlm.nih.gov/clinvar/variation/608/
gnomAD: 0.001025, https://gnomad.broadinstitute.org/variant/12-102912816-A-G?dataset=gnomad_r3
I. 1
CaseBI-1: N/A
CasePresentingHPOs: N/A
HPOsFreeText: Pretreatment phenylalanine level at 375 umol/L
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: N/A
Variant1: NM_000277.3(PAH):c.1222C>T (p.Arg408Trp)
ClinVar: 577 https://www.ncbi.nlm.nih.gov/clinvar/variation/577/
gnomAD: 0.001766, https://gnomad.broadinstitute.org/variant/12-102840493-G-A?dataset=gnomad_r3
Variant2: NM_000277.3(PAH):c.688G>A (p.Val230Ile)
ClinVar: 102784 https://www.ncbi.nlm.nih.gov/clinvar/variation/102784/
gnomAD: 0.0009025, https://gnomad.broadinstitute.org/variant/12-102855154-C-T?dataset=gnomad_r3
1.1
CaseEI-1: N/A
CasePresentingHPOs: N/A
HPOsFreeText: Pretreatment phenylalanine level at 430 umol/L
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: N/A
Variant1: NM_000277.3(PAH):c.1066-11G>A
ClinVar: 607 https://www.ncbi.nlm.nih.gov/clinvar/variation/607/
gnomAD: 0.0004116, https://gnomad.broadinstitute.org/variant/12-103237568-C-T
Variant2: NM_000277.3(PAH):c.533A>G (p.Glu178Gly)
ClinVar: 92746 https://www.ncbi.nlm.nih.gov/clinvar/variation/92746/
gnomAD: 0.0001473, https://gnomad.broadinstitute.org/variant/12-103249087-T-C
I. 1
CaseAI-1: N/A
CasePresentingHPOs: N/A
HPOsFreeText: Pretreatment phenylalanine level at 330 umol/L
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: N/A
Variant1: NM_000277.3(PAH):c.143T>C (p.Leu48Ser)
ClinVar: 608 https://www.ncbi.nlm.nih.gov/clinvar/variation/608/
gnomAD: 0.001025, https://gnomad.broadinstitute.org/variant/12-102912816-A-G?dataset=gnomad_r3
Variant2: NM_000277.3(PAH):c.898G>T (p.Ala300Ser)
ClinVar: 92751 https://www.ncbi.nlm.nih.gov/clinvar/variation/92751/
gnomAD: 0.006318, https://gnomad.broadinstitute.org/variant/12-102851701-C-A?dataset=gnomad_r3
I. 1
CaseDI-1: N/A
CasePresentingHPOs: N/A
HPOsFreeText: Pretreatment phenylalanine level at 365 umol/L
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: N/A
Variant1: NM_000277.3(PAH):c.561G>A (p.Trp187Ter)
ClinVar: 102736 https://www.ncbi.nlm.nih.gov/clinvar/variation/102736/
gnomAD: 0.00001760, https://gnomad.broadinstitute.org/variant/12-103249059-C-T
Variant2: NM_000277.3(PAH):c.898G>T (p.Ala300Ser)
ClinVar: 92751 https://www.ncbi.nlm.nih.gov/clinvar/variation/92751/
gnomAD: 0.006318, https://gnomad.broadinstitute.org/variant/12-102851701-C-A?dataset=gnomad_r3
2929 (M)
Case2929: Male, 4 months diagnosis, Czech
CasePresentingHPOs: HP:0001270, HP:0011344, HP:0003153, HP:0003698, HP:0002300, HP:0004484, HP:0008454 (Motor delay, Severe psychomotor retardation, Cystathioninuria, Difficulty standing, Mutism, Craniofacial asymmetry, Lumbar kyphosis)
HPOsFreeText: Unknown total homocysteine (N/A μM/l; reference 5.1–13.9), Elevated cystathionine (5.4 μM/l; reference 0.04–0.34), Unknown total cysteine (N/A μmol/l; reference 203–369), Response to B6 treatment unknown
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CasePMIDs: 615480
CaseAddInfo: Patient is homozygous for this mutation, Proband is born of father-daughter incest and is therefore consanguineous
CasePreviousTesting: Cystathionine (Cysta), total cysteine (tCys), and total homocysteine (tHcy) panels
CaseGenotypingMethod: PCR amplification of CTH coding regions and exon-intron boundaries was performed. These fragments were sequenced and aligned with a reference to find mutations. Those found were confirmed by restriction digest of 100 controls.
Variant: NM_001902.5:c.589C>T (p.Arg197Cys)
CAID: CA906222 https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_001902.5%3Ac.589C%3ET
gnomAD: South Asian 1.312e-4, Overall 6.378e-5 https://gnomad.broadinstitute.org/variant/1-70895477-C-T
2930 (F)
Case2930: Female, 3 weeks diagnosis, United States
CasePresentingHPOs: HP:0003153 (Cystathioninuria)
HPOsFreeText: Elevated total homocysteine (18.2 μM/l; reference 5.1–13.9), Elevated cystathionine (11.8 μM/l; reference 0.04–0.34), Normal total cysteine (246 μmol/l; reference 203–369)
CaseNotHPOs: HP:0001270, HP:0001263, HP:0100543, HP:0030972 (Motor delay, Global developmental delay, Cognitive impairment, Abnormal systemic blood pressure)
NotHPOsFreeText: Unresponsive to B6 treatment
CaseAddInfo: Patient is compound heterozygous for these mutations, Parental testing has confirmed these variants are in trans
CasePreviousTesting: Cystathionine (Cysta), total cysteine (tCys), and total homocysteine (tHcy) panels
CaseGenotypingMethod: PCR amplification of CTH coding regions and exon-intron boundaries was performed. These fragments were sequenced and aligned with a reference to find mutations. Those found were confirmed by restriction digest of 100 controls.
Variant1: NM_001902.5:c.932C>T (p.Thr311Ile)
CAID: CA340839077 https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_001902.5%3Ac.932C%3ET
gnomAD: Not in gnomAD
Variant Too Long
Variant2: NP_001893.2:p.Gly57_Gln196del
ClinVar:
gnomAD:
Proband
CaseF4P: 4 yrs report, India
CasePresentingHPOs: HP:0001010, HP:0000750, HP:0001249, HP:0006801, HP:0004923 (Hypopigmentation of the skin, Delayed speech and language development, Intellectual disability, Brisk deep tendon reflexes, Hyperphenylalaninemia)
HPOsFreeText: N/A
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: Family is consanguinous, Parents were confirmed heterozygous, Variant disrupts the WT donor site and is predicted to alter splicing
CasePreviousTesting: Blood phenylalanine before treatment was 1150 μmol/l, Blood tyrosine before treatment was 30 μmol/l, PKU diagnosis was based on ferric chloride test on patient urine samples and detection of elevated Phenylalanine levels in blood samples by using HPLC, in addition to analysis of clinical features.
CaseGenotypingMethod: Genomic DNA was isolated from blood samples of proband and family members. PCR amplification and sequencing was used to screen for mutations. Each mutation was confirmed by bi-directional DNA sequencing.
Variant: NM_000277.3(PAH):c.60+5G>A
ClinVar: 120281 https://www.ncbi.nlm.nih.gov/clinvar/variation/120281/
gnomAD: Not in gnomAD
Sibling
CaseF5S: 21 yrs report, India
CasePresentingHPOs: N/A
HPOsFreeText: N/A
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: Variant has been shown to abolish canonical splice donor site and lead to a null protein
CasePreviousTesting: Blood phenylalanine before treatment was 1698 μmol/l, Blood tyrosine before treatment was 37 μmol/l
CaseGenotypingMethod: N/A
Variant: NM_000277.3(PAH):c.842+1G>A
ClinVar: 599 https://www.ncbi.nlm.nih.gov/clinvar/variation/599/
gnomAD: 0.00007752, http://gnomad.broadinstitute.org/variant/12-103246592-C-T
Proband
CaseF5P: 18 yrs report, India
CasePresentingHPOs: N/A
HPOsFreeText: N/A
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: Proband for Family 5, Variant has been shown to abolish canonical splice donor site and lead to a null protein
CasePreviousTesting: Blood phenylalanine before treatment was 1260 μmol/l, Blood tyrosine before treatment was 36 μmol/l
CaseGenotypingMethod: N/A
Variant: NM_000277.3(PAH):c.842+1G>A
ClinVar: 599 https://www.ncbi.nlm.nih.gov/clinvar/variation/599/
gnomAD: 0.00007752, http://gnomad.broadinstitute.org/variant/12-103246592-C-T
Sibling
CaseF1S: 5 yrs report, India
CasePresentingHPOs: N/A
HPOsFreeText: N/A
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: Variant is demonstrated to activate a cryptic splice site and abolish the canon splice site leading to a premature termination and nonsense-mediated decay
CasePreviousTesting: Blood phenylalanine before treatment was 1431 μmol/l, Blood tyrosine before treatment was 35 μmol/l
CaseGenotypingMethod: N/A
Variant: NM_000277.3(PAH):c.169-2A>G
ClinVar: 555212 https://www.ncbi.nlm.nih.gov/clinvar/variation/555212/
gnomAD: 0.00003267, http://gnomad.broadinstitute.org/variant/12-103288698-T-C
Proband
CaseF2P: 2 yrs report, India
CasePresentingHPOs: HP:0001010, HP:0000750, HP:0001249, HP:0006801, HP:0004923 (Hypopigmentation of the skin, Delayed speech and language development, Intellectual disability, Brisk deep tendon reflexes, Hyperphenylalaninemia)
HPOsFreeText: N/A
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: Family is consanguinous, Parents were confirmed heterozygous, Variant may not undergo NMD however would be missing essential domains and is predicted to be null
CasePreviousTesting: Blood phenylalanine before treatment was 1619 μmol/l, Blood tyrosine before treatment was 60 μmol/l, PKU diagnosis was based on ferric chloride test on patient urine samples and detection of elevated Phenylalanine levels in blood samples by using HPLC, in addition to analysis of clinical features.
CaseGenotypingMethod: Genomic DNA was isolated from blood samples of proband and family members. PCR amplification and sequencing was used to screen for mutations. Each mutation was confirmed by bi-directional DNA sequencing.
Variant: NM_000277.3:c.1177_1178insT (p.Asn393Ilefs*2)
CAID: CA16020958 http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA16020958
gnomAD: Not in gnomAD
2
CaseCA2: Male, 17 months death
CasePresentingHPOs: HP:0001644, HP:0001875, HP:0001508, HP:0003535 (Dilated cardiomyopathy, Neutropenia, Failure to thrive, 3-Methylglutaconic aciduria)
HPOsFreeText: N/A
CaseNotHPOs: HP:0003107 (Abnormal circulating cholesterol concentration)
NotHPOsFreeText: N/A
CaseAddInfo: Family history of high urinary 3-MGC
CasePreviousTesting: N/A
CaseGenotypingMethod: The TAZ gene was PCR amplified in three fragments and directly sequenced in the mother and proband.
Variant: NM_000116.4:c.548T>G (p.Val183Gly)
CAID: CA415183843, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA415183843
gnomAD: Not in gnomAD
4
CaseCA4: Male, 6 months death
CasePresentingHPOs: HP:0001644, HP:0001508 (Dilated cardiomyopathy, Failure to thrive)
HPOsFreeText: N/A
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: Cardiac transplant 11 months after presentation; Variant also found in mother and grandmother
CasePreviousTesting: N/A
CaseGenotypingMethod: The TAZ gene was PCR amplified in three fragments and directly sequenced in obligate heterozygotes, III.2, a heterozygous carrier, and III.4.
Variant: NM_000116.5(TAZ):c.589G>A (p.Gly197Arg)
ClinVar: 11105, https://www.ncbi.nlm.nih.gov/clinvar/variation/11105/
gnomAD: Not in gnomAD
Patient description
CaseWA: Female, 5 yrs onset, French-Canadian
CasePresentingHPOs: HP:0002013, HP:0001944, HP:0001289, HP:0002367, HP:0001942, HP:0031962, HP:0001987, HP:0003236, HP:0001946, HP:0002919, HP:0000651, HP:0012120 (Vomiting, Dehydration, Confusion, Visual hallucinations, Metabolic acidosis, Elevated serum anion gap, Hyperammonemia, Elevated serum creatine kinase, Ketosis, Ketonuria, Diplopia, Methylmalonic aciduria)
HPOsFreeText: Low incorporation of 14C-propionate (4.1 nmol propionate/mg protein/18 h; control mean 10.8, SD 3.7) with no response to hydroxycobalamin
CaseNotHPOs: HP:0002151 (Increased serum lactate)
NotHPOsFreeText: N/A
CaseAddInfo: Parents are non-consanguineous with unremarkable family history, Treatment with carnitine and restricted protein intake normalized symptoms, Sequencing of the mother revealed Variant 2 without Variant 1 confirming compound heterozygosity
CasePreviousTesting: Metabolic acidosis values w/ elevated anion gap (pH = 6.96, bicarbonate 3.5 mmol/L and pCO2 15.9 mm Hg, anion gap 25.5 mmol/L); Mild hyperammonemia (107 μmol/L; ref. < 50); Elevated creatine kinase (from 498 IU/L initially up to 3062 IU/L, ref. < 150); Organic acid profiles were analyzed via gas chromatography–mass spectrometry with Table 1 showing relevant organic acid values; Proband was negative for propionyl-coA carboxylase deficency (811 pmol/min/mg protein with control mean 1123, PCCA and PCCB variants were negative) and ruled out MUT/cobalamin issues as well; Fusion experiments showed negative results for mut, cblA, and cblB complementation but no increase in activity when fused with MCEE confirming the pathway blockage
CaseGenotypingMethod: Extracted DNA from blood was amplified and three coding exons/splice site junctions of MCEE were Sanger sequenced. A deletion/duplicaiton analysis yeilded normal results. To search for an intronic sequence variant, total RNA was extracted and reverse-transcribed to confirm a 92-bp insertion between Exons 2 and 3. Resulting sequencing of this genomic area revealed a deep intronic variant that created a new consensus donor splice site that leads to a premature stop codon.
Variant1: NM_032601.4(MCEE):c.139C>T (p.Arg47Ter)
ClinVar: 2343, http://www.ncbi.nlm.nih.gov/clinvar/variation/2343
gnomAD: 0.0004884, https://gnomad.broadinstitute.org/variant/2-71351575-G-A
Variant2: NM_032601.3:c.379-644A>G
CAID: CA892631472, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA892631472
gnomAD: Not in gnomAD
OS-104 II-1
CaseOS-104_II-1: Male, Birth onset, Turkey
CasePresentingHPOs: HP:0001992, HP:0001324, HP:0002317 (Organic aciduria, Muscular hypotonia, Unsteady gait)
HPOsFreeText: N/A
CaseNotHPOs: HP:0001263, HP:0001252 (Global developmental delay, Muscle weakness)
NotHPOsFreeText: N/A
CaseAddInfo: Parents are consanguineous, Two younger brothers are unaffected, The variant results in a frameshift that extends the WT protein to 408 AAs and affects the C-terminal peptidase domain
CasePreviousTesting: GS-MS analysis identified urinary organic acids dominated by N-aceylated AAs, supported by NMR spectroscopy of urine samples with serum samples being negative; Metabolite pattern of brother was unremarkable; Values of excreted AAs are in Table 1; Ultrasound, electromyography, and NMR tomography of the musculature from the lower extremities showed unremarkable results; Routine histological, histochemical, enzyme histochemical, and immunohistochemical studies did not reveal any significant myopathological abnormalities
CaseGenotypingMethod: Genomic DNA was extracted from blood samples or after EBV transformation of peripheral blood lymphocytes. Exons and exon-intron boundaries were amplified and bidirectionally sequenced.
Variant: NM_000666.3(ACY1):c.1102_1103AC[3] (p.Pro369fs)
ClinVar: 18109, https://www.ncbi.nlm.nih.gov/clinvar/variation/18109/
gnomAD: Not in gnomAD
2
Case2: Male, 1y 7m, Chinese
HPOsFreeText: (at 11 days) 1.69 C4 umol/L, 0.19 C4/C2, 2.38 C4/C3
NotHPOsFreeText: normal urine isobutyrylglycine
Case2 (Level 2)
CasePreviousTesting: same as group
CaseMethod1: same as group
CaseMethod2: same as group
CaseGenotypingMethod: same as group
Variant: NM_014384.2:c.286G>A (p.Gly96Ser)
ClinVar: n/a
CAID: CA6372895
gnomAD: 0.001453 (East Asian)
CaseAddInfo:
7
Case7: Male, 6m, Chinese
CasePresentingHPOs: HP:0002248, HP:0001290, HP:0008872, HP:0002572 (haematemesis, hypotonia, feeding difficulties in infancy, recurrent vomiting)
HPOsFreeText: (at 19 days) 1.01 C4 umol/L, 0.38 C4/C2, 1.61 C4/C3
NotHPOsFreeText: normal urine isobutyrylglycine
Case7 (Level 2):
CasePreviousTesting: same as group
CaseMethod1: same as group
CaseMethod2: same as group
CaseGenotypingMethod: same as group
Variant1: NM_014384.2:c.444G>T (p.Pro148=)
ClinVar: n/a
CAID: CA6372946
gnomAD: 0.0002772 (Other)
Variant2: NM_014384.2:c.1176G>T (p.Arg392Ser)
ClinVar: n/a
CAID: CA6373249
gnomAD: 0.0001088 (East Asian)
CaseAddInfo: trans heterozygous, inherited one allele from each parent
14
Case 14 (Level 2)
CasePreviousTesting: same as group
CaseMethod1: PCR
CaseGenotypingMethod: same as group __
Variant1: NM_015506.2(MMACHC):c.658_660delAAG (p.Lys220del)
ClinVar: 95707
CAID: CA223197
gnomAD: 0.0003071 (East Asian)
Variant2: NM_015506.2(MMACHC):c.567dupT (p.Ile190Tyrfs*13)
ClinVar: 556708
CAID: CA522810899
gnomAD: [0.0001024] (https://gnomad.broadinstitute.org/variant/1-45974604-G-GT) (East Asian)
CaseAddInfo: proband genotype, unknown cis or trans, no phenotypic info, sibling (fetus) carrier for p.K220del maternal variant
2
Case 2 (Level 2)
CasePreviousTesting: same as group
CaseMethod1: PCR
CaseGenotypingMethod: same as group
Variant1: NM_015506.2(MMACHC):c.217C > T
ClinVar: 203825
CAID: CA312728
gnomAD: 0.00005560 (East Asian)
Variant2: NM_015506.2(MMACHC):c.658_660delAAG
ClinVar: 95707
CAID: CA223197
gnomAD: 0.0003071 (East Asian)
CaseAddInfo: proband genotype, unknown cis or trans, not any phenotypic info given, sibling (fetus) carrier of p.R73X maternal variant
15
Case 15 (Level 2)
CasePreviousTesting: same as group
CaseMethod1: PCR
CaseGenotypingMethod: same as group
__
Variant1: NM_015506.2(MMACHC):c.394C > T (p.Arg132Ter)
ClinVar: 1423
CAID: CA251787
gnomAD: 0.0007190 (South Asian)
Variant2: NM_015506.2(MMACHC):c.615C > A (p.Tyr205Ter)
ClinVar: 558292
CAID: CA340133688
gnomAD: 0.0006427 (East Asian)
CaseAddInfo: proband genotype, unknown cis or trans, no phenotypic info, sibling (fetus) carries both variants
13
Case 13 (Level 2)
CasePreviousTesting: same as group
CaseMethod1: PCR
CaseGenotypingMethod: same as group __
Variant1: NM_015506.2(MMACHC):c.609G > A (p.Trp203Ter)
ClinVar: 30800
CAID: CA259906
gnomAD: 0.0005562 (East Asian)
CaseAddInfo: proband genotype, homozygous, no phenotypic info, sibling (fetus) carrier for p.W203X variant
Case history and genetic analysis
CaseKO: Male, 22 yrs report, Serbia
CasePresentingHPOs: HP:0002076, HP:0002017, HP:0000505, HP:0002357, HP:0003474, HP:0004302, HP:0001269, HP:0012229, HP:0011288, HP:0002321, HP:0000622 (Migraine, Nausea and vomiting, Visual impairment, Dysphasia, Sensory impairment, Functional motor deficit, Hemiparesis, CSF pleocytosis, EEG with parietal sharp slow waves, Vertigo, Blurred vision)
HPOsFreeText: Mechanosensitivity
CaseNotHPOs: HP:0011182, HP:0001251, HP:0001250 (Interictal epileptiform activity, Ataxia, Seizure)
NotHPOsFreeText: N/A
CaseAddInfo: No evidence of headache attacks with focal neurological deficits in any other family member, but the patient’s father was found to suffer from migraine without aura
CasePreviousTesting: Responsive to treatment with ibuprofen; Mild head trauma is a trigger; Neuroimaging during attacks was normal; Screen for variants in CACNA1A, ATP1A2, SCN1A, and PRRT2 was negative
CaseGenotypingMethod: All exons and exon-intron boundaries of the SLC1A3 gene were seuqenced and a variant was found that segregates with the phenotype.
Variant: NM_004172.5:c.1159A>C (p.Thr387Pro)
CAID: CA359482299, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA359482299
gnomAD: Not in gnomAD
a patient
CaseJE: Male, 10 yrs report,
CasePresentingHPOs: HP:0002131, HP:0004374, HP:0001319, HP:0001270, HP:0001350, HP:0002076, HP:0010547, HP:0001272, HP:0002381, HP:0002181, HP:0011182, HP:0045084, HP:0001289, HP:0002078, HP:0007034, HP:0007772, HP:0011289 (Episodic ataxia, Hemiplegia/hemiparesis, Neonatal hypotonia, Motor delay, Slurred speech, Migraine, Muscle flaccidity, Cerebellar atrophy, Aphasia, Cerebral edema, Interictal epileptiform activity, Limb myoclonus, Confusion, Truncal ataxia, Generalized hyperreflexia, Impaired smooth pursuit, EEG with temporal sharp slow waves)
HPOsFreeText: Left visual field neglect, Episodic left hemifield distortion
CaseNotHPOs: HP:0000639, HP:0000570, HP:0007670, HP:0000267 (Nystagmus, Impaired saccades, Abnormal vestibulo-ocular reflex, Cranial asymmetry)
NotHPOsFreeText: N/A
CaseAddInfo: Variant is confirmed heterozygous de novo via parental testing and confirmed paternity; No family member has any neurological signs or symptoms
CasePreviousTesting: Previously screened for CACNA1A and ATP1A2 with negative results; Episodic migraine attacks led to progressive right-sided headache and left-sided symptoms such as weakness and visual field neglect; Comprehensive metabolic workup revealed no abnormality in the CSF, serum, and urine; MRI showed a diffuse right-sided cortical hyperintensity most prominent in fluid-attenuated inversion recovery (FLAIR); EEG showed subclinical seizure activity in the left frontal temporal cortex and diffuse slowing on the right
CaseGenotypingMethod: DNA was extracted from blood samples. All exons and flanking intronic regions of SLC1A3 were PCR-amplified and directly sequenced. These were confirmed via resequencing.
Variant: NM_004172.5(SLC1A3):c.869C>G (p.Pro290Arg)
ClinVar: 9441, https://www.ncbi.nlm.nih.gov/clinvar/variation/9441/
gnomAD: Not in gnomAD
AmishGA1patient.
Case1: Amish
HPOsFreeText: GA1 confirmed
Case (Level 2)
CasePreviousTesting: GA1 confirmed
CaseMethod1: PCR
CaseMethod2: MaeII restriction digest
CaseGenotypingMethod: same as Amish group
Variant: NM_000159.3(GCDH):c.1262C>T (p.Ala421Val)
ClinVar: 2082
gnomAD: 0.0002867 (European non-Finnish)
CaseAddInfo: homozygous, founder allele in Amish of Lancaster County from immigrant from Switzerland to US in early 18th century. 4 non-Amish patients were found heterozygous for this allele with central European ancestry.
Case report
CaseBH: Male, Somalia, 8 yrs report
CasePresentingHPOs: HP:0003026, HP:0001511, HP:0000973, HP:0008936, HP:0000023, HP:0008780, HP:0000519, HP:0000639, HP:0011493, HP:0001263, HP:0001999, HP:0000337, HP:0000325, HP:0000494, HP:0000160, HP:0000977, HP:0001181, HP:0002119, HP:0005116 (Short long bone, Intrauterine growth retardation, Cutis laxa, Truncal hypotonia, Inguinal hernia, Congenital bilateral hip dislocation, Developmental cataract, Nystagmus, Central opacification of the cornea, Global developmental delay, Abnormal facial shape, Broad forehead, Triangular face, Downslanted palpebral fissures, Narrow mouth, Soft skin, Adducted thumb, Ventriculomegaly, Arterial tortuosity)
HPOsFreeText: At age 8 years, his height was 96 cm (Z=−5.8) and weight was 11.6 kg (Z=−7.26); Head circumference was 45.4 cm, (Z=−5.0) which is the 50th centile for a 10-month-old boy; Walked with support
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: Parents are consanguineous fourth cousins, Had an older sister and younger brother who were developmentally appropriate and well grown
CasePreviousTesting: N/A
CaseGenotypingMethod: PYCR1 and ALDH18A1 were Sanger sequenced in the proband which revealed a single variant. Chromosomal SNP microarray showed no regions of homozygosity or any other deletions or duplications. Whole Exome Sequencing of genomic DNA from the proband was performed for confirmation again only revealing the single heterozygous missense variant in ALDH18A1. Copy-number analysis was performed and identified no significant variation. Sequencing of the parents revealed a de novo inheritance pattern.
Variant: NM_002860.3:c.377G>A (p.Arg126His)
CAID: CA377706756 http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA377706756
gnomAD: Not in gnomAD
patient 1
Case1: Male, 3 months diagnosis/death, Egypt, African
CasePresentingHPOs: HP:0001999, HP:0011968, HP:0001531, HP:0001270, HP:0001252, HP:0003468, HP:0001636, HP:0001274 (Dysmorphic facial features, Poor feeding, Failure to thrive in infancy, Motor delay, Muscle hypotonia, Abnormal vertebrae, Tetraology of Fallot, Agenesis of corpus callosum)
HPOsFreeText: Agenesis of the cingulate gyrus
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo: Parents are consanguinous, Proband is homozygous for this mutation, Died a few days after hospital admission in infancy
CasePreviousTesting: Increased levels of S-2-carboxypropyl-cysteamine and S-2-carboxypropyl-cysteine, Fibroblast and liver homogenates of patient 1 showed normal hydratase activities towards methacrylyl-CoA (as well as crotonyl-CoA and tiglyl-CoA),
CasePMIDs: 7122152
CaseGenotypingMethod: After confirming low HICBH activity in fibroblasts of the patients, the gene was analyzed at the genomic level and the mRNA level in both patients using sequence analysis.
Variant: NM_014362.3:c.220-9T>G
ClinVar: 1144 https://www.ncbi.nlm.nih.gov/clinvar/variation/1144/
gnomAD: Not in gnomAD
patient 2
Case2: Male, Caucasian, 9 months onset
CasePresentingHPOs: HP:0011968, HP:0001270, HP:0001251, HP:0002376, HP:0002121, HP:0000737, HP:0002317, HP:0002599, HP:0002078, HP:0012389, HP:0001310, HP:0001337, HP:0001254, HP:0001942, HP:0002329, HP:0001308, HP:0002599, HP:0001332, HP:0002181, HP:0002134 (Poor feeding, Delayed motor milestones, Ataxia, Developmental regression, Absence seizures, Irritability, Unsteady gait, Head titubation, Truncal ataxia, Appendicular hypotonia, Dysmetria, Tremor, Lethargy, Metabolic acidosis, Drowsiness, Tongue fasciculation, Head titubation, Dystonia, Cerebral edema, Abnormality of the basal ganglia)
HPOsFreeText: Head bobbing at 4 months, Rolled over at 5 mo but lost the ability at 10 mo, Reaching out and grasping objects at 4 mo but lost the ability at 13 mo, Eye rolling episodes at 9 months, Lost ability to finger feed at 10 months, Inability to sit unsupported, At 14 months blood pH was 7.29 with a base deficit of 15.8 mmol/L, Sluggish papillary responses, Pooling of secretions in the mouth, No improvement on treatment with thiamine or a combination of vitamin C, vitamin E, and ubiquinone, Signal abnormalities in the globus pallidus and the midbrain
CaseNotHPOs: HP:0000639, HP:0002151, HP:0001987, HP:0003116, HP:0012443 (Nystagmus, Increased serum lactate, Hyperammonemia, Abnormal echocardiogram, Abnormality of brain morphology)
NotHPOsFreeText: N/A
CaseAddInfo: Parents were nonconsanguinous, Proband is compound heterozygous for these mutations with parental testing
CasePreviousTesting: Pyruvate dehydrogenase and pyruvate carboxylase in cultured human skin fibroblasts, Activities of respiratory chain complexes in a muscle biopsy, Marked reduction of complex I (patient 0.089, controls 0.104–0.268) and a borderline reduction of complex IV (patient 0.013, controls 0.014–0.034), Organic acid analysis during ketotic episodes showed excessive excretion of 3-hydroxybutyrate and acetoacetate and moderate excretion of lactate, 2-hydroxyisovalerate, 2-oxoisocaproate, dicarboxylic acids (C6, C8, C10), and methylmalonate, with normal levels of methylcitrate as opposed to normal levels when well, Urine amino acid analysis, Elevated levels of hydroxy-C4-carnitine (patient 0.45-1.73 μM, controls <0.4 μM) even when not ketotic
CaseGenotypingMethod: After confirming low HICBH activity in fibroblasts of the patients, the gene was analyzed at the genomic level and the mRNA level in both patients using sequence analysis.
Variant1: NM_014362.4:c.365A>G (p.Tyr122Cys)
ClinVar: 1145 https://www.ncbi.nlm.nih.gov/clinvar/variation/1145/
gnomAD: Latino 4.338e-4, Overall 6.373e-5 https://gnomad.broadinstitute.org/variant/2-191155151-T-C
Variant2: NM_014362.3:c.79-3C>G
ClinVar: 1146 https://www.ncbi.nlm.nih.gov/clinvar/variation/1146/
gnomAD: Not in gnomAD
CHN2.1
CaseCHN2.1: Canada, White
CasePresentingHPOs: HP:0008353 (Neutral hyperaminoaciduria)
HPOsFreeText: N/A
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: Variants segregate with the disease
CasePreviousTesting: Hartnup aminoaciduria profile was confirmed by ion exchange high performance liquid chromatography
CaseGenotypingMethod: All SLC6A19 exons and flanking introns were directly amplified and sequenced from genomic DNA.
Variant1: NM_001003841.3:c.532C>T (p.Arg178Ter)
CAID: CA3182753, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA3182753
gnomAD: 0.0004414, https://gnomad.broadinstitute.org/variant/5-1212468-C-T
Variant2: NM_001003841.3:c.1213G>A (p.Glu405Lys)
CAID: CA3183103, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA3183103
gnomAD: 0.0001203, https://gnomad.broadinstitute.org/variant/5-1219057-G-A
CHN1.1
CaseCHN1.1: Canada, White
CasePresentingHPOs: HP:0008353 (Neutral hyperaminoaciduria)
HPOsFreeText: N/A
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: Variants segregate with the disease, Has a sibling with the same variant and amino acid profile
CasePreviousTesting: Hartnup aminoaciduria profile was confirmed by ion exchange high performance liquid chromatography;
CaseGenotypingMethod: All SLC6A19 exons and flanking introns were directly amplified and sequenced from genomic DNA.
Variant1: NM_001003841.3:c.196G>A (p.Gly66Arg)
CAID: CA359061114 http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA359061114
gnomAD: Not in gnomAD
Variant2: NM_001003841.3:c.982C>T (p.Arg328Cys)
CAID: CA3182972, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA3182972
gnomAD: 0.0002479, https://gnomad.broadinstitute.org/variant/5-1216767-C-T
AHN16.1
CaseAHN16.1: Australia, White
CasePresentingHPOs: HP:0008353 (Neutral hyperaminoaciduria)
HPOsFreeText: N/A
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: Variants segregate with the disease
CasePreviousTesting: Hartnup aminoaciduria profile was confirmed by ion exchange high performance liquid chromatography;
CaseGenotypingMethod: All SLC6A19 exons and flanking introns were directly amplified and sequenced from genomic DNA.
Variant1: NM_001003841.3:c.277G>A (p.Gly93Arg)
CAID: CA3182636 http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA3182636
gnomAD: 0.0001195, https://gnomad.broadinstitute.org/variant/5-1208935-G-A
Variant2: NM_001003841.3(SLC6A19):c.517G>A (p.Asp173Asn)
ClinVar: 2019 https://www.ncbi.nlm.nih.gov/clinvar/variation/2019/
gnomAD: 0.003016, https://gnomad.broadinstitute.org/variant/5-1212453-G-A
Patient 9
Case9: Male, Turkey, 24 yrs report,
CasePresentingHPOs: HP:0002251, HP:0001321, HP:0001161, HP:0025356, HP:0002474, HP:0000708, HP:0001488, HP:0002317, HP:0000646, HP:0000486 (Aganglionic megacolon, Cerebellar hypoplasia, Hand polydactyly, Psychomotor retardation, Expressive language delay, Behavioral abnormality, Bilateral ptosis, Unsteady gait, Strabismus)
HPOsFreeText: Dysgnathia
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: Proband is homozygous, Parents are consanguineous, cDNA amplification of the exons 8 and 9 in this patient revealed an insertion of 64 base pairs due to the use of a cryptic donor site leading to a premature stop codon and a likely null allele; Proband has two healthy sisters
CasePreviousTesting: Patient fibroblasts were analyzed for mutations in SLC25A21 and activities of KATII with no abnormalities; A metabolic work-up revealed alpha-ketoadipic aciduria and alpha-aminoadipic aciduria; A non-verbal intelligence test yielded a slightly decreased value; A single metabolic decompensation in adulthood was ascribed to Helicobacter pylori and its eradication improved the patient’s well-being.
CaseGenotypingMethod: All 17 exons and flanking intronic sequences of DHTKD1 were Sanger sequenced.
Variant: NM_018706.6:c.1671+1G>A
CAID: CA5407905 http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_canonicalid?canonicalid=CA5407905
gnomAD: 0.0001399, https://gnomad.broadinstitute.org/variant/10-12139996-G-A
Patient 8
Case8: Female
CasePresentingHPOs: HP:0001270, HP:0001252, HP:0011342, HP:0007479 (Motor delay, Muscular hypotonia, Mild motor developmental delay, Congenital nonbullous ichthyosiform erythroderma)
HPOsFreeText: N/A
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: Consanguineity is suspected, Proband is homozygous
CasePreviousTesting: Patient fibroblasts were analyzed for mutations in SLC25A21 and activities of KATII with no abnormalities; Urine AAA and KAA were elevated. Oxidation of radiolabeled AAA in fibroblasts was deficient.
CaseGenotypingMethod: All 17 exons and flanking intronic sequences of DHTKD1 were Sanger sequenced.
CasePMIDs: 1112064, 1112065
Variant: NM_018706.7(DHTKD1):c.2134C>T (p.Arg712Ter)
ClinVar: 572241 https://www.ncbi.nlm.nih.gov/clinvar/variation/572241/
gnomAD: 0.00003267, https://gnomad.broadinstitute.org/variant/10-12149994-C-T
other
CaseSA3P: Female, 16 months onset, European
CasePresentingHPOs: HP:0001988, HP:0000825, HP:0001987 (Recurrent hypoglycemia, Hyperinsulinemic hypoglycemia, Hyperammonemia)
HPOsFreeText: N/A
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: Proband is confirmed de novo via parental teting and confirmed paternity
CasePreviousTesting: Protein/leucine restriction was effective at reducing symptoms
CaseGenotypingMethod: Genomic DNA was prepared from all patients via peripheral blood leukocytes. The GLUD1 gene exons 1-13 and the flanking intronic regions were PCR-amplified and directly sequenced. All variants were confirmed via restriction enzyme analysis. Additionally, paternity testing was performed by HLA typing and by southern blot analysis of DNA fragments as well as PCR analysis of STRs.
Variant: NM_005271.5(GLUD1):c.965G>A (p.Arg322His)
ClinVar: 16129, https://www.ncbi.nlm.nih.gov/clinvar/variation/16129/
gnomAD: Not in gnomAD
from
CaseSA5P: Female, 3 months onset, European
CasePresentingHPOs: HP:0001988, HP:0000825, HP:0001249, HP:0001250 (Recurrent hypoglycemia, Hyperinsulinemic hypoglycemia, Intellectual disability, Seizure)
HPOsFreeText: N/A
CaseNotHPOs: HP:0001987 (Hyperammonemia)
NotHPOsFreeText: N/A
CaseAddInfo: Has father with confirmed variant and similar phenotypes
CasePreviousTesting: Leucine load test showed leucine sensitivity; Protein/leucine restriction and dioxazide was effective at reducing symptoms
CaseGenotypingMethod: Genomic DNA was prepared from all patients via peripheral blood leukocytes. The GLUD1 gene exons 1-13 and the flanking intronic regions were PCR-amplified and directly sequenced. All variants were confirmed via restriction enzyme analysis. Additionally, paternity testing was performed by HLA typing and by southern blot analysis of DNA fragments as well as PCR analysis of STRs.
Variant: NM_005271.5(GLUD1):c.965G>A (p.Arg322His)
ClinVar: 16129, https://www.ncbi.nlm.nih.gov/clinvar/variation/16129/
gnomAD: Not in gnomAD
16
Patient16: Group 3
CasePresentingHPOs: same as group 3
CasePreviousTesting: same as group 3
CaseGenotypingMethod: same as group 3
Variant1: NM_001159508.1:c.149G>C (p.Arg50Thr) listed in paper as (p.Arg21Pro)
CAID: CA391743853, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA391743853
gnomAD: n/a
Variant2: NM_002225.4:c.851G>A
CAID: CA7480763, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA7480763
**In ClinVar as: NM_002225.3(IVD):c.860G>A (p.Arg287Gln), https://www.ncbi.nlm.nih.gov/clinvar/variation/555453/ **
gnomAD: 0.00001770, http://gnomad.broadinstitute.org/variant/15-40707154-G-A
18
Patient18: Group 3
CasePresentingHPOs: same as group 3
CasePreviousTesting: same as group 3
CaseGenotypingMethod: same as group 3
Variant1: NM_002225.3:c.1136T>C (p.p.Ile349Thr) **listed in paper as (p.Phe350Ser)
CAID: CA391723904, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA391723904
gnomAD: n/a
Variant2: IVS3+5G>T no ClinVar or CAID
We evaluated 16 patients with IVA, including 3 pairs of siblings
Patient4: Female, 3yo sibling to patient 5
CasePresentingHPOs:
HPOsFreeText: Asymptomatic, C5 (DBS) = 4.0 μmol l−1, IVA incorp (%) = 80, IVG in urine mmol permol creatinine = 242, Ammonium (μmol l−1) = 31, pH = 7.37, Protein intake (g kg−1 per day) = 1.5, treated with carnitine supplements, PDI/IQ in follow-up = 92
CaseNotHPOs: HP:0011968, HP:0002013, HP:0001944, HP:0001254, HP:0001259
(poor feeding, vomiting, dehydration, lethargy, coma)
NotHPOsFreeText: sweaty feet odor
CaseAddInfo: Diagnosed with NBS, diagnosed at 26 days old
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant1: NM_002225.4(IVD):c.1205T>C (p.Ile402Thr)
ClinVar: 529433, https://www.ncbi.nlm.nih.gov/clinvar/variation/529433/
gnomAD: n/a
Variant2: NM_001159508.1:c.500T>C
CAID: CA391717541, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA391717541
gnomAD: n/a
We evaluated 16 patients with IVA, including 3 pairs of siblings
Patient7: Male, 2yo
CasePresentingHPOs:
HPOsFreeText: Asymptomatic, C5 (DBS) = 1.6 μmol l−1, IVG in urine mmol permol creatinine = 272, IVA incorp (%) = 72, Ammonium (μmol l−1) = 51, pH = 7.39, Protein intake (g kg−1 per day) = 1.5, PDI/IQ in follow-up = 93
CaseNotHPOs: HP:0011968, HP:0002013, HP:0001944, HP:0001254, HP:0001259
(poor feeding, vomiting, dehydration, lethargy, coma)
NotHPOsFreeText: sweaty feet odor
CaseAddInfo: Diagnosed with NBS at 28 days, homozygous
CasePMIDs:
CasePreviousTesting: same as group
CaseGenotypingMethod: same as group
Variant: NM_002225.3:c.706G>A
CAID: CA268780419, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA268780419
gnomAD: 0.00003187, http://gnomad.broadinstitute.org/variant/15-40705199-G-A
Table 2
Case10: Male, Ecuador
CasePresentingHPOs: HP:0001290, HP:0003324, HP:0002093, HP:0011968, HP:0001283, HP:0001561, HP:0001558, HP:0000602, HP:0001622, HP:0001371, HP:0001623, HP:0002804 (Generalized hypotonia, Generalized muscle weakness, Respiratory insufficiency, Feeding difficulties, Bulbar weakness, Polyhydramnios, Decreased fetal movements, Ophthalmoplegia, Preterm delivery, Contractures, Breech presentation, Arthrogryposis)
HPOsFreeText: Bilateral femoral fractures
CaseNotHPOs: HP:0001627 (Cardiac abnormality)
NotHPOsFreeText: N/A
CaseAddInfo: Severe congenital myopathy, Deceased in 6 weeks
CasePreviousTesting: N/A
CaseGenotypingMethod: After LMOD3 was identified as a potential causal gene, bidirectional Sanger sequencing was performed on DNA in genetically unresolved patients using PCR amplification covering 3 exons.
Variant1: NM_198271.4:c.976G>C (p.Gly326Arg)
CAID: CA353473660 http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_198271.4%3Ac.976G%3EC
gnomAD: Not in gnomAD
Variant2: NM_198271.4:c.1372C>T (p.Gln458*)
CAID: CA353470920 http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_198271.4%3Ac.1372C%3ET
gnomAD: Not in gnomAD
Table 2
Case6: Female, Japan, Asian
CasePresentingHPOs: HP:0001290, HP:0003324, HP:0002093, HP:0011968, HP:0001283, HP:0003798, HP:0001561, HP:0001558, HP:0001789, HP:0000252, HP:0001622, HP:0001371 (Generalized hypotonia, Generalized muscle weakness, Respiratory insufficiency, Feeding difficulties, Bulbar weakness, Nemaline bodies, Polyhydramnios, Decreased fetal movement, Hydrops fetalis, Microcephaly, Preterm delivery, Contractures)
HPOsFreeText: Atrophic myofibers
CaseNotHPOs: HP:0001627 (Cardiac abnormality)
NotHPOsFreeText: N/A
CaseAddInfo: Severe congenital myopathy, Alive at 10 months
CasePreviousTesting: N/A
CaseGenotypingMethod: After LMOD3 was identified as a potential causal gene, bidirectional Sanger sequencing was performed on DNA in genetically unresolved patients using PCR amplification covering 3 exons.
Variant: NM_198271.4:c.349C>T (p.Gln117*)
CAID: CA353477271 http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_198271.4%3Ac.349C%3ET
gnomAD: Not in gnomAD
Table 2
Case3: Female, Portugal
CasePresentingHPOs: HP:0001290, HP:0003324, HP:0002093, HP:0011968, HP:0001283, HP:0002804, HP:0001558, HP:0001561, HP:0001371 (Generalized hypotonia, Generalized muscle weakness, Respiratory insufficiency, Feeding difficulties, Bulbar weakness, Decreased fetal movement, Polyhydramnios, Contracture)
HPOsFreeText: N/A
CaseNotHPOs: HP:0001627 (Cardiac abnormality)
NotHPOsFreeText: N/A
CaseAddInfo: Severe congenital myopathy, Deceased in neonatal period
CasePreviousTesting: N/A
CaseGenotypingMethod: After LMOD3 was identified as a potential causal gene, bidirectional Sanger sequencing was performed on DNA in genetically unresolved patients using PCR amplification covering 3 exons.
Variant: NM_198271.4:c.154del (p.Met52*)
CAID: CA909810717 http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_198271.4%3Ac.154delA
gnomAD: Not in gnomAD
Table 2
Case12a: Male, Afghanistan
CasePresentingHPOs: HP:0001290, HP:0003324, HP:0002093, HP:0011968, HP:0001283, HP:0002804, HP:0001558, HP:0001622, HP:0001623, HP:0003798 (Generalized hypotonia, Generalized muscle weakness, Respiratory insufficiency, Feeding difficulties, Bulbar weakness, Arthrogryposis, Decreased fetal movement, Preterm delivery, Breech presentation, Nemaline bodies)
HPOsFreeText: Atrophic myofibers
CaseNotHPOs: HP:0001627 (Cardiac abnormality)
NotHPOsFreeText: N/A
CaseAddInfo: Severe congenital myopathy, Deceased in 2 months, Has 2 siblings with same genotype/phenotype
CasePreviousTesting: N/A
CaseGenotypingMethod: After LMOD3 was identified as a potential causal gene, bidirectional Sanger sequencing was performed on DNA in genetically unresolved patients using PCR amplification covering 3 exons.
Variant: NM_198271.4:c.1099_1100delAA (p.Asn367Glnfs*11)
ClinVar: 162218 https://www.ncbi.nlm.nih.gov/clinvar/variation/162218/
gnomAD: South Asian 4.575e-4, Overall 5.625e-5 https://gnomad.broadinstitute.org/variant/3-69168405-GTT-G
Table 2
Case14a: Female, Australia
CasePresentingHPOs: HP:0001290, HP:0003324, HP:0002093, HP:0011968, HP:0001283, HP:0001561, HP:0001622, HP:0002804, HP:0003798, HP:0001558, HP:0000602 (Generalized hypotonia, Generalized muscle weakness, Respiratory insufficiency, Feeding difficulties, Bulbar weakness, Polyhydramnios, Nemaline bodies, Decreased fetal movements, Ophthalmoplegia)
HPOsFreeText: Atrophic myofibers, Percutaneous endoscopic gastrostomy performed, Nocturnal noninvasive ventilation
CaseNotHPOs: HP:0001627, HP:0002540 (Cardiac abnormality, Inability to walk)
NotHPOsFreeText: N/A
CaseAddInfo: Typical congenital nemaline myopathy, Alive at 10 yrs, Parents are not consanguineous
CasePreviousTesting: N/A
CaseGenotypingMethod: Linkage analysis combined with homozygosity mapping was used to identify candidate chromosomal loci. Whole exome sequencing in this family revealed likely pathogenic mutations in LMOD3 which agreed with the aforementioned analysis and was consistent with autosomal recessive inheritance.
Variant1: NM_198271.4:c.1103_1105del (p.Asn368del)
ClinVar: 162216 https://www.ncbi.nlm.nih.gov/clinvar/variation/162216/
gnomAD: Not in gnomAD
Variant2: NM_198271.4:c.1201C>T (p.Arg401Ter)
ClinVar: 162217 https://www.ncbi.nlm.nih.gov/clinvar/variation/162217/
gnomAD: African 4.137e-5, Overall 7.135e-6 https://gnomad.broadinstitute.org/variant/3-69168305-G-A
Case Report
CaseAN: Male, 78 yrs report, Germany, White
CasePresentingHPOs: HP:0003774, HP:0001638, HP:0000822, HP:0002099, HP:0012125, HP:0001297, HP:0002134, HP:0002549, HP:0000738, HP:0000739, HP:0000746, HP:0002322, HP:0002172, HP:0012120 (Stage 5 chronic kidney disease, Cardiomyopathy, Hypertension, Asthma, Prostate cancer, Stroke, Abnormality of the basal ganglia, Deficit in phonologic short-term memory, Hallucinations, Anxiety, Delusions, Resting tremor, Postural instability, Methylmalonic aciduria)
HPOsFreeText: N/A
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: Mother had dementia, Proband is diagnosed with Parkinson's disease, Sanger sequencing confirmed compound heterozygous as unaffected sons are heterozygous for one variant each
CasePreviousTesting: Montreal Cognitive Assessment (MoCA) score of 17/30 in 2013; Mild MMA-uria, together with increased plasma levels of propionyl-carnitine, was demonstrated in 2016 via metabolic investigation (values in Table 1)
CaseGenotypingMethod: Whole genome sequencing data was analyzed using a pipeline restricted to 681 genes known to cause IEM. Heterozygous mutations in MCEE were identified.
Variant1: NM_032601.4(MCEE):c.139C>T (p.Arg47Ter)
ClinVar: 2343, http://www.ncbi.nlm.nih.gov/clinvar/variation/2343
gnomAD: 0.0004884, https://gnomad.broadinstitute.org/variant/2-71351575-G-A
Variant2: NM_032601.3:c.419del (p.Lys140Argfs*6)
CAID: CA1702578, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA1702578
gnomAD: 0.00007076, https://gnomad.broadinstitute.org/variant/2-71337211-CT-C
The patient
Case1: Male, 15 months onset, Iran
CasePresentingHPOs: HP:0006579, HP:0001324, HP:0001336, HP:0000639, HP:0002134, HP:0002282, HP:0002453, HP:0002540, HP:0002463, HP:0006801, HP:0001252, HP:0011443, HP:0001251, HP:0001310, HP:0000565, HP:0001510 (Neonatal jaundice, Muscle weakness, Myoclonus, Nystagmus, Abnormality of the basal ganglia, Heterotopia, Abnormality of the globus pallidus, Inability to walk, Language impairment, Hyperactive deep tendon reflexes, Muscular hypotonia, Abnormality of coordination, Ataxia, Dysmetria, Esotropia, Growth delay)
HPOsFreeText:
CaseNotHPOs: HP:0012443, HP:0012447 (Abnormality of brain morphology, Abnormal myelination)
NotHPOsFreeText:
CaseAddInfo: No parental consanguinity,
CasePreviousTesting: Plasma amino acids and plasma acylcarnitine profile were normal. The organic acid in the urine showed an elevated 3‐hydroxyisovaleric acid (110 mmol/mol creatinine, normal <44 mmol/mol creatinine). Serum biotinidase activity was normal. Blood lactate and ammonia were normal in repeated measurements.
CaseGenotypingMethod: Patient had the IVD exons and exon-intron boundaries analyzed using PCR/Sanger sequencing to follow up on suspected IVA, with no variants found. Whole Exome Sequencing was performed to determine the correct genetic cause of the disorder by evaluating all known exons and their flanking regions. This found two heterozygous missense mutations in HIBCH consistent with the diagnosis. Trio PCR/Sanger sequencing confirmed parental heterozygosity and the variants in the patient.
Variant1: NM_014362.3:c.641C>T (p.Thr214Ile)
CAID: CA349890265 http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_014362.3%3Ac.641C%3ET
gnomAD: Not in gnomAD
Variant2: NM_014362.3:c.913A>G (p.Thr305Ala)
CAID: CA62635843 http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_014362.3%3Ac.913A%3EG
gnomAD: European (Non-Finnish) 1.767e-5, Overall 7.978e-6 https://gnomad.broadinstitute.org/variant/2-191077780-T-C
a
CaseST-8: Female, 1 day onset, Germany
CasePresentingHPOs: HP:0006579, HP:0001643, HP:0001410, HP:0001319, HP:0006236, HP:0001786 (Prolonged neonatal jaundice, Patent ductus arteriosus, Decreased liver function, Neonatal hypotonia, Slender metacarpals, Narrow foot)
HPOsFreeText: N/A
CaseNotHPOs: HP:0001250 (Seizure)
NotHPOsFreeText: N/A
CaseAddInfo: Family is non-consanguineous, Proband is compound heterozygous for these variants
CasePreviousTesting: See Group
CaseGenotypingMethod: See Group
Variant1: NM_001123.3:c.893C>A (p.Ala298Asp)
CAID: CA377399006, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA377399006
gnomAD: Not in gnomAD
Variant2: NM_001123.3:c.925C>T (p.Gln309Ter)
CAID: CA377398330, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA377398330
gnomAD: Not in gnomAD
e
CaseST-6: Male, 1 day onset, Morocco
CasePresentingHPOs: HP:0006579, HP:0001249, HP:0001270, HP:0001324, HP:0004322, HP:0000256, HP:0000316, HP:0006236, HP:0001786, HP:0008070, HP:0000708, HP:0002355, HP:0003202, HP:0002071 (Prolonged neonatal jaundice, Intellectual disability, Motor delay, Muscle weakness, Short stature, Macrocephaly, Hypertelorism, Slender metacarpals, Narrow foot, Sparse hair, Behavioral abnormality, Difficulty walking, Skeletal muscle atrophy, Abnormality of extrapyramidal motor function)
HPOsFreeText: N/A
CaseNotHPOs: HP:0001250 (Seizure)
NotHPOsFreeText: N/A
CaseAddInfo: Family is consanguineous, Proband is homozygous for the variant
CasePreviousTesting: See Group
CaseGenotypingMethod: See Group
Variant: NM_001123.3:c.685_687delinsCC (p.Thr229ProfsTer16)
CAID: CA1139768931, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA1139768931
gnomAD: Not in gnomAD
Table 1
Case4: Female, 2 wks at initation of follow up, European ancestry
HPOsFreeText: NBS C4-acylcarnitine 2.0 umol/L, Plasma C4-acylcarnitine 1.52 umol/L
CaseAddInfo: no data for urine excretion, unremarkable clinical condition
Case4 (Level 2)
CasePreviousTesting: same as group
CaseMethod1: same as group
CaseMethod2: same as group
CaseGenotypingMethod: same as group
Variant1: NM_014384.2:c.443C>T (p.Pro148Leu)
ClinVar: n/a
CAID: CA6372945
gnomAD: not in gnomAD
Variant2: NM_014384.2(ACAD8):c.455T>C (p.Met152Thr)
ClinVar: 5355
CAID: CA117433
gnomAD: 0.0001395 (European Non-Finnish)
CaseAddInfo: compound heterozygote, indicated alleles 1 and 2 but not specified maternal and paternal, potential splice site variant of ACAD8 at exon3 (+3A>G)
Table 1
Case3a: Male, 5d at initiation of follow up, East Indian Ancestry, sibling of Case 3b (family 1)
HPOsFreeText: NBS C4-acylcarnitine 2.4 umol/L, Plasma C4-acylcarnitine 1.14 umol/L, in vitro probe isoC4-acylcarnitine 0.133 umol/ g protein,
NotHPOsFreeText: normal urine isobutyrylglycine ug/mg creatinine
CaseAddInfo: unremarkable clinical condition
Case3a (Level 2)
CasePreviousTesting: same as group
CaseMethod1: same as group
CaseMethod2: same as group
CaseGenotypingMethod: same as group
Variant: NM_014384.2(ACAD8):c.867C>A (p.His289Gln)
ClinVar: 5358
CAID: CA117441
gnomAD: not in gnomAD
CaseAddInfo: homozygous mutations
Table 1:
Case9: Male, 2 mo at initiation of follow up, Hispanic ancestry
HPOsFreeText: NBS C4-acylcarnitine 1.8 umol/L, Plasma C4-acylcarnitine 3.28, umol/L, in vitro probe isoC4-acylcarnitine 0.074 umol/g protein, urine C4-acylcarnitine 7.86 mmol/mol creatinine, Urine C4/C3 ratio 63
NotHPOsFreeText: normal urine isobutyrylglycine
CaseAddInfo: unremarkable clinical condition
Case9 (Level 2)
CasePreviousTesting: same as group
CaseMethod1: same as group
CaseMethod2: same as group
CaseGenotypingMethod: same as group
Variant: NM_014384.2(ACAD8):c.233T>C (p.Met78Thr)
ClinVar: 430160
CAID: CA6372883
gnomAD: n/a
CaseAddInfo: homozygous variants, no potential splice site alterations, no data for ACADS (SCAD-deficient) gene variants
CaseLE12: Female, 23 yrs report
CasePresentingHPOs: HP:0002725 (Systemic lupus erythematosus)
HPOsFreeText: N/A
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: Variant 1 homozygous, with variant 2 in-cis with one copy confirmed via parental testing
CasePreviousTesting: Specific plasma MMA levels, urine MMA levels, urine MA levels, and MMA/MA ratio available in Table 2
CaseGenotypingMethod: See Group
Variant1: NM_001243279.3:c.1553C>A (p.Ala518Asp)
CAID: CA8238286, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA8238286
gnomAD: 0.00006153, https://gnomad.broadinstitute.org/variant/16-89212397-C-A
Variant2: NM_001243279.3:c.473C>T (p.Pro158Leu)
CAID: CA8237662, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA8237662
gnomAD: 0.0002823, https://gnomad.broadinstitute.org/variant/16-89167562-C-T
(OS-138II-1)
CaseOS-138_II-1: Female, 4 yrs report, Asian
CasePresentingHPOs: HP:0001992, HP:0002373, HP:0001263 (Organic aciduria, Febrile seizure (within the age range of 3 months to 6 years), Global developmental delay)
HPOsFreeText: N/A
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: Parents are consanguineous, Proband is homozygous for this variant
CasePreviousTesting: Routine urine screening for organic acidurias by gas chromatography–mass spectrometry showed markedly increased urinary excretion of several N-acetylated amino acids
CaseGenotypingMethod: PCR-amplification and bidirectional sequencing of all exons and exon-intron boundaries was performed on genomic DNA.
Variant: NM_000666.3(ACY1):c.589C>T (p.Arg197Trp)
ClinVar: 18113, https://www.ncbi.nlm.nih.gov/clinvar/variation/18113/
gnomAD: 0.00001764, https://gnomad.broadinstitute.org/variant/3-52021009-C-T
t
CaseSE5: Male, Australia
CasePresentingHPOs: HP:0008353 (Neutral hyperaminoaciduria)
HPOsFreeText: N/A
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseGenotypingMethod: Five loci were investigated for evidence of linkage to Hartnup due to their established role in amino acid transport including SLC3A2, SLC7A8, SLC1A5, SLC6A18, and SLC6A19. These 5 regions were studied with microsattelite markers and produced linkage only between D5S392 and D5S417, the region with SLC6A18 and 19. SLC6A18 did not increase neutral amino acid uptake in X. laevis oocytes so SLC6A19 was investigated and directly sequenced in the families each of which displayed a causal variant.
CasePreviousTesting: SLC1A5 had no causative variants detected.
CaseAddInfo: Asymptomatic except for hyperaminoaciduria
Variant1: NM_001003841.3(SLC6A19):c.517G>A (p.Asp173Asn)
ClinVar: 2019 https://www.ncbi.nlm.nih.gov/clinvar/variation/2019/
gnomAD: 0.003016, https://gnomad.broadinstitute.org/variant/5-1212453-G-A?dataset=gnomad_r2_1
Variant2: NM_001003841.3(SLC6A19):c.718C>T (p.Arg240Ter)
ClinVar: 2020 https://www.ncbi.nlm.nih.gov/clinvar/variation/2020/
gnomAD: 0.0001960, https://gnomad.broadinstitute.org/variant/5-1213632-C-T
A
CaseC1: Female, Arab, Israel
CasePresentingHPOs: HP:0010896, HP:0010897, HP:0001638 (Hypersarcosinemia, Hypersarcosinuria, Cardiomyopathy)
HPOsFreeText: Elevated blood Sarcosine (345 μmol/l; reference 0-9), Elevated urine Sarcosine (481 μmol/mmol; reference 0-36)
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: Parents are consanguineous and first cousins, sister has the same genotype
CasePreviousTesting: N/A
CaseGenotypingMethod: DNA was extracted from the probands and immediate family. The whole coding region and the exon-intron boundaries of the SARDH gene was then amplified and sequenced.
Variant: NM_007101.3:c.211G>T (p.Val71Phe)
ClinVar: 39448 https://www.ncbi.nlm.nih.gov/clinvar/variation/39448/
gnomAD: Not in gnomAD
F2)
CaseF2: Female, 6 yrs report, Italy
CasePresentingHPOs: HP:0004923 (Hyperphenylalaninemia)
HPOsFreeText: N/A
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: Parents do not appear to be tested, DNA sequence analysis "shows the sense sequence expected of compound heterozygotes with two comigrating bands seen"
CasePreviousTesting: Pre-treatment phenylalanine levels determined soon after birth were above 20 mg / 100 ml, Proband has been under treatment since birth and currently tolerates less than 20 mg Phe/kg bodyweight per day
CaseGenotypingMethod: DNA as isolated from leukocytes and haplotype analysis performed. Enzymatic digestion of PCR-amplified DNA fragments was performed and DGGE analysis of all 13 exons and flanking introns were carried out. The resulting samples containing abberant bands were sequenced and cleaved by MaeI and MaeIII for analysis.
Variant1: NM_000277.3(PAH):c.620A>G (p.Asn207Ser)
ClinVar: 102765 https://www.ncbi.nlm.nih.gov/clinvar/variation/102765/
gnomAD: Not in gnomAD
Variant2: NM_000277.3(PAH):c.842C>T (p.Pro281Leu)
ClinVar: 589 https://www.ncbi.nlm.nih.gov/clinvar/variation/589/
gnomAD: 0.0002016, https://gnomad.broadinstitute.org/variant/12-103246593-G-A
families
CaseKLE: Male, Japan, Asian
CasePresentingHPOs: HP:0008353 (Neutral hyperaminoaciduria)
HPOsFreeText:
CaseNotHPOs:
NotHPOsFreeText:
CaseAddInfo:
CasePreviousTesting: Identified via neonatal mass screening
CaseGenotypingMethod: Both SLC6A18 and SLC6A19 were investigated for possible pathogenicity, with SLC6A19's pattern of expression supporting it as a primary candidate. Intronic primers were used to bidirectionally sequence each exon and flanking intronic regions, locating two compound heterozygous mutations that perfectly segregate with the phenotype.
Variant1: NM_001003841.3:c.340del (L114fs*114)
CAID: CA916079859 http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA916079859
gnomAD: Not in gnomAD
Variant2: NM_001003841.3:c.682_683delinsTA (p.Thr228Ter)
CAID: CA916079860 http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA916079860
gnomAD: Not in gnomAD
girl with urocanic aciduria
CaseES: Female, 1 yr onset
CasePresentingHPOs: HP:0002312, HP:0002131, HP:0002719, HP:0002078, HP:0002066, HP:0100560, HP:0002345, HP:0008376, HP:0000666, HP:0001348, HP:0002342, HP:0410217, HP:0012237 (Clumsiness, Episodic ataxia, Recurrent infections, Truncal ataxia, Gait ataxia, Upper limb asymmetry, Action tremor, Dysarthic speech, Horizontal nystagmus, Brisk reflexes, Moderate intellectual disability, Reduced blood 5-methyltetrahydrofolate level, Urocanic aciduria)
HPOsFreeText: Urocanis acid levels 158-202 mmol/mol creatinine (reference <10)
CaseNotHPOs: HP:0000496, HP:0001324, HP:0002160, HP:0001903 (Abnormal ocular movements, Muscle weakness, Hyperhomocystinemia, Anemia)
NotHPOsFreeText: N/A
CaseAddInfo: Parents are healthy and nonconsanguineous, Steady improvement after mid-life, Proband is confirmed compound heterozygous by parental confirmation (father heterozygous for Variant 2)
CasePreviousTesting: Cranial MRI and neurophysiological studies, including electroencephalography, electroretinography, visual and brainstem evoked potentials, electromyography, nerve conduction velocities, fundus oculi and cardiological examinations, gave normal results; Cognitive evaluation rated her IQ at 54; Routine laboratory analyses including serum amino transferases, creatinine, urea and other parameters were normal; Screening for inborn errors of metabolism, including plasma and urine amino acids (no histidine accumulation), blood lactate, sialotransferrin isoelectricfocusing, creatine deficiency syndromes, purine and pyrimidine defects, and organic acidurias, gave normal results; Hypothyroidism and coeliac disease were also excluded; Biochemical and/or genetic screening for early onset forms of inherited ataxia gave normal results; Deficiencies in 5-methyltetrahydrofolate, neopterin and biopterin deficiencies were seen, together with an evident reduction in homovanillic acid (HVA) and the HVA:5-hydroxyindolacetic acid ratio; Other parameters determined in cerebrospinal fluid (CSF), such as glucose, proteins, cells and amino acids were normal.
CaseGenotypingMethod: Genomic DNA was obtained from peripheral white blood cells from the proband and her father. Mutation analysis of UROC1 was performed via direct sequencing and PCR amplification of the 20 exons and flanking exon-intronic sequences. In-silico analysis and modeling was performed on the variants.
Variant1: NM_144639.3(UROC1):c.209T>C (p.Leu70Pro)
ClinVar: 408 https://www.ncbi.nlm.nih.gov/clinvar/variation/408/
gnomAD: 0.00005647, https://gnomad.broadinstitute.org/variant/3-126229555-A-G
Variant2: NM_144639.3(UROC1):c.1348C>T (p.Arg450Cys)
ClinVar: 407, https://www.ncbi.nlm.nih.gov/clinvar/variation/407/
gnomAD: 0.00008012, https://gnomad.broadinstitute.org/variant/3-126216984-G-A
3.1.2. Patient 2
CaseFI2: Male, Turkey, Birth onset
CasePresentingHPOs: HP:0009800, HP:0001195, HP:0000773, HP:0003026, HP:0001650, HP:0003561, HP:0001518, HP:0000252, HP:0004887, HP:0001274, HP:0001250, HP:0000411, HP:0007957, HP:0007495, HP:0000963, HP:0000973, HP:0100678, HP:0010648, HP:0001382, HP:0009815, HP:0001181, HP:0010557, HP:0001374, HP:0012330, HP:0030750, HP:0040187 (Maternal diabetes, Single umbilical artery, Short ribs, Short long bone, Aortic valve stenosis, Birth length less than 3rd percentile, Small for gestational age, Microcephaly, Respiratory failure requiring assisted ventilation, Agenesis of corpus callosum, Seizures, Protruding ear, Corneal opacity, Prematurely aged appearance, Thin skin, Cutis laxa, Premature skin wrinkling, Dermal translucency, Joint hypermobility, Aplasia/hypoplasia of the extremities, Adducted thumb, Overlapping fingers, Congenital hip dislocation, Pyelonephritis, Grade III preterm intraventricular hemorrhage, Neonatal sepsis)
HPOsFreeText: Intrauterine growth restriction birth length: 38 cm (< 3rd percentile), birth weight 1370 g (< 3rd percentile) and microcephaly (OFC at birth was 29.5 cm (3rd–10th percentile)). APGAR scores were 5, 9, and 9 after 1, 5, and 10 min, respectively; Typical facial gestalt
CaseNotHPOs: N/A
NotHPOsFreeText: N/A
CaseAddInfo: Parents are first-degree cousins that had three healthy daughters and three early abortions
CasePreviousTesting: N/A
CaseGenotypingMethod: Familial DNA was extracted from peripheral blood samples. Direct sequencing of PYCR1 and exons 2-18 of ALDH18A1 was performed in the affected individual with a homozygous single-basepair deletion found predicted to lead to a frameshift and premature stop codon.
Variant: NM_002860.4(ALDH18A1):c.2131del (p.Leu711fs)
ClinVar: 156546 https://www.ncbi.nlm.nih.gov/clinvar/variation/156546/
gnomAD: Not in gnomAD
ID no. 764
Case764: Female, 4 years report, Spain
CasePresentingHPOs: HP:0011344, HP:0003153, HP:0001257, HP:0003698, HP:0002474 (Severe psychomotor retardation, Cystathioninuria, Spasticity, Difficulty standing, Communication delay)
HPOsFreeText: Elevated urine cystathionine (1611 umol/g creatine; reference <46) and Elevated tHcys in urine (54.3 umol/g creatine; reference <20), Elevated plasma tHcys (20.5 umol/l; reference <7.5), Post treatment normal urine cystathionine (42 umol/g creatine)
CaseNotHPOs: HP:0003345 (Glutathione synthetase deficiency)
NotHPOsFreeText: N/A
CaseAddInfo: Patient is homozygous for this variant
CasePreviousTesting: Karyotype, magnetic resonance imaging, specific genetic tests for neurogenetic diseases and screening for inborn errors of metabolism (lactate, pyruvate, ammonium, uric acid, amino acids, organic acids, glycosaminoglycanes, creatine and guanidinoacetate, purines and pyrimidines, and isoelectric focusing pattern of transferrin), as well as folate, pyridoxine and cobalamine deficiencies, neural tumors and genetically determined homocystinurias, were all ruled out.
CaseGenotypingMethod: All twelve exons of the CTH gene and the intronic flanking sequences of the subjects and their parents was PCR amplified and directly sequenced.
Variant: NM_001902.5:c.200C>T (p.Thr67Ile)
ClinVar: 2939 https://www.ncbi.nlm.nih.gov/clinvar/variation/2939/
gnomAD: Ashkenazi Jewish 9.934e-3, Overall 6.308e-3 https://gnomad.broadinstitute.org/variant/1-70881670-C-T
Patient description
CaseVC: Male, Birth onset
CasePresentingHPOs: HP:0030082, HP:0002013, HP:0200048, HP:0001250, HP:0005949, HP:0001290, HP:0001662, HP:0008610, HP:0002120 (Abnormal drinking behavior, Vomiting, Cyanotic episode, Seizure, Apneic episodes in infancy, Generalized hypotonia, Bradycardia, Infantile sensorineural hearing impairment, Cerebral cortical atrophy)
HPOsFreeText: Birth weight of 2565 g, Length of 48 cm, Head circumference of 33 cm, Elevated excretion of TMS-derivatives of N-acetylated amino acids
CaseNotHPOs: HP:0001263 (Global developmental delay)
NotHPOsFreeText: N/A
CaseAddInfo: Parents are non-consanguineous, Proband confirmed homozygous via parental testing
CasePreviousTesting: Cerebral MRI showed abnormal signals in the cortico-subcortical zones of the fronto-parietal and temporo-occipital areas consistent with cortical laminar necrosis; Most presenting phenotypes were ameliorated after 6 weeks of age; N-acetylated amino acid excretion shown in Table 1
CaseGenotypingMethod: RT-PCR confirmed expression of aminoacylase I mRNA was significantly lowered in the proband than in controls. Southern blot and nested PCR confirmed the weak band observed was aminoacylase I mRNA and the relative expression levels. Following this, PCR amplification of all 14 coding exons and flanking introns of ACY1 was performed and sequenced.
Variant: NM_000666.3(ACY1):c.1057C>T (p.Arg353Cys)
ClinVar: 18110 https://www.ncbi.nlm.nih.gov/clinvar/variation/18110/
gnomAD: 0.004135 (4 homozygotes), https://gnomad.broadinstitute.org/variant/3-52022837-C-T
P3
CaseBE2P3: Male, 9 days onset
CasePresentingHPOs: HP:0001399, HP:0006579, HP:0001396, HP:0004914, HP:0002240, HP:0001290, HP:0007772, HP:0000347, HP:0000218, HP:0000954, HP:0012448, HP:0001684, HP:0003265, HP:0002490, HP:0002151, HP:0003235, HP:0001897, HP:0001272, HP:0002119, HP:0001263, HP:0000733, HP:0001414, HP:0002612 (Hepatic failure, Prolonged neonatal jaundice, Cholestasis, Recurrent infantile hypoglycemia, Hepatomegaly, Generalized hypotonia, Impaired smooth pursuit, Micrognathia, High palate, Single transverse palmar crease, Delayed myelination, Secundum atrial septal defect, Neonatal hyperbilirubinemia, Increased CSF lactate, Increased serum lactate, Hypermethioninemia, Normocytic anemia, Cerebellar atrophy, Ventriculomegaly, Global developmental delay, Stereotypy, Microvesicular hepatic steatosis, Congenital hepatic fibrosis)
HPOsFreeText: Increased bile salts, Biliary stones in gallbladder, Severe intrahepatic extramedullary haematopoiesis
CaseNotHPOs: HP:0001744, HP:0000842, HP:0008163 (Splenomegaly, Hyperinsulinemia, Decreased circulating cortisol level)
NotHPOsFreeText: Abnormally coloured stools
CaseAddInfo: Parents are first cousins
CasePreviousTesting: All patients received ursodeoxycholic acid (600 mg.m−2.d−1) and fat-soluble vitamin supplementation; All patients received an enriched diet with medium chain triglycerides and dextrin maltose; Sanger sequencing of POLG, DGUOK, and TRMU in P3 revealed no pathogenic variants; Mitochondrial RC defect was considered but no anomaly was found in isolated lymphocytes and in primary culture of fibroblasts
CaseGenotypingMethod: Sanger sequencing of the ADK gene revealed a homozygous termination variant. Both parents carried this in a heterozygous state and the younger healthy brother did not carry the mutation
Variant: NM_006721.3:c.519G>A (p.Trp173Ter)
CAID: CA377397711, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvsOrDescriptor=NM_006721.3%3Ac.519G%3EA
gnomAD: Not in gnomAD