4,719 Matching Annotations
  1. Oct 2026
    1. One is a novel 5-bp insertion between the thymidine at nt 704 and a cytosine at nt 705 (704ins5), which is seen only in the Japanese population.

      annotating here since this is a PDF

      Case#: Yamagishi Case 2, female, 10m at dx

      DiseaseAssertion: Hurler

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: mental delay. height=70cm

      CaseNotHPOs: HP:0002240

      CaseNotHPOFreeText: cardiac involvement

      PreviouslyPublished: n/a

      Variant: 704ins5/704ins homozygous

      ClinVar: 11921

      CAID: CA256123

      SupplementalData: n/a

    2. One is a novel 5-bp insertion between the thymidine at nt 704 and a cytosine at nt 705 (704ins5), which is seen only in the Japanese population.

      annotating here since this is a PDF

      Case#: Yamagishi Case 3, female, 3y4m at dx

      DiseaseAssertion: Hurler/Scheie

      FamilyInfo: Case 4 is this patient's sibling. Same genotype and similar phenotype

      CasePresentingHPOs: HP:0001433

      CaseHPOFreeText: height=90cm (-1.2SD)

      CaseNotHPOs:

      CaseNotHPOFreeText: mental delay. cardiac involvement

      PreviouslyPublished: n/a

      Variant: 704ins5; R89Q

      ClinVar: 11921; 11922

      CAID: CA256123; CA256124

      SupplementalData: n/a

    3. One is a novel 5-bp insertion between the thymidine at nt 704 and a cytosine at nt 705 (704ins5), which is seen only in the Japanese population.

      annotating here since this is a PDF

      Case#: Yamagishi Case 1, female, 3y1m at dx

      DiseaseAssertion: Hurler

      FamilyInfo: consanguinity

      CasePresentingHPOs: HP:0002240

      CaseHPOFreeText: mental delay. height=89cm (-1.5SD)

      CaseNotHPOs:

      CaseNotHPOFreeText: cardiac involvement

      PreviouslyPublished: n/a

      Variant: 704ins5/704ins homozygous

      ClinVar: 11921

      CAID: CA256123

      SupplementalData: n/a

    1. KMP 1

      Case#: KMP 1, female, 39 yrs, East Slovakia

      DiseaseAssertion: HCM

      FamilyInfo: n/a

      CasePresentingHPOs: n/a

      CaseHPOFreeText: symptomatic; LVEF 60%; NYHA I.; ECG; echocardiography

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: no LVOTO; no ICD

      CasePreviousTesting: Additional Sanger sequencing of exons 12, 24, 25 of MYBPC3, exon 12 NEBL, exons 12, 20, 21 of SCN5A, exon 7 of TNNI3, and exon 9 of TNNT2 gene

      CaseGenotypingMethod: Sanger sequencing

      Variant: NM_000257.4(MYH7):c.2845G>A (p.Glu949Lys)

      ClinVar: 14093 https://www.ncbi.nlm.nih.gov/clinvar/variation/14093/

      CAID: n/a

      gnomAD: absent

    2. KMP 16

      Case#: KMP 16, female, 60 yrs, East Slovakia

      DiseaseAssertion: HCM

      FamilyInfo: n/a

      CasePresentingHPOs: n/a

      CaseHPOFreeText: symptomatic; LVOTO yes; LVEF 39-40%; NYHA I.; ICD yes; ECG; echocardiography;

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      CasePreviousTesting: Additional Sanger sequencing of exons 12, 24, 25 of MYBPC3, exon 12 NEBL, exons 12, 20, 21 of SCN5A, exon 7 of TNNI3, and exon 9 of TNNT2 gene

      CaseGenotypingMethod: Sanger sequencing;

      Variant: NM_000257.4(MYH7):c.2845G>A (p.Glu949Lys)

      ClinVar: 14093 https://www.ncbi.nlm.nih.gov/clinvar/variation/14093/

      CAID: n/a

      gnomAD: absent

    1. Patient1 (Pt1)

      Case# Pt1, female, 16yo diagnosis, French

      CasePresentingHPOs HP:0001433, HP:0001263, HP:0001252, HP:0001395, HP:0000744, HP:0000718, HP:0000713, HP:0001397, HP:0003651, HP:0012465, HP:0001999, HP:0003155, HP:0003124, HP:0010837, HP:0011967, HP:0012852 (Hepatosplenomgaly, Psychomotor delay, Hypotonia, Hepatic fibrosis, Low tolerance to frustration, Aggressiveness, Agitation, Hepatic steatosis, Foamy histiocytes, Increased liver iron, Dysmorphic facies, Elevated alkaline phosphatase, High cholesterol, Decreased ceruloplasmin, Copper deficiency, Hepatic bridging fibrosis)

      HPOsFreeText Hepatospenomegaly and cholestasis(spontaneously resolved) (neonate); Elevated liver enzymes, psychomotor delay, hypotonia(6mo); liver cytolysis, portal-to-portal bridging fibrosis without regenerative nodules, fatty hepatocytes, foamy histiocytes, and iron overload(4yo); behavioral issues, dysmorphic features, elevated relative exchangeable and urinary copper and other metabolic abnormalities(13yo);enlarged portal tracts and liver tissue abnormalities (Fig1)

      CaseNotHPOs HP:0200032 (Kayser-Fleischer ring)

      CasePreviousTesting Negative for NPC and Wilson disease(ATP7B variants) as well as TMEM199 variants. Metabolic results: ASAT 56 U/L, ALAT 45 U/L [N < 40 U/L]; ALP 196 U/L [N < 119 U/L], cholesterol 5.50 mmol/L [N < 5.20 mmol/L], ceruloplasmin 0.55 μmol/L [N = 2–4.5 μmol/L], total copper 5.44 μmol/L [N = 12.5–22.5 μmol/L], y-gutamyltransferase, bilirubin, CK, glucose, lactic acid, plasma amino acids, urinary organic acids, and lysosomal acid lipase were normal, Bis(Monoacylglycero)Phosphate was also elevated.

      CaseMethod1 Direct sequencing

      CaseMethod2 n/a

      CaseGenotypingMethod Sequenced CCDC115 and TMEM199 in patients and parents

      Variant (1) NM_032357.3(CCDC115):c.92T>C (p.Leu31Ser) (2) NM_032357.3:c.19C>T(p.Arg7Ter)

      ClinVar (1) 218967 (2) n/a

      CAID (2) CA1871401

      gnomAD (1) 0.00002384(European (Non-Finnish)), 0.00001086(Total) (2) 0.00002691(European (Non-Finnish)), 0.00001220(Total)

      VariantEvidence see note on Fig 2

      CaseAddInfo nonconsanguineous

      CasePMIDs 26833332

    2. Patient 2 (Pt2)

      Case# Pt2, male, 20yo report, French

      CasePresentingHPOs HP:0200123, HP:0003155, HP:0003236, HP:0003124, HP:0003141, HP:0010837, HP:0006580, HP:0012852, HP:0025321 (Chronic Hepatitis, Elevated alkaline phosphatase, Elevated CK, High cholesterol, Elevated LDL cholesterol, Decreased ceruloplasmin, Portal fibrosis, Hepatic bridging fibrosis, Liver copper accumulation)

      CaseNotHPOs HP:0002240, HP:0001744, HP:0001999, HP:0200032 (Hepatomegaly, Splenomegaly, Dysmorphic facies, Kayser-Fleischer ring)

      CasePreviousTesting Negative for NPC and Wilson disease(ATP7B variants) as well as TMEM199 variants. Metabolic workup: ALAT 154 U/L, ASAT 137 U/L [N < 40 U/L] for >6 months, GGT was normal, ALP 218 U/L [N < 119 U/L], CK 519 U/L [N < 190 U/L], cholesterol 8.16 mmol/L [N < 5.7 mmol/L], ceruloplasmin 0.54 μmol/L [N = 2–4.5 μmol/L], normal urinary copper, REC 19% [N = 3.0–8.1%], liver copper 2.47 μmol/g, [N = 0.3–0.9 μmol/g]

      CaseMethod1 Direct sequencing

      CaseMethod2 n/a

      CaseGenotypingMethod Sequenced CCDC115 and TMEM199 in patients and parents

      Variant (1) NM_032357.3(CCDC115):c.92T>C (p.Leu31Ser) (2) NM_032357.3:c.38T>C(p.Leu13Pro)

      ClinVar (1) 218967 (2) n/a

      CAID (2) CA348488009

      gnomAD (1) 0.00002384(European (Non-Finnish)), 0.00001086(Total) (2) n/a

      VariantEvidence see note on Fig 2

      CaseAddInfo nonconsanguineous

      CasePMIDs 26833332

    3. Patient 3

      Case# Pt3, male, 16yo diagnosis, French

      CasePresentingHPOs HP:0009062, HP:0001433, HP:0001396, HP:0003124, HP:0012852, HP:0001414, HP:0011924, HP:0001409, HP:0001394, HP:0011343, HP:0002342, HP:0003236, HP:0001315, HP:0010837, HP:0010836 (Infantile axial hypotonia, Hepatosplenomegaly, Cholestasis, High cholesterol, Hepatic bridging fibrosis, Microvesicular hepatic steatosis, Mitochondrial complex III deficiency, Portal hypertension, Cirrhosis, Moderate global developmental delay, Moderate ID, Elevated CK, Absent deep tendon reflexes Decreased ceruloplasmin, Abnormal copper homeostasis)

      HPOsFreeText Hepatosplenomegaly and choleostasis reported at birth. Enlarged portal tracts, focal portal inflammation, loss of interlobular ducts in 1/3 of portal tracts and proliferation of bile ductules, lobular steatosis

      CaseNotHPOs HP:0003200 (Ragged red fibers)

      NotHPOsFreeText foamy hepatoocytes, bile plug

      CasePreviousTesting Negative for NPC, Gaucher and Wilson disease(ATP7B variants) as well as TMEM199 variants. Excluded acid lipase deficiency. Negative for disease causing variants in any known genes involved in mitochondrial metabolism. Ruled out type IV glycogen storage disease. Metabolic results: cholesterol 9.92 mmol/L [N < 5.2 mmol/L], ceruloplasmin 0.09 g/L [N = 0.2–0.5 g/L], REC 18% [N = 3.0–8.1%], normal serum(4.16 μmol/L) and exchangeable copper(0.75 μmol/L). Glycogen and cytochrome oxidases were normal.

      CaseMethod1 Exome sequencing

      CaseMethod2 n/a

      CaseGenotypingMethod Exome sequenced patient DNA, direct sequenced CCDC115 and TMEM199 in parents

      Variant (1) NM_032357.3(CCDC115):c.92T>C (p.Leu31Ser) (2) NM_032357.3:c.19C>T(p.Arg7Ter)

      ClinVar (1) 218967 (2) n/a

      CAID (2) CA1871401

      gnomAD (1) 0.00002384(European (Non-Finnish)), 0.00001086(Total) (2) 0.00002691(European (Non-Finnish)), 0.00001220(Total)

      VariantEvidence see note on Fig 2

      CaseAddInfo nonconsanguineous

      CasePMIDs 26833332

    1. Case#: Consequence 4 Table 1 in Data Supplement (1 cases)

      DiseaseAssertion: HCM

      FamilyInfo: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Cardiac magnetic resonance imaging, BSA, NYHA functional class, obstructive HCM, atrial fibrillation, coronary artery disease, NSVT, Syncope, SCD family hitory, wall thickness

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      CasePreviousTesting: Additional oligonucleotide hybridization–based DNA sequencing and dideoxy-based DNA sequencing for MYBPC3, TMP1, TNNC1, TNNI2, TNNI3, TNNT2, ACTC1, MYL3

      CaseGenotypingMethod: oligonucleotide hybridization–based DNA sequencing and dideoxy-based DNA sequencing

      Variant: NM_000257.4(MYH7):c.2156G>A (p.Arg719Gln)

      ClinVar: 14107 https://www.ncbi.nlm.nih.gov/clinvar/variation/14107/

      CAID: n/a

      gnomAD: absent

    2. Case#: Consequence 6 Table 1 in Data Supplement (1 cases)

      DiseaseAssertion: HCM

      FamilyInfo: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Cardiac magnetic resonance imaging, BSA, NYHA functional class, obstructive HCM, atrial fibrillation, coronary artery disease, NSVT, Syncope, SCD family hitory, wall thickness

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      CasePreviousTesting: Additional oligonucleotide hybridization–based DNA sequencing and dideoxy-based DNA sequencing for MYBPC3, TMP1, TNNC1, TNNI2, TNNI3, TNNT2, ACTC1, MYL3

      CaseGenotypingMethod: oligonucleotide hybridization–based DNA sequencing and dideoxy-based DNA sequencing

      Variant: NM_000257.4(MYH7):c.2146G>A (p.Gly716Arg)

      ClinVar: 14105 https://www.ncbi.nlm.nih.gov/clinvar/variation/14105/

      CAID: n/a

      gnomAD: absent

    3. Case#: Consequence 3 Table 1 in Data Supplement (4 cases)

      DiseaseAssertion: HCM

      FamilyInfo: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Cardiac magnetic resonance imaging, BSA, NYHA functional class, obstructive HCM, atrial fibrillation, coronary artery disease, NSVT, Syncope, SCD family hitory, wall thickness

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      CasePreviousTesting: Additional oligonucleotide hybridization–based DNA sequencing and dideoxy-based DNA sequencing for MYBPC3, TMP1, TNNC1, TNNI2, TNNI3, TNNT2, ACTC1, MYL3

      CaseGenotypingMethod: oligonucleotide hybridization–based DNA sequencing and dideoxy-based DNA sequencing

      Variant: NM_000257.4(MYH7):c.2717A>G (p.Asp906Gly)

      ClinVar: 14125 https://www.ncbi.nlm.nih.gov/clinvar/variation/14125/

      CAID: n/a

      gnomAD: 0.000008792 European (non-Finnish) https://gnomad.broadinstitute.org/variant/14-23893321-T-C

    4. Case#: Consequence 12 Table 1 in Data Supplement (1 cases)

      DiseaseAssertion: HCM

      FamilyInfo: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Cardiac magnetic resonance imaging, BSA, NYHA functional class, obstructive HCM, atrial fibrillation, coronary artery disease, NSVT, Syncope, SCD family hitory, wall thickness

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      CasePreviousTesting: Additional oligonucleotide hybridization–based DNA sequencing and dideoxy-based DNA sequencing for MYBPC3, TMP1, TNNC1, TNNI2, TNNI3, TNNT2, ACTC1, MYL3

      CaseGenotypingMethod: oligonucleotide hybridization–based DNA sequencing and dideoxy-based DNA sequencing

      Variant: NM_000257.4(MYH7):c.208A>T (p.Thr70Ser)

      ClinVar: 42877 https://www.ncbi.nlm.nih.gov/clinvar/variation/42877/

      CAID: n/a

      gnomAD: 0.00001761 European (non-Finnish) https://gnomad.broadinstitute.org/variant/14-23902430-T-A

    5. Case#: Consequence 24 Table 1 in Data Supplement (1 cases)

      DiseaseAssertion: HCM

      FamilyInfo: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Cardiac magnetic resonance imaging, BSA, NYHA functional class, obstructive HCM, atrial fibrillation, coronary artery disease, NSVT, Syncope, SCD family hitory, wall thickness

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      CasePreviousTesting: Additional oligonucleotide hybridization–based DNA sequencing and dideoxy-based DNA sequencing for MYBPC3, TMP1, TNNC1, TNNI2, TNNI3, TNNT2, ACTC1, MYL3

      CaseGenotypingMethod: oligonucleotide hybridization–based DNA sequencing and dideoxy-based DNA sequencing

      Variant: NM_000257.4(MYH7):c.1357C>T (p.Arg453Cys)

      ClinVar: 14089 https://www.ncbi.nlm.nih.gov/clinvar/variation/14089/

      CAID: n/a

      gnomAD: absent

    6. Case#: Consequence 1 Table 1 in Data Supplement (1 case)

      DiseaseAssertion: HCM

      FamilyInfo: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Cardiac magnetic resonance imaging, BSA, NYHA functional class, obstructive HCM, atrial fibrillation, coronary artery disease, NSVT, Syncope, SCD family hitory, wall thickness

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      CasePreviousTesting: Additional oligonucleotide hybridization–based DNA sequencing and dideoxy-based DNA sequencing for MYBPC3, TMP1, TNNC1, TNNI2, TNNI3, TNNT2, ACTC1, MYL3

      CaseGenotypingMethod: oligonucleotide hybridization–based DNA sequencing and dideoxy-based DNA sequencing

      Variant: NM_000257.4(MYH7):c.1988G>A (p.Arg663His)

      ClinVar: 42875 https://www.ncbi.nlm.nih.gov/clinvar/variation/42875/

      CAID: n/a

      gnomAD: 0.00003097 European (non-Finnish) https://gnomad.broadinstitute.org/variant/14-23896042-C-T

    7. Case#: Consequence 17 Table 1 in Data Supplement (1 cases)

      DiseaseAssertion: HCM

      FamilyInfo: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Cardiac magnetic resonance imaging, BSA, NYHA functional class, obstructive HCM, atrial fibrillation, coronary artery disease, NSVT, Syncope, SCD family hitory, wall thickness

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      CasePreviousTesting: Additional oligonucleotide hybridization–based DNA sequencing and dideoxy-based DNA sequencing for MYBPC3, TMP1, TNNC1, TNNI2, TNNI3, TNNT2, ACTC1, MYL3

      CaseGenotypingMethod: oligonucleotide hybridization–based DNA sequencing and dideoxy-based DNA sequencing

      Variant: NM_000257.4(MYH7):c.2681A>G (p.Glu894Gly)

      ClinVar: 42922 https://www.ncbi.nlm.nih.gov/clinvar/variation/42922/

      CAID: n/a

      gnomAD: absent

    8. Case#: Consequence 21 Table 1 in Data Supplement (1 cases)

      DiseaseAssertion: HCM

      FamilyInfo: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Cardiac magnetic resonance imaging, BSA, NYHA functional class, obstructive HCM, atrial fibrillation, coronary artery disease, NSVT, Syncope, SCD family hitory, wall thickness

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      CasePreviousTesting: Additional oligonucleotide hybridization–based DNA sequencing and dideoxy-based DNA sequencing for MYBPC3, TMP1, TNNC1, TNNI2, TNNI3, TNNT2, ACTC1, MYL3

      CaseGenotypingMethod: oligonucleotide hybridization–based DNA sequencing and dideoxy-based DNA sequencing

      Variant: NM_000257.4(MYH7):c.2945T>C (p.Met982Thr)

      ClinVar: 42941 https://www.ncbi.nlm.nih.gov/clinvar/variation/42941/

      CAID: n/a

      gnomAD: 0.001416 European (non-Finnish) https://gnomad.broadinstitute.org/variant/14-23892910-A-G

    9. Case#: Consequence 18 Table 1 in Data Supplement (4 cases)

      DiseaseAssertion: HCM

      FamilyInfo: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Cardiac magnetic resonance imaging, BSA, NYHA functional class, obstructive HCM, atrial fibrillation, coronary artery disease, NSVT, Syncope, SCD family hitory, wall thickness

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      CasePreviousTesting: Additional oligonucleotide hybridization–based DNA sequencing and dideoxy-based DNA sequencing for MYBPC3, TMP1, TNNC1, TNNI2, TNNI3, TNNT2, ACTC1, MYL3

      CaseGenotypingMethod: oligonucleotide hybridization–based DNA sequencing and dideoxy-based DNA sequencing

      Variant: NM_000257.4(MYH7):c.1750G>C (p.Gly584Arg)

      ClinVar: 14090 https://www.ncbi.nlm.nih.gov/clinvar/variation/14090/

      CAID: n/a

      gnomAD: 0.000008790 European (non-Finnish) https://gnomad.broadinstitute.org/variant/14-23896932-C-G

    1. 3-1

      Case# Subject 3-1, male, 11yo, Pakistani

      CasePresentingHPOs HP:0000750, HP:0011342, HP:0000286, HP:0000431, HP:0000490, HP:0000717, HP:0007302, HP:0000218, HP:0001500, HP:0001837, HP:0002650, HP:0001249, HP:0001252, HP:0000717 (Speech delay, Mild global developmental delay, Epicanthus, Broad nasal bridge, Deep set eyes, Bipolar disorder, High palate, Broad fingers, Broad toes, Scoliosis, Intellectual Disability, Hypotonia, Autism)

      HPOFreeText: mild speech/motor/cognitive delay, mild prominence of lateral ventricles, mild scoliosis, mild-moderate hypotonia

      CaseNotHPOs HP:0002376, HP:0001250 (Developmental regression, Seizures)

      NotHPOFreeText: Ventillator dependence

      CasePreviousTesting Variants previously reported with a minor allele frequency > 1% were excluded. WES for additional compound-heterozygous, X-linked, or heterozygous de novo variants was negative.

      CaseMethod1 WES

      CaseMethod2 Sanger

      CaseGenotypingMethod WES on all families, confirmed heterozygous/compound heterozygous with Sanger. Sanger on individuals with an affected family member. Parents confirmed heterozygous for childrens' variants

      Variant NM_001163435.2:c.1652T>C(p.Leu551Pro), homozygous

      ClinVar n/a

      CAID CA357822100

      gnomAD n/a

      VariantEvidence n/a

      CaseAddInfo consanguinity

      CasePMIDs n/a

    2. 1-1

      Case# Subject 1-1, male, 5yo died, Saudi

      CasePresentingHPOs HP:0001558, HP:0000750, HP:0011344, HP:0002283, HP:0006829, HP:0001250, HP:0000340, HP:0000414, HP:0010804, HP:0000582, HP:0000496, HP:0002099, HP:0000964, HP:0001249 (Decreased fetal movement, Speech delay, Severe global developmental delay, Diffuse brain atrophy, Severe hypotonia, Seizures, Sloping forehead, Bulbous nose, Tented upper lip, Upslanted palpebral fissure, Abnormality of eye movement, Asthma, Eczema, Intellectual disability)

      HPOFreeText: Oligohydramnios, Abnormal white matter signal intensity, Delayed reflexes

      CaseNotHPOs HP:0002376 (Developmental regression)

      NotHPOFreeText: Ventilator dependence

      CasePreviousTesting Variants previously reported with a minor allele frequency > 1% were excluded. WES for additional compound-heterozygous, X-linked, or heterozygous de novo variants was negative. Included in previous study based on a neurogenetic diagnosis, positive family history, consanguineous parents, and no candidate genes identified by autozygosity mapping.

      CaseMethod1 WES

      CaseMethod2 Sanger

      CaseGenotypingMethod WES on all families, confirmed heterozygous/compound heterozygous with Sanger. Sanger on individuals with an affected family member. Parents confirmed heterozygous for childrens' variants

      Variant NM_033115.4(TBCK):c.1708+1G>A, homozygous

      ClinVar 183338

      gnomAD 0.00006693(European(Non-Finnish)), 0.00003244(total)

      VariantEvidence (Fig 2A) Western blot: TBCK expression reduced in patient fibroblasts by 78%.

      CaseAddInfo Consanguinity

      CasePMIDs 25558065

    1. Patient 2

      Case2: Female, Austria, 18 yrs report

      CasePresentingHPOs: HP:0010628, HP:0002643, HP:0002015, HP:0040288, HP:0001260, HP:0003690, HP:0003798, HP:0001511, HP:0001561, HP:0005216, HP:0002540, HP:0002650 (Facial weakness, Neonatal respiratory distress, Swallowing difficulties, Nasogastric tube feeding, Dysarthric speech, Limb weakness, Nemaline bodies, Intrauterine growth restriction, Polyhydramnios, Chewing difficulties, Non-ambulatory, Scoliosis)

      HPOsFreeText: 3/3/5 Apgar score

      CaseNotHPOs: HP:0002015 (Swallowing difficulties)

      NotHPOsFreeText: N/A

      CaseAddInfo: N/A

      CasePreviousTesting: N/A

      CaseGenotypingMethod: Whole exome sequencing of the proband revealed these homozygous LMOD3 mutations.

      Variant1: NM_198271.4:c.1648C>T (p.Leu550Phe)

      ClinVar: 374498 https://www.ncbi.nlm.nih.gov/clinvar/variation/374498/

      gnomAD: Not in gnomAD

      Variant2: NM_198271.4:c.1004A>G (p.Gln335Arg)

      ClinVar: 374499 https://www.ncbi.nlm.nih.gov/clinvar/variation/374499/

      gnomAD: Not in gnomAD

    2. Patients 3

      Case3: Male, Germany, 20 yrs report

      CasePresentingHPOs: HP:0010628, HP:0002015, HP:0040288, HP:0001260, HP:0003690, HP:0003798, HP:0002650 (Facial weakness, Swallowing difficulties, Nasogastric tube feeding, Dysarthric speech, Limb weakness, Nemaline bodies, Scoliosis)

      HPOsFreeText: 7/8/9 Apgar score

      CaseNotHPOs: HP:0002015, HP:0002540, , HP:0002098 (Swallowing difficulties, Non-ambulatory, Respiratory distress)

      NotHPOsFreeText: N/A

      CaseAddInfo: N/A

      CasePreviousTesting: N/A

      CaseGenotypingMethod: Next generation sequnecing-based panel analysis detected the below variants in LMOD3.

      Variant1: NM_198271.4:c.1648C>T (p.Leu550Phe)

      ClinVar: 374498 https://www.ncbi.nlm.nih.gov/clinvar/variation/374498/

      gnomAD: Not in gnomAD

      Variant2: NM_198271.4:c.1004A>G (p.Gln335Arg)

      ClinVar: 374499 https://www.ncbi.nlm.nih.gov/clinvar/variation/374499/

      gnomAD: Not in gnomAD

    1. All nine affected individuals presented with various skeletal dysplasias. In four families (A and C–E), X-rays revealed severe platyspondyly leading to disproportionate stature (Figure 1). Lumbar gibbus and kyphoscoliosis were observed in families C and D, respectively. Three individuals (from families D and E) had cervical malformations and a hypoplastic odontoid peg with cervical instability. Short stature was also present in families A and B but appeared to be the result of limb shortening. Metaphyseal abnormalities of the long bones were found in families A and E, whereas families B–D showed epiphyseal abnormalities (Figure 1). Brachydactyly was observed in affected individuals from families A, B, and D. In addition to showing skeletal abnormalities, all affected individuals in families B and C had intellectual disability (ID). This could not be assessed for individuals A:II-1, E:II-1, and E:II-2 because of their early death at 7 weeks, 6 months, and 10 months of age, respectively. Both siblings of family B were severely disabled and unable to speak and are currently wheelchair bound. Dysmorphic facial features were non-discriminatingly mild but included coarse facial features, a prominent nose, and full cheeks in almost all affected individuals (Figure S1). A single palmar crease was also observed in six of nine affected individuals. A striking phenotype present in three of the five families was T-cell-negative SCID. Affected individuals from families A and B showed a lack of T cells, whereas B cell numbers were normal (Figure 4). Family E showed idiopathic CD4+ lymphopenia and an absolute lack of naive T cells (both CD4+CD45RA+ and CD8+CD45RA+ T cells were missing). In families B and E, a typical skin rash prompted further evaluation of the blood cells. Maternal T cells were excluded, and the oligoclonal T cell reaction found in the presence of eosinophilia was compatible with an Omenn-like presentation of SCID.1,2 Worth mentioning are also the liver cysts seen in affected individuals from families A and E. Although the phenotypes were widely variable and partly contrasting (e.g., severe versus no ID, severe versus mild platyspondyly, and epiphyseal versus metaphyseal changes), all major malformations and features occurred in three organ systems only: the immune system, the skeleton, and the neurological system. All together, we classify these five families as having phenotypic variability of an EXTL3-related neuro-immuno-skeletal dysplasia phenotype. The affected individuals from families A and E died in early infancy, whereas the others are currently between 2 and 38 years of age. Individual III-1 from family D died at 30 years of age from a unknown cause. Table 1 gives an overview of the most affected organ systems in all affected individuals. Detailed case reports and clinical data for each affected individual can be found in the Supplemental Note.

      Case 1: Family A: AII-1, female

      Born at 37 weeks, consanguineous family, APGAR = 9, tachypnea developed shortly after birth. At 20 weeks, skeletal abnormalities and kidney and liver cysts were detected. Died at 7 weeks from renal insufficiency.

      HPO Terms: HP:0002652, HP:0001999, HP:0002789, HP:0005562, HP:0001407, HP:0009826, HP:0000926, HP:0001156, HP:0000085, HP:0000083, HP:0002079, HP:0002119, HP:0030747, HP:0011839

      Previous Testing: Found autosomal recessive variant in CHST9 (MIM: 610191; c.1133A>G [p.Asn378Ser] [GenBank: NM_031422])

      Genotyping Method: WES, CNV performed on WES data, EXTL3 fibroblast localization tested and compared to non-affected controls using immunocytochemistry

      Variant: p.Arg513Cys, g.28575113, c.1537C>T

      ClinVar ID: n/a

      gnomAD: http://gnomad.broadinstitute.org/variant/8-28575113-C-T

      Inheritance: autosomal recessive

      Variant Evidence:

    1. Case 3

      Case#: 3, female, 12 days (onset), 4 y (current- this differs than what is in table 1), Chinese

      CasePresentingHPOs: HP: 0008344, HP: 0012088, HP:0011968, HP: 0002013, HP:0011344, HP: 0002543, HP: 0012751 (elevated A keto acids in urine, abnormal urinary odor, feeding difficulties, vomiting, severe global developmental delay, abnormal globus pallidus, abnormal basal ganglia)

      HPOsFreeText: Bilateral damage to capsula interna and externa, Blood ammonia: 205 uM, Hemoglobin: 118 g/L, Leucin: 891.90 uM, Valine: 502.50 uM, Isoleucine: 165.99 uM, Alloisoleucine: 90.12 uM

      CaseNotHPOs: N/A

      NotHPOsFreeText: N/A

      CaseAddInfo: 2 different variants, unsure of cis or trans

      CasePreviousTesting: n/a

      CaseMethod1: same as group

      CaseMethod2: same as group

      CaseGenotypingMethod: same as group

      Variant: NM_000709.3(BCKDHA):c.178G>T (p.Glu60Ter), NM_000709.3(BCKDHA):c.1214_1219dupCCAACC (p.Asn406Leu407insProGln)

      ClinVar: n/a

      CAID: CA406004676 , CA658820662

      gnomAD: neither in gnomAD

    2. Case 6

      Case#: 6, male, 18 m (onset), 2 y 6 m (current), Chinese

      CasePresentingHPOs: HP: 0008344, HP; 0012088, HP: 0011342, HP: 0001332, HP:0002543, HP: 0012751, HP:0012747 (elevated A keto acids in urine, abnormal urinary odor, mild global developmental delay, dystonia, abnormal globus pallidus, abnormal basal ganglia, abnormal brainstem MRI signal intensity)

      HPOsFreeText: damage to cerebellar dentate nucleus, damage to corpora quadrigemina, damage to frontal lobe, damage to insular cortex, Isoleucine: 167.13 uM, Alloisoleucine: 44.88 uM

      CaseNotHPOs: N/A

      NotHPOsFreeText: N/A

      CaseAddInfo: unsure cis or trans

      CasePreviousTesting: same as group

      CaseMethod1: same as group

      CaseMethod2: same as group

      CaseGenotypingMethod: same as group

      Variant: NM_183050.3:c.767A>G (p.Tyr256Cys), NM_183050.3:c.768C>G (p.Tyr256Ter)

      ClinVar: neither found

      CAID: CA364659935, CA142287564

      gnomAD: 0.000008820 (European, non-Finnish), not found

    3. Case 8

      Case#: 8, male, 13 days (onset), 1 y 6 m (current), Chinese

      CasePresentingHPOs: HP: 0008344, HP:0012088, HP:0011968, HP:0001254, HP:0002415, HP: 0006989 (elevated A keto acids in urine, abnormal urinary odor, feeding difficulties, lethargy, leukodystrophy, dysplastic corpus callosum)

      FreeTextHPOs: blood ammonia: 96 uM, hemoglobin: 98 g/L, leucin: 1047.24 uM, isoleucine: 261.09 uM, alloisoleucine: 127.05 uM

      CaseNotHPOs: N/A

      NotHPOsFreeText: N/A

      CaseAddInfo: homozygous mutation

      CasePreviousTesting: same as group

      CaseMethod1: same as group

      CaseMethod2: same as group

      CaseGenotypingMethod: same as group

      Variant: NM_001918.3:c.1A>G (p.Met1Val)

      ClinVar: not found

      CAID: CA969877

      gnomAD: not found

    4. Case 1

      Case#: 1, male, 3 days (onset), 2 y 8 mo (current), Chinese

      CasePresentingHPOs: HP:0008344 HP: 0012088, HP: 0001250, HP: 0011968, HP: 0001941, HP: 0001943, HP: 0001987, HP: 0001903, HP:0012751, HP:0002543, HP: 0001276, HP:0011343 (elevated A keto acids in urine, abnormal urinary odor, seizures, feeding difficulties, acidosis, hypoglycemia, hyperammonemia, anemia, abnormal basal ganglia MRI signal intensity, abnormal globus pallidus signals, hypertonia, moderate global developmental delay)

      HPOsFreeText: Blood ammonia: 75 uM, Valine: 532.83 uM, Isoleucine: 384.90 uM, Alloisoleucine: 213.09 uM

      CaseNotHPOs: N/A

      NotHPOsFreeText: N/A

      CaseAddInfo: variants also found in parents

      Case (Level 2)


      CasePreviousTesting: same as group

      CaseMethod1: same as group

      CaseMethod2: same as group

      CaseGenotypingMethod: same as group


      Variant1: NM_000709.3(BCKDHA): IVS6+1delG (can't search this format of an intronic mutations, how do I change it?)

      ClinVar: not sure how to search for BCKDHA IVS6 + 1delG

      CAID:

      gnomAD:


      Variant2: NM_000709.3(BCKDHA):c.740A>G (p.His247Arg)

      ClinVar: not found

      CAID: CA406012849

      gnomAD: not in gnomAD

      There are two variants listed for every patient except, one. The text said that all the mutations found were also found in the parents so does that mean they would be in trans?

      (didn't see this template at first, so still need to apply it to the other entries)

    1. VI-4 Son

      CaseVI-4: Male, 3.5 years, Turkey

      CasePresentingHPOs: HP:0004912, HP:0002540, HP:0002970 (Hypophosphatemic rickets, Inability to walk, Genu varum)

      HPOsFreeText: -3.76 standard deviation score

      CaseNotHPOs: HP:0000083, HP:0002024, HP:0001947 (Renal failure, Malabsorption, Renal tubular acidosis)

      NotHPOsFreeText: Other tubulopathies that cause secondary hypophosphatemia, Vitamin D-dependent rickets type 1 and 2

      CaseAddInfo: Variant is asserted de novo and confirmed by parental testing, Proband is hemizygous for this mutation

      CasePreviousTesting: Calcium levels (9.8 mg/dL), Decreased serum phosphate levels (2.8 mg/dL; reference 3.8-6.5), Elevated serum ALP (925 IU/L; reference 90-325), 25OHD3 levels (35 ng/ml), 1,25(OH)2D3 levels (N/A pg/mL), PTH levels (62.2 ng/L), TPR levels (69.7), Decreased TmP/GFR levels (1.95; reference 2.9-6.1)

      CaseGenotypingMethod: Genomic DNA was isolated from peripheral blood leukocytes, amplified, and directly sequenced in all the coding exons and intron-exon boundaries of PHEX. If no mutations were found, FGF23 followed by consecutive analysis of DMP1, ENPP1, CLCN5, SLC34A3 and SLC34A1 was performed. Significance of found mutations was predicted by computational programs and sorted.

      Variant: NM_000444.5:c.1217G>T (p.Cys406Phe)

      CAID: CA412573391 https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_000444.5%3Ac.1217G%3ET

      gnomAD: Not in gnomAD

    1. P7

      Case# P7, 2yo report

      CasePresentingHPOs HP:0005528, HP:0001873

      CasePreviousTesting genes related to MDS/inherited bone marrow failure syndromes was performed in patients, negative for this patient

      CaseMethod1 NGS

      CaseMethod2 Sanger

      CaseGenotypingMethod NGS then variant confirmed with Sanger

      Variant NM_152703.4(SAMD9L):c.2640C>A (p.His880Gln)

      ClinVar 242372

      CaseAddInfo transient monosomy 7 with somatic mutation of new variant NM_152703.3:c.3951_3955del (p.Ser1317ArgfsTer21) - CA658820702

    2. P5

      Case# P5, 7yo report

      CasePresentingHPOs HP:0005528, HP:0001873

      CasePreviousTesting genes related to MDS/inherited bone marrow failure syndromes was performed in patients, negative for this patient

      CaseMethod1 NGS

      CaseMethod2 Sanger

      CaseGenotypingMethod NGS then variant confirmed with Sanger

      Variant NM_152703.4(SAMD9L):c.2956C>T (p.Arg986Cys)

      ClinVar 446530

      VariantEvidence (Figure 5) 293FT cells transfected with p.Arg986Cys showed more limited cell proliferation than WT SAMD9L in 28202457

      CaseAddInfo "The HLA-identical brother of P5 was thoroughly evaluated as a potential bone marrow donor. He was clinically healthy and had a normal complete blood count, but he did not qualify as a donor because of hypocellular bone marrow with mild dysplastic features. He was also a carrier of the p.R986C mutation."

    1. Patient 1

      Case1: Male, 3 months onset, Australia

      CasePresentingHPOs: HP:0002878, HP:0002460, HP:0001270, HP:0003701, HP:0000467, HP:0001488, HP:0002938, HP:0003691, HP:0003391, HP:0003803, HP:0003755 (Respiratory failure, Distal muscle weakness, Motor delay, Proximal muscle weakness, Neck muscle weakness, Bilateral ptosis, Lumbar hyperlordosis, Scapular winging, Gowers sign, Type 1 muscle fiber predominance, Type 1 fibers relatively smaller than type 2 fibers)

      HPOsFreeText: BiPAP from 3.5 yrs, Type 2B fibers absent

      CaseNotHPOs: HP:0003798, HP:0030177, HP:0031237 (Nemaline bodies, Abnormal nerve conduction study, Internally nucleated skeletal muscle fibers)

      NotHPOsFreeText: N/A

      CaseAddInfo: Variant is de novo with parental testing confirmed

      CasePreviousTesting: Patients were diagnosed with CFTD via clinical notes and muscle biopsies at pathology centers throughout Australia and several international centers.

      CaseGenotypingMethod: Two methods were used for genotyping. In 16 patients, the 10 exons spliced onto the muscle-specific isoform of TPM3 were bidirectionally sequenced from genomic DNA. For the other 7 patients, complementary DNA was generated from patient muscle and isoform-specific primers were used to sequence the transcript. Paternity was confirmed in isolated patients using microsatellite markers.

      Variant: NM_152263.4(TPM3):c.733A>G (p.Arg245Gly)

      ClinVar: 42117 https://www.ncbi.nlm.nih.gov/clinvar/variation/42117/

      gnomAD: Not in gnomAD

    2. Patient 2

      Case2: Male, Birth onset, Australia

      CasePresentingHPOs: HP:0008947, HP:0002460, HP:0001270, HP:0003701, HP:0000467, HP:0001488, HP:0002938, HP:0010628, HP:0003391, HP:0002942, HP:0003803, HP:0003755 (Infantile muscular hypotonia, Distal muscle weakness, Motor delay, Proximal muscle weakness, Neck muscle weakness, Bilateral ptosis, Lumbar hyperlordosis, Facial palsy, Gowers sign, Thoracic kyphosis, Type 1 muscle fiber predominance, Type 1 fibers relatively smaller than type 2 fibers)

      HPOsFreeText: Type 2B fibers absent

      CaseNotHPOs: HP:0003798, HP:0030177, HP:0030877, HP:0031237 (Nemaline bodies, Abnormal nerve conduction study, Obstructive deficit on pulmonary function testing, Internally nucleated skeletal muscle fibers)

      NotHPOsFreeText: N/A

      CaseAddInfo: Variant is de novo with parental testing confirmation

      CasePreviousTesting: Patients were diagnosed with CFTD via clinical notes and muscle biopsies at pathology centers throughout Australia and several international centers.

      CaseGenotypingMethod: Two methods were used for genotyping. In 16 patients, the 10 exons spliced onto the muscle-specific isoform of TPM3 were bidirectionally sequenced from genomic DNA. For the other 7 patients, complementary DNA was generated from patient muscle and isoform-specific primers were used to sequence the transcript. Paternity was confirmed in isolated patients using microsatellite markers.

      Variant: NM_152263.4(TPM3):c.505A>G (p.Lys169Glu)

      ClinVar: 42115 https://www.ncbi.nlm.nih.gov/clinvar/variation/42115/

      gnomAD: Not in gnomAD

    1. Case 9

      Case9 Male, Finland

      CasePresentingHPOs HP:0000202, HP:0000347, HP:0001829, HP:0010066, HP:0000157, HP:0002101, HP:0002324, HP:0010664, HP:0030449

      (Oral cleft, Micrognathia, Hand polydactyly, Duplicated hallux, Tongue abnormality, Defective lung lobation, Hydranencephaly, Fused thalami, Therapeutic abortion)

      HPOsFreeText Crown-heel body length 22cm, body weight 245g, brain weight 6g, abnormal larynx/trachea, occipitoschisis/keyhole, absent developed and identifiable mamillary bodies, absent anterior commissure, difficult to identify nucleus dentatus, duplicated central canal in lumbar spinal cord, posterior columns seem disorganized. The ventral horn shows normal-appearing motor neurons with an SMI-311 neurofilament immunostain.

      CaseNotHPOs HP:0001161

      (Hand polydactyly)

      NotHPOsFreeText Uterus duplex, true alobar or semilobar holoprosencephaly

      CasePreviousTesting n/a

      Variant NM_145014.2(HYLS1):c.632A>G (p.Asp211Gly), homozygous

      ClinVar 1143

      gnomAD MAF= 0.009594(European(Finnish)), no homozygotes

      CaseAddInfo induced abortion at 19+5wk gestational age

      CasePMIDs n/a

    2. Case 14

      Case14 Female, Finland

      CasePresentingHPOs HP:0000347, HP:0001829, HP:0010066, HP:0002101, HP:0000238, HP:0001341, HP:0007370, HP:0010664, HP:0002126, HP:0007260

      (Micrognathia, Foot polydactyly, Duplicated hallux, Defective lung lobulation, Hydrocephalus, Olfactory lobe agenesis, Callosal agenesis, Fused thalami, Polymicrogyria, Type II lissencephaly)

      HPOsFreeText Crown-heel body length 35.5cm, body weight 1162g, brain weight 153g, abnormal larynx/trachea, uterus duplex, hydrocephalus/open-book, occipitotemporal hypoplasia, infratentorial hypoplasia, occipitoschisis/keyhole, leptomeningeal heterotopia in the Sylvian fissures , neuroepithelial rosettes, absent developed and identifiable mamillary bodies, absent anterior commissure, difficult to identify nucleus dentatus, large hypothalamic hamartoma that covers the brainstem (Fig4:) consisting of slightly nodular areas of small, round, probably partly immature, neuronal, and possibly some oligodendroglial cells, capillaries, astroglial cells, and occasional larger pyramidal neuronal cells on hematoxylin and eosin stain.

      CaseNotHPOs HP:0000202, HP:0001627, HP:0000157, HP:0007165

      (Oral cleft, Congenital heart defect, Tongue abnormality, Periventricular neuronal heterotopia)

      NotHPOsFreeText hydranencephaly/anencephaly, true alobar or semilobar holoprosencephaly

      CasePreviousTesting n/a

      Variant NM_145014.2(HYLS1):c.632A>G (p.Asp211Gly), homozygous

      ClinVar 1143

      gnomAD MAF= 0.009594(European(Finnish)), no homozygotes

      CaseAddInfo death at 20 minutes old, 33+5wk gestational age

      CasePMIDs n/a

    3. Subjects

      Case8 Male, Finland

      CasePresentingHPOs HP:0000202, HP:0000347, HP:0001829, HP:0010066, HP:0001627, HP:0002101, HP:0000238, HP:0001341, HP:0007370, HP:0010664, HP:0002126, HP:0007260, HP:0030449

      (Oral cleft, Micrognathia, Foot polydactyly, Duplicated hallux, Congenital heart defect, Defective lung lobation, Hydrocephalus, Olfactory lobe agenesis, Callosal agenesis, Fused thalami, Polymicrogyria, Type II lissencephaly, Therapeutic abortion)

      HPOsFreeText Crown-heel body length 20cm, Body weight 323g, abnormal larynx/trachea, hydrocephalus/open-book, occipitotemporal hypoplasia, infratentorial hypoplasia, occipitoschisis/keyhole, neuroepithelial rosettes, absent developed and identifiable mamillary bodies, absent anterior commissure, difficult to identify nucleus dentatus

      CaseNotHPOs HP:0001161, HP:0000157, HP:0007165

      (Hand polydactyly, Tongue abnormality, Periventricular neuronal heterotopia)

      NotHPOsFreeText Uterus duplex, hydranencephaly/anencephaly, leptomeningeal heterotopia, true alobar or semilobar holoprosencephaly

      CasePreviousTesting n/a

      Variant NM_145014.2(HYLS1):c.632A>G (p.Asp211Gly), homozygous

      ClinVar 1143

      gnomAD MAF= 0.009594(European(Finnish)), no homozygotes

      CaseAddInfo induced abortion at 19+0wk gestational age

      CasePMIDs n/a

    4. Subjects

      Case3 Female, Finland

      CasePresentingHPOs HP:0000347, HP:0010066, HP:0001829, HP:0002101, HP:0000238, HP:0001341, HP:0007370, HP:0010664, HP:0002126, HP:0007165, HP:0030449

      (Micrognathia, Duplicated hallux, Foot polydactyly, Defective lung lobation, Hydrocephalus, Olfactory lobe agenesis, Callosal agenesis, Fused thalami, Polymicrogyria, Periventricular neuronal heterotopia, Therapeutic abortion)

      HPOsFreeText crown-heel body length 17cm, body weight 103g, abnormal larynx/trachea, occipitotemporal hypoplasia, infratentorial hypoplasia, occipitoschisis/keyhole, leptomeningeal heterotopia, hydrocephalus/open-book, neuroepithelial rosettes, absent developed and identifiable mamillary bodies, absent anterior commissure, difficult to identify nucleus dentatus

      CaseNotHPOs HP:0000202, HP:0001627, HP:0000157, HP:0007260

      (Oral cleft, Congenital heart defect, Tongue abnormality, Type II lissencephaly)

      NotHPOsFreeText Uterus duplex, true alobar or semilobar holoprosencephaly

      CasePreviousTesting n/a

      Variant NM_145014.2(HYLS1):c.632A>G (p.Asp211Gly), homozygous

      ClinVar 1143

      gnomAD MAF= 0.009594(European(Finnish)), no homozygotes

      CaseAddInfo induced abortion at 15+6wk gestational age

      CasePMIDs n/a

    5. Subjects

      Case18 Male, Finland

      CasePresentingHPOs HP:0003826, HP:0000347, HP:0001627, HP:0002101, HP:0000238, HP:0001341, HP:0007370, HP:0010664, HP:0002126, HP:0007260

      (Stillbirth, Micrognathia, Congenital heart defect, Defective lung lobation, Hydrocephalus, Olfactory lobe agenesis, Callosal agenesis, Fused thalami, Polymicrogyria, Type II lissencephaly)

      HPOsFreeText Crown-heel bodylength 45cm, body weight 2050g, brain weight 265g, abnormal larynx/trachea, occipitotemporal hypoplasia, infratentorial hypoplasia, occipitoschisis/keyhole, leptomeningeal heterotopia, absent developed and identifiable mamillary bodies, absent anterior commissure, difficult to identify nucleus dentatus

      CaseNotHPOs HP:0000202, HP:0001161, HP:0001829, HP:0007165

      (Oral cleft, Hand polydactyly, Foot polydactyly, Periventricular heterotopia)

      NotHPOsFreeText Uterus duplex, neuroepithelial rosettes, true alobar or semilobar holoprosencephaly

      CasePreviousTesting n/a

      Variant NM_145014.2(HYLS1):c.632A>G (p.Asp211Gly), homozygous

      ClinVar 1143

      gnomAD MAF= 0.009594(European(Finnish)), no homozygotes

      CaseAddInfo stillbirth, 36+6wk gestational age

      CasePMIDs n/a

    6. Subjects

      Case5 Male, Finland

      CasePresentingHPOs HP:0000347, HP:0001161, HP:0001829, HP:0000157, HP:0002101, HP:0000238, HP:0001341, HP:0007370, HP:0010664, HP:0002126, HP:0007260, HP:0030449

      (Micrognathia, Hand polydactyly, Foot polydactyly, Tongue abnormality, Defective lung lobation, Hydrocephalus, Olfactory lobe agenesis, Callosal agenesis, Fused thalami, Polymicrogyria, Type II lissencephaly, Therapeutic aboriton)

      HPOsFreeText Crown-heel body length 22cm, body weight 315g, Toe polydactly with multiple extra toes, Abnormal larynx/trachea, Hydrocephalus/open-book, Occipitotemporal hypoplasia, Infratentorial hypoplasia, occipitotemporal hypoplasia, leptomeningeal heterotopia, neuroepithelial rosettes, absent developed and identifiable mamillary bodies, absent anterior commissure, difficult to identify nucleus dentatus

      CaseNotHPOs HP:0000202, HP:0001627, HP:0002444, HP:0007165

      (Oral cleft, Congenital heart defect, Hypothalamic hamartoma, Periventricular neuronal heterotopia)

      NotHPOsFreeText Uterus duplex, hypothalamic hamartoma/bulging, true alobar or semilobar holoprosencephaly

      CasePreviousTesting n/a

      Variant NM_145014.2(HYLS1):c.632A>G (p.Asp211Gly), homozygous

      ClinVar 1143

      gnomAD MAF= 0.009594(European(Finnish)), no homozygotes

      CaseAddInfo induced abortion at 18+1wk gestational age

      CasePMIDs n/a

    7. Case 13

      Case13 Female, 6day old death, Finland

      CasePresentingHPOs HP:0000347, HP:0000157, HP:0002101, HP:0000238, HP:0001341, HP:0007370, HP:0010664, HP:0002126, HP:0007260, HP:0007165

      (Micrognathia, Tongue abnormality, Defective lung lobulation, Hydrocephalus, Olfactory lobe aplasia, Callosal aplasia, Fused thalami, Polymicrogyria, Type II lissencephaly, Periventricular neuronal heterotopia)

      HPOsFreeText Crown-heel body length 42cm, Body weight 2326g, brain weight 206g, abnormality larynx/trachea, uterus duplex, hydrocephalus/open-book, occipitotemporal hypoplasia, infratentorial hypoplasia, occipitoschisis/keyhole, leptomeningeal heterotopia, neuroepithelial rosettes, absent developed and identifiable mamillary bodies, absent anterior commissure, difficult to identify nucleus dentatus, small unilateral remnant of the olfactory tract, (Fig2:)small proximal stumps of callosal fibers with a small longitudinal Probst bundle element, lateral periventricular nodular heterotopia, smooth cortical surface without normal gyration; missing midline commissures , large leptomeningeal heterotopia between the ba and brain tissue surface immunopositive for microtubule-associated protein 2 (MAP-2), hypoplastic temporal lobe displays a miniature dentate fascia, dysplastic hippocampus, heterotopic (Fig5:) glioneuronal wart-like eruption, irregular and disrupted bundles of radial glial structures, calretinin (CR)-positive and reelin positive neurons in dysplastic cortex, (Fig6:) minute dysplastic inferior olive only in some neuronal groups, totally narrowed pyramid medially below in the right lower corner of the medulla oblongata, all layers are narrowed in the atrophic cerebellar cortex of HLS, short and small frontal bundle of Probst

      CaseNotHPOs HP:0000202, HP:0001829, HP:0001627

      (Oral cleft, Foot polydactyly, Congenital heart defect)

      NotHPOsFreeText true alobar or semilobar holoprosencephaly

      CasePreviousTesting n/a

      Variant NM_145014.2(HYLS1):c.632A>G (p.Asp211Gly), homozygous

      ClinVar 1143

      gnomAD MAF= 0.009594(European(Finnish)), no homozygotes

      CaseAddInfo 33+5wk gestational age

      CasePMIDs n/a

    1. Subject 3

      Case# Subject 3, F, 5mo onset, Hispanic

      CasePresentingHPOs HP:0002910, HP:0001942, HP:0003201, HP:0001664, HP:0002878, HP:0001663, HP:0001249, HP:0001250, HP:0008619, HP:0100295, HP:0001260, HP:0004756, HP:0001259, HP:0012734, HP:0002151, HP:0003236, HP:0002307, HP:0000252, HP:0004322, HP:0004325, HP:0002058, HP:0002136

      HPOcont: Elevated Transaminases, Metabolic acidosis, Rhabdomyolysis, Torsade de pointes, Respiratory Failure, Ventricular fibrillation, Intellectual Disability, Seizures, Bilateral sensorineural hearing impairment, Muscle fiber atrophy, Dysarthria, Ventricular tachycardia, Coma, Ketotic hypoglycemia, Elevated Lactate, Elevated CPK, Drooling, Microcephaly, Short Stature, Low body weight, Myopathic facies, Broad-based gait

      HPOFreeText: (5 months) coma, metabolic acidosis and rhabdomyolysis. (24 years) torsade de pointes, respiratory and multiorgan failure, ventricular fibrillation, epilepsy, bilateral sensorineural hearing loss, intellectual disability and atrophic muscle fibers. She was ambulatory, some speech, drooling, myopathic facies, and wide-based gait. "Height and weight below the 5th percentile for age (weight 42.9 kg, height 147 cm), head circumference below 5th percentile for age (51.4 cm)."

      CaseNotHPOs HP:0002540, HP:0001987

      NotHPOcont: Non-ambulatory, Hyperammonemia

      CasePreviousTesting CPK elevated to 8,000 U/I on first episode, then 22,000 U/I during most severe episode.

      CaseMethod1 WES

      CaseMethod2 Sanger

      CaseGenotypingMethod WES and cSNP results confirmed with Sanger

      Variant (1) NM_152906.6:c.460G>A (p.Gly154Arg)

      ClinVar (1) 208823

      CAID (1) CA358646

      gnomAD (1) 0.001549(Other), 0.0001208(Overall)

      VariantEvidence (Figure 3) using "EBV-transformed B-lymphoblastoid cell lines (BLCLs) from another individual, subject 4 with homozygous c.460G>A (p.Gly154Arg) mutation, and evaluated the Golgi by intracellular staining with WGA, as well as cis Golgi marker, anti-GM130 antibody." WGA stain resolved lower area of golgi bodies in p.Gly154Arg cells than WT. Measured immunoglobulin heavy chain binding protein levels in WT and and patient fibroblasts, BiP levels in patient cells lower than WT after ER induced stress by Brefeldin A.

      CaseAddInfo nonconsanguineous, parents confirmed heterozygotes

      CasePMIDs n/a

    1. Gene and mutation identification Analysis of the single nucleotide polymorphism (SNP) microarray genotypes from six patients with PHID identified a single common 1.4 Mb region of shared homozygosity within cytogenetic band 10q22.1, between SNPs rs10509321 and rs1900515 (Fig. 1A). Inspection of the Ensembl and UCSC Genome Browsers demonstrated that the region included 14 known and predicted genes: ADAMTS14, C10orf27, CDH23, EIF4EBP2, LRRC2, KIAA1274, NODAL, NPFFR1, PCBD1, PPA1, PRF1, SLC29A3, SGPL1, UNC5B. Positional candidate genes were selected for sequencing in order to identify pathogenic mutations (Fig. 1B). Five different homozygous mutations were identified in the SLC29A3 gene encoding the equilibrative nucleoside transporter 3 (Fig. 1C, Table 1). Human ENT3 has been shown recently to be the cause of H syndrome, an autosomal recessive disorder with overlapping skin features to PHID (6), indicating that these are allelic disorders. hENT3 belongs to a structurally unique protein family of nucleoside and/or nucleobase transporters (13,14). The five homozygous mutations identified segregated with the disease within each family and were not present in over 100 Lebanese and Pakistani control chromosomes. Figure 1.Open in new tabDownload slideHomozygosity mapping and mutation results in five PHID families. (A) Homozygosity mapping of chromosome 10. Red bars indicate heterozygous single nucleotide polymorphisms (SNPs); blue bars, an extended run of homozygous SNPs greater than would be predicted by chance; green bars, a run of homozygous SNPs but insufficient to meet criteria for significance. (B) Genes within the 1.4 Mb interval bounded by heterozygous SNPs rs10509321 (CII.3) and rs1900515 (DII.1). (C) SLC29A3 sequence electrophoretograms demonstrating homozygous mutations in five PHID families. (D) Protein structure prediction of hENT3 by SVMTM software. (E) Multispecies alignment of the second transmembrane and the C-terminal cytoplasmic domains of ENT3 protein (accession numbers: Homo sapiens, NP_060814.4; Canis lupus, XP_546152.2; Bos taurus, XP_580640.3; Mus musculus, NP_076085.1; monodelphus domesticus, XP_001344438.1; Gallus gallus, XP_421594.2; Gasterosteus aculeatus, ENSGACP00000006741; Takifugu rubipens, ENSTRUP00000028258; Drosophila melangaster, FBpp0077753; Caenorhabditis elegans, NP_501807.3). Table 1.Mutation summary Mutation NM_018344.4 . Protein CCDS7310.1 . Protein domain . Predicted . Mutation predictions . Grantham . SIFT . c.347T>Gp.Met116ArgTransmembrane Domain 2Missense Hydrophobic to large basic910.03c.940delTp.Tyr314ThrfsX91Transmembrane Domain 7Frameshift––c.1309G>Ap.Gly437ArgIntra-cytoplasmic DomainMissense Small hydrophobic to large basic12512.0c.1330G>Tp.Glu444XIntra-cytoplasmic DomainNonsense––c.1346C>Gp.Thr449ArgIntra-cytoplasmic DomainMissense Small polar to large basic710.03Mutation NM_018344.4 . Protein CCDS7310.1 . Protein domain . Predicted . Mutation predictions . Grantham . SIFT . c.347T>Gp.Met116ArgTransmembrane Domain 2Missense Hydrophobic to large basic910.03c.940delTp.Tyr314ThrfsX91Transmembrane Domain 7Frameshift––c.1309G>Ap.Gly437ArgIntra-cytoplasmic DomainMissense Small hydrophobic to large basic12512.0c.1330G>Tp.Glu444XIntra-cytoplasmic DomainNonsense––c.1346C>Gp.Thr449ArgIntra-cytoplasmic DomainMissense Small polar to large basic710.03 Open in new tab Table 1.Mutation summary Mutation NM_018344.4 . Protein CCDS7310.1 . Protein domain . Predicted . Mutation predictions . Grantham . SIFT . c.347T>Gp.Met116ArgTransmembrane Domain 2Missense Hydrophobic to large basic910.03c.940delTp.Tyr314ThrfsX91Transmembrane Domain 7Frameshift––c.1309G>Ap.Gly437ArgIntra-cytoplasmic DomainMissense Small hydrophobic to large basic12512.0c.1330G>Tp.Glu444XIntra-cytoplasmic DomainNonsense––c.1346C>Gp.Thr449ArgIntra-cytoplasmic DomainMissense Small polar to large basic710.03Mutation NM_018344.4 . Protein CCDS7310.1 . Protein domain . Predicted . Mutation predictions . Grantham . SIFT . c.347T>Gp.Met116ArgTransmembrane Domain 2Missense Hydrophobic to large basic910.03c.940delTp.Tyr314ThrfsX91Transmembrane Domain 7Frameshift––c.1309G>Ap.Gly437ArgIntra-cytoplasmic DomainMissense Small hydrophobic to large basic12512.0c.1330G>Tp.Glu444XIntra-cytoplasmic DomainNonsense––c.1346C>Gp.Thr449ArgIntra-cytoplasmic DomainMissense Small polar to large basic710.03 Open in new tab Two novel homozygous mutations predicted to cause premature protein truncation were identified, a 1 bp deletion c.940delT and a nonsense mutation c.1330G>T. The deletion causes a frame shift mutation p.Y314Tfs in transmembrane domain 7 and is predicted to result in the substitution of transmembrane domains 8–11 with an irrelevant protein sequence of 91 amino acids derived from an alternate reading frame. The nonsense mutation p.E444X is predicted to lead to premature protein truncation with loss of part of the final cytoplasmic domain and transmembrane domain 11 of hENT3. It would appear unlikely that the either residual protein would be capable of nucleoside transport function.Three homozygous missense mutations of SLC29A3 were identified to involve conserved amino acids (Table 1). The first missense mutation involves Methionine116 in transmembrane domain 2, which is a hydrophobic amino acid in species as distantly related as humans and nematodes, with a large basic amino acid, Arginine (p.M116R; Fig. 1C and E). The Grantham score for this substitution is 91, which is classified as a moderate change (15). Analysis using the SIFT prediction software also classifies this as a likely deleterious change (16). The introduction of a large basic amino acid into a transmembrane domain would likely result in significant disruption of the hydrophobic nature of the domain and result in retention of the transporter protein within the endoplasmic reticulum, as has been demonstrated for other membrane proteins (17).The second missense change is a recently reported Glycine to Arginine substitution at hENT3 amino acid 437 (p.G437R Fig. 1C), which is located in the putative cytoplasmic domain between transmembrane domains 10 and 11. This is the only mutation in the PHID cohort that is shared with the known mutations in H syndrome. Of particular interest is the observation that this is the sole individual in the PHID cohort who has not developed insulin-dependent DM. The p.G437R change involves the substitution of a large basic amino acid at a position where 41 members of the ENT family as distantly related as humans and Arabidopsis thaliana encode a small hydrophobic amino acid (Fig. 1E) (18). The Grantham difference for this change is 125 and is classified as a moderately radical change.The third missense change occurs at hENT3 amino acid residue 449, which is also located in the final putative intracellular domain between transmembrane domains 10 and 11, and involves the substitution of a Threonine by an Arginine (p.T449R). The amino acids encoded at this position in hENT3 orthologs are small polar/uncharged or small hydrophobic residues (Fig. 1E). Substitution by arginine is associated with a Grantham score of 71 and is predicted by SIFT as not to be tolerated.

      Case: Family D/Prendiville Patient 4, male, 12yo, American, Causasian

      CasePresentingHPOs: HP:0100651, HP:0000953, HP:0000998, HP:0005912, HP:0001993

      CasePresentingHPOsFreeText: Hyperpigmentation onset at 10yo; located on proximal anterior thighs initially, but spread to chest, lower back, abdomen, thighs, and posterior lower legs. Decreased IgM.

      CaseNOTHPOs: HP:0002716, HP:0001433, HP:0003493, HP:0001999, HP:0004322, HP:0001738

      CaseNOTHPOSFreeText: inflammatory symptoms

      CasePreviousTesting: ADAMTS14, C10orf27, CDH23, EIF4EBP2, LRRC2, KIAA1274, NODAL, NPFFR1, PCBD1, PPA1, PRF1, SLC29A3, SGPL1, UNC5B were sequenced since they were positional candidate genes

      CaseGenotypingMethod: homozygosity mapping (50K SNP array), candidate gene sequencing

      Variant: M116R homozygous

      ClinVarID: or CAID: CA114353

      gnomAD: This missense variant, p.M116R, is present in gnomAD v4.0.0 with a MAF=0.0001517 (179/1180030 alleles) in the European NF population and 0 homozygotes. Downscoring for homozygosity since parents are consanguineous.

      AddCaseInfo: consanguineous parents

      PreviouslyPublished: 17461801

      VariantEvidence: Functional studies in Xenopus oocytes expressing M116R displayed a near-total loss of transport activity compared to WT SLC29A3. Studies in NIH 3T3 fibroblasts demonstrated mistrafficking of the mutant protein to the ER or Gogli apparatus (Kang et al. 2010; PMID: 20595384).

    2. RESULTS Gene and mutation identification Analysis of the single nucleotide polymorphism (SNP) microarray genotypes from six patients with PHID identified a single common 1.4 Mb region of shared homozygosity within cytogenetic band 10q22.1, between SNPs rs10509321 and rs1900515 (Fig. 1A). Inspection of the Ensembl and UCSC Genome Browsers demonstrated that the region included 14 known and predicted genes: ADAMTS14, C10orf27, CDH23, EIF4EBP2, LRRC2, KIAA1274, NODAL, NPFFR1, PCBD1, PPA1, PRF1, SLC29A3, SGPL1, UNC5B. Positional candidate genes were selected for sequencing in order to identify pathogenic mutations (Fig. 1B). Five different homozygous mutations were identified in the SLC29A3 gene encoding the equilibrative nucleoside transporter 3 (Fig. 1C, Table 1). Human ENT3 has been shown recently to be the cause of H syndrome, an autosomal recessive disorder with overlapping skin features to PHID (6), indicating that these are allelic disorders. hENT3 belongs to a structurally unique protein family of nucleoside and/or nucleobase transporters (13,14). The five homozygous mutations identified segregated with the disease within each family and were not present in over 100 Lebanese and Pakistani control chromosomes. Figure 1.Open in new tabDownload slideHomozygosity mapping and mutation results in five PHID families. (A) Homozygosity mapping of chromosome 10. Red bars indicate heterozygous single nucleotide polymorphisms (SNPs); blue bars, an extended run of homozygous SNPs greater than would be predicted by chance; green bars, a run of homozygous SNPs but insufficient to meet criteria for significance. (B) Genes within the 1.4 Mb interval bounded by heterozygous SNPs rs10509321 (CII.3) and rs1900515 (DII.1). (C) SLC29A3 sequence electrophoretograms demonstrating homozygous mutations in five PHID families. (D) Protein structure prediction of hENT3 by SVMTM software. (E) Multispecies alignment of the second transmembrane and the C-terminal cytoplasmic domains of ENT3 protein (accession numbers: Homo sapiens, NP_060814.4; Canis lupus, XP_546152.2; Bos taurus, XP_580640.3; Mus musculus, NP_076085.1; monodelphus domesticus, XP_001344438.1; Gallus gallus, XP_421594.2; Gasterosteus aculeatus, ENSGACP00000006741; Takifugu rubipens, ENSTRUP00000028258; Drosophila melangaster, FBpp0077753; Caenorhabditis elegans, NP_501807.3). Table 1.Mutation summary Mutation NM_018344.4 . Protein CCDS7310.1 . Protein domain . Predicted . Mutation predictions . Grantham . SIFT . c.347T>Gp.Met116ArgTransmembrane Domain 2Missense Hydrophobic to large basic910.03c.940delTp.Tyr314ThrfsX91Transmembrane Domain 7Frameshift––c.1309G>Ap.Gly437ArgIntra-cytoplasmic DomainMissense Small hydrophobic to large basic12512.0c.1330G>Tp.Glu444XIntra-cytoplasmic DomainNonsense––c.1346C>Gp.Thr449ArgIntra-cytoplasmic DomainMissense Small polar to large basic710.03Mutation NM_018344.4 . Protein CCDS7310.1 . Protein domain . Predicted . Mutation predictions . Grantham . SIFT . c.347T>Gp.Met116ArgTransmembrane Domain 2Missense Hydrophobic to large basic910.03c.940delTp.Tyr314ThrfsX91Transmembrane Domain 7Frameshift––c.1309G>Ap.Gly437ArgIntra-cytoplasmic DomainMissense Small hydrophobic to large basic12512.0c.1330G>Tp.Glu444XIntra-cytoplasmic DomainNonsense––c.1346C>Gp.Thr449ArgIntra-cytoplasmic DomainMissense Small polar to large basic710.03 Open in new tab Table 1.Mutation summary Mutation NM_018344.4 . Protein CCDS7310.1 . Protein domain . Predicted . Mutation predictions . Grantham . SIFT . c.347T>Gp.Met116ArgTransmembrane Domain 2Missense Hydrophobic to large basic910.03c.940delTp.Tyr314ThrfsX91Transmembrane Domain 7Frameshift––c.1309G>Ap.Gly437ArgIntra-cytoplasmic DomainMissense Small hydrophobic to large basic12512.0c.1330G>Tp.Glu444XIntra-cytoplasmic DomainNonsense––c.1346C>Gp.Thr449ArgIntra-cytoplasmic DomainMissense Small polar to large basic710.03Mutation NM_018344.4 . Protein CCDS7310.1 . Protein domain . Predicted . Mutation predictions . Grantham . SIFT . c.347T>Gp.Met116ArgTransmembrane Domain 2Missense Hydrophobic to large basic910.03c.940delTp.Tyr314ThrfsX91Transmembrane Domain 7Frameshift––c.1309G>Ap.Gly437ArgIntra-cytoplasmic DomainMissense Small hydrophobic to large basic12512.0c.1330G>Tp.Glu444XIntra-cytoplasmic DomainNonsense––c.1346C>Gp.Thr449ArgIntra-cytoplasmic DomainMissense Small polar to large basic710.03 Open in new tab Two novel homozygous mutations predicted to cause premature protein truncation were identified, a 1 bp deletion c.940delT and a nonsense mutation c.1330G>T. The deletion causes a frame shift mutation p.Y314Tfs in transmembrane domain 7 and is predicted to result in the substitution of transmembrane domains 8–11 with an irrelevant protein sequence of 91 amino acids derived from an alternate reading frame. The nonsense mutation p.E444X is predicted to lead to premature protein truncation with loss of part of the final cytoplasmic domain and transmembrane domain 11 of hENT3. It would appear unlikely that the either residual protein would be capable of nucleoside transport function.Three homozygous missense mutations of SLC29A3 were identified to involve conserved amino acids (Table 1). The first missense mutation involves Methionine116 in transmembrane domain 2, which is a hydrophobic amino acid in species as distantly related as humans and nematodes, with a large basic amino acid, Arginine (p.M116R; Fig. 1C and E). The Grantham score for this substitution is 91, which is classified as a moderate change (15). Analysis using the SIFT prediction software also classifies this as a likely deleterious change (16). The introduction of a large basic amino acid into a transmembrane domain would likely result in significant disruption of the hydrophobic nature of the domain and result in retention of the transporter protein within the endoplasmic reticulum, as has been demonstrated for other membrane proteins (17).The second missense change is a recently reported Glycine to Arginine substitution at hENT3 amino acid 437 (p.G437R Fig. 1C), which is located in the putative cytoplasmic domain between transmembrane domains 10 and 11. This is the only mutation in the PHID cohort that is shared with the known mutations in H syndrome. Of particular interest is the observation that this is the sole individual in the PHID cohort who has not developed insulin-dependent DM. The p.G437R change involves the substitution of a large basic amino acid at a position where 41 members of the ENT family as distantly related as humans and Arabidopsis thaliana encode a small hydrophobic amino acid (Fig. 1E) (18). The Grantham difference for this change is 125 and is classified as a moderately radical change.The third missense change occurs at hENT3 amino acid residue 449, which is also located in the final putative intracellular domain between transmembrane domains 10 and 11, and involves the substitution of a Threonine by an Arginine (p.T449R). The amino acids encoded at this position in hENT3 orthologs are small polar/uncharged or small hydrophobic residues (Fig. 1E). Substitution by arginine is associated with a Grantham score of 71 and is predicted by SIFT as not to be tolerated.

      Case: Family A/Prendiville Patient 1, male, 14yo at report, East Indian

      CasePresentingHPOs: HP:0004322, HP:0000343, HP:0030084, HP:0001993, HP:5000011, HP:0003261, HP:0000953, HP:0000998, HP:0000520, HP:0001433, HP:0012094, HP:0430023, HP:0003565, HP:0001935, HP:0012343, HP:0040303, HP:0100651, HP:0004322, HP:0001999, HP:0100534, HP:0000670, HP:0000767, HP:0031664, HP:0002716, HP:0001763, HP:0001698

      CasePresentingHPOsFreeText: hyperpigmentation onset at 15yo; located on chin, axillae, back, abdomen. inner thigh, inguinal folds, genitalia. Pancreatomegaly. Orbital thickening and EOM infiltrate on MR/CT. Opacification of the maxillary sinuses. Posterior pericardial thickening. Thickened right atrial wall.

      CaseNOTHPOs: HP:0001738

      CaseNOTHPOSFreeText: inflammatory symptoms

      CasePreviousTesting: ADAMTS14, C10orf27, CDH23, EIF4EBP2, LRRC2, KIAA1274, NODAL, NPFFR1, PCBD1, PPA1, PRF1, SLC29A3, SGPL1, UNC5B were sequenced since they were positional candidate genes

      CaseGenotypingMethod: homozygosity mapping (50K SNP array), candidate gene sequencing

      Variant: E444X homozygous

      ClinVarID: or CAID: CA114350

      gnomAD: This nonsense variant p.E444X, located in exon 6/6, is present in gnomAD v4.0.0 with a MAF=0.0002525 (23/91078 alleles) in the South Asian population and 1 homozygote. Downscoring this variant since NMD is not expected to occur and there is 1 homozygote in gnomAD.

      AddCaseInfo: consanguinity not reported

      PreviouslyPublished: 17461801

      VariantEvidence: Functional studies in Xenopus oocytes expressing E444X displayed a partial reduction in nucleoside transport activity and impaired protein stability.

    1. subject 10

      Case# Subject 10, female, 14yo, non-Hispanic

      CasePresentingHPOs HP:0010535, HP:0002098, HP:0031064, HP:0000729, HP:0000750, HP:0001249, (Sleep apnea, Difficulty breathing, Impaired continence, Autism spectrum disorder, Speech delay, Intellectual disability)

      HPOFreeText: Phenotypes described postnatally.

      CaseNotHPOs HP:0001250, HP:0001252, HP:0000708, HP:0001285, HP:0007018, HP:0011968, HP:0000589, HP:0000648, HP:0000568, HP:0000659, HP:0000525, HP:0000581, HP:0000407, HP:0000453, HP:0410030, HP:0001629, HP:0001655, HP:0001643, HP:0010772, HP:0002020, HP:0002247, HP:0001734, HP:0002021, HP:0000076, HP:0000107, HP:0001159, HP:0001385, HP:0002650, HP:0002938, HP:0001511, HP:0011328, HP:0002007, HP:0000325, HP:0000534, HP:0000601, HP:0000316, HP:0000582, HP:0000494, HP:0045025, HP:0000286, HP:0000490, HP:0000598, HP:0004467, HP:0000414, HP:0000463, HP:0000319, HP:0012471, HP:0000160, HP:0000221, HP:0000164, HP:0000187, HP:0000218, HP:0000347, HP:0002557, HP:0003186, HP:0200055, HP:0004209, HP:0011297, HP:0001792, HP:0010490, HP:0000349, HP:0004532, HP:0000957 (Seizures, Hypotonia, Behavioral problems, Spastic quadriparesis, ADHD, Poor feeding, Coloboma, Optic atrophy, Microphthalmia, Peter's anomaly, Iris anomalies, Blepharophimosis, Sensorineural hearing loss, Choanal atresia, Cleft lip, Ventricular septal defect, Patent foramen ovale, Patent ductus arteriosus, Anomalous pulmonary venous return, Gastroesophageal reflux, Duodenal atresia, Annular pancreas, Pyloric stenosis, Vesicoureteral reflux, Cystic kidney, Syndactyly, Hip dysplasia, Scoliosis, Lumbar lordosis, Intrauterine growth retardation, Fontanel abnormality, Frontal bossing, Triangular face, Abnormal eyebrows, Hypotelorism, Hypertelorism, Upslanting palpebral fissures, Down-slanting palpebral fissures, Small palpebral fissures, Epicanthal folds, Deeply set eyes, Abnormal ears, Preauricular pits, Bulbous nose, Anteverted nares, Flat philtrum, Full lips, Small mouth, Furrowed tongue, Abnormal teeth, Broad alveolar ridges, High-arched palate, Micrognathia, Small nipples, Inverted nipples, Small hands, 5th finger clinodactyly, Digital Anomalies, Nail hypoplasia, Abnormal palmar creases, Widow's peak, Sacral hypertrichosis, Café Au Lait spots)

      CasePreviousTesting Screen for variants involved with Autism, de novo RERE variant was only result

      CaseMethod1 Exome sequencing

      CaseMethod2 sanger

      CaseGenotypingMethod exome sequencing confirmed with sanger in patient and parents by Krumm et al.

      Variant NM_012102.3:c.2278C>T(p.Gln760Ter), de novo

      ClinVar n/a

      CAID CA338172916

      gnomAD n/a

      VariantEvidence n/a

      CaseAddInfo both parents tested

      CasePMIDs 25961944

    1. The subjects of this study are two sisters of Arab Muslim origin and their parents are entirely healthy first-degree cousins with no visual or neurological complaints. Patient I-1 was born prematurely at 35 weeks gestation and failure to thrive was a problem since birth. At 2 months of age, she was also noted to have truncal hypotonia that was replaced by multiple episodes of hypertonia and opisthotonic posturing. Furthermore, she had a weak cry and abnormal eye pursuits. An initial echocardiography and ophthalmological examinations performed at that time were unremarkable. Metabolic investigations revealed elevated serum alanine and lactate levels, but a normal cerebrospinal fluid (CSF) lactate concentration. Disease progression was marked by a persisting failure to thrive with severe neurodevelopmental delay, but brain MRI was normal. The patient subsequently developed a progressive, non-obstructive, generalised hypertrophic cardiomyopathy, in the absence of overt heart failure. The patient died at 10 months of age following an apnoeic episode.

      Case#: Speigel Patient I-1, onset at birth, death at 10mo

      DiseaseAssertion: Fatal infantile mitochondrial encephalomyopathy, hypertrophic cardiomyopathy and optic atrophy

      FamilyInfo: Parents are healthy first-degree cousins with no visual or neurological complaints. Both parents were heterozygous for this OPA1 variant. Their optic discs did not look pale on dilated fundus examination and optical coherence tomography (OCT) imaging did not show any subclinical thinning of the retinal nerve fibre layer. The parents have two clinically unaffected sons who were 14 and 11 years old when last reviewed in clinic. The older son is heterozygous for the c.1601T>G OPA1 variant, whereas the other son only carries the wild-type OPA1 allele.

      CasePresentingHPOs: HP:0001622, HP:0001531, HP:0008936, HP:0001276, HP:0002179, HP:0001612, HP:0000617, HP:0031964, HP:0012758, HP:0001639, HP:0002104

      CaseHPOFreeText: elevated lactate levels, but a normal cerebrospinal fluid (CSF) lactate concentration. progressive, non-obstructive, generalised hypertrophic cardiomyopathy,

      CaseNotHPOs: HP:0001635

      CaseNotHPOFreeText: abnormal brain MRI

      GenotypingMethod: genome-wide autozygosity mapping and next-generation exome sequencing

      PreviouslyPublished: n/a

      Variant: OPA1 NM_015560.2 c.1601T>G p.Leu534Arg

      ClinVar:

      CAID: CA357235

      SupplementalData: n/a

    1. Pt3

      CasePt3 male, 4yo death, Italian

      CasePresentingHPOs HP:0001987 (Hyperammonemia)

      HPOsFreeText Severe hyperammonemia at 48h of life

      CaseNotHPOs n/a

      CasePreviousTesting Metabolic testing: ammonia(348[normal< 75 μg/dl])

      CaseMethod1 PCR

      CaseMethod2 n/a

      CaseGenotypingMethod PCR using primers 80 nucleotides from the splice sites flanking the 38 exons of CPS1. Tested both patients and parents. (found in 12955727, Funghini et al. (2003))

      Variant 1. NM_001875.4:c.1022T>C(p.Leu341Ser), 2. NM_001875.4:c.3784C>T(p.Arg1262Ter ) compound heterozygous

      ClinVar n/a

      CAID 1. CA350430554, 2. CA350438463

      gnomAD 1. n/a, 2. 0.00004485(European (Finnish)), 0.000004062(Total)

      VariantEvidence n/a

      CaseAddInfo similarly affected brother died without diagnosis

      CasePMIDs n/a

    1. A 54-year-old female proband

      Case# Fam2Pat1, F, Turkish, 15yo onset

      CasePresentingHPOs HP:0002061, HP:0002066, HP:0002070, HP:0001260, HP:0001310, HP:0000563, HP:0006986

      CasePreviousTesting Neurologic examination revealed severe spasticity in the lower and mild spasticity in the upper extremities, hyperactive deep tendon reflexes, bilateral extensor plantar responses, and patellar clonus. The Hoffmann sign was positive. She had bilateral mild dysmetria and dysdiadochokinesia. Nerve conduction studies, EMG, sensory evoked potential tests, and MRI did not reveal any pathology

      CaseMethod1 Whole Exome

      Variant NM_001198869.1:c.1176G>A

      CAID CA6093326

      VariantEvidence premature stop codon

      gnomAD 1.554e-05(European (Non-Finnish)), 8.513e-06(Overall)-Exac

    1. III-6

      Case: Family I Proband III-6, female, 20yo at report

      CasePresentingHPOs: HP:0000953, HP:0000998, HP:0030053, HP:0001822, HP:0000365, HP:0001698, HP:0012385, HP:0034373, HP:0002619, HP:0000520, HP:0007380

      CasePresentingHPOsFreeText: Dilated lateral scleral vasculature

      CaseNOTHPOs: HP:0000823, HP:0001433, HP:0001256

      CaseNOTHPOSFreeText:

      CasePreviousTesting: Direct sequencing of AIFM2, ADAMTS14, EIF4EBP2, C10ORF54, PPA1, H2AFY2, LRRC20, NODAL, PRF1, TYSND1, SAR1A, PSAP, NPFFR1, and C10ORF27

      CaseGenotypingMethod: Microarray, homozygosity mapping, haplotype analysis, direct sequencing of exons of SLC29A3

      Variant: G427S homozygous

      ClinVarID: or CAID: 563/CA114349

      gnomAD: The missense variant G427S is present in gnomAD v4.0.0 with a MAF=0.00005339 (4/74926 alleles) in the African/African American population and 0 homozygotes.

      AddCaseInfo: Consanguineous parents, not genotyped. 3 additional affected family members

      PreviouslyPublished: n/a

      VariantEvidence: Functional studies in Xenopus oocytes demonstrated that G427S results in a total loss of transport activity (Kang et al. 2010; PMID: 20595384).

    2. Figure 2Haplotype Analysis Performed in Six Families with H SyndromeAffected individuals are marked by gray symbols. The disease-associated haplotypes in the linked interval on chromosome 10q21.3–q22.1 are shown by vertical bars (red and green) in families A–F. Alleles excluded by recombination events are marked in pink. The physical locations of the polymorphic microsatellites are given near the haplotype for individual AI-2.

      Case: Family E Proband EII-1, male, Arabic, Israeli, 17yo at report

      CasePresentingHPOs: HP:0000953, HP:0030053, HP:0000998, HP:0000054, HP:0000771, HP:0002619, HP:0001433, HP:0000520, HP:0012385, HP:0003565

      CasePresentingHPOsFreeText: scrotal masses, dilated scleral vessels, maturation arrest in all tubules with few spermatids in 4% to 5% of the tubules on testicular biopsy

      CaseNOTHPOs: HP:0008064, HP:0011025, HP:0000365, HP:0007380

      CaseNOTHPOSFreeText:

      CasePreviousTesting: direct sequencing of AIFM2, ADAMTS14, EIF4EBP2, C10ORF54, PPA1, H2AFY2, LRRC20, NODAL, PRF1, TYSND1, SAR1A, PSAP, NPFFR1, and C10ORF27

      CaseGenotypingMethod: microarray, haplotype analysis, direct sequencing of exons of SLC29A3, restriction digestion

      Variant: G437R homozygous

      ClinVarID: or CAID: 565/CA114352

      gnomAD: The missense variant G437R is present in gnomAD v4.0.0 with a MAF=0.00006666 (4/60002 alleles) in the Admixed American population and 0 homozygotes.

      AddCaseInfo: consanguineous, heterozygous, unaffected parents.

      PreviouslyPublished: PMID: 18410979

      VariantEvidence: Kang et al. (2010; PMID: 20595384) performed functional characterization of the G437R mutation in Xenopus oocytes and observed transport activity that was approximately half that of wildtype SLC29A3. Studies in NIH 3T3 fibroblasts demonstrated accelerated turnover of the G437R mutant compared to wildtype, suggesting decreased stability.

    1. These patients are born to consanguineous parents of Moroccan origin, which are both heterozygous for this mutation (Fig. 1C) and are not related to patient TTD218UT. Patient TTD241HE was diagnosed at 18 months of age with brittle hair (tiger-tail banding pattern), dysmorphic features, developmental delay, moderate intellectual disability, microcephaly, difficulty swallowing and failure to thrive, cheerful character, mild Ichthyosis, growth retardation (length −4.7 SD, weight −2.6 SD), occipitofrontal circumference (OFC) (−3.1 SD), hypertonia, microcytic hypochromic anemia and recurrent infections. At 6 years of age, she still showed spasticity, ataxia and mild cognitive retardation without significant speech, but no signs of progressive deterioration. She has one affected younger sib (TTD275HE), also diagnosed with brittle hair, dysmorphic features, mild developmental delay, microcephaly, mild difficulty swallowing, no failure to thrive, cheerful character, mild ichthyosis, additional left thumb, no recurrent infections and growth retardation were noticed.

      Case: TTD241HE

      CaseDemographics: Female, diagnosis at 18 months, Moroccan origin

      CasePresentingHPOs: HP:0002299, HP:0045055, HP:0001999, HP:0001263, HP:0002342, HP:0000252, HP:0200136, HP:0001508, HP:0008064, HP:0008897, HP:0001276, HP:0004840, HP:0001257, HP:0002497,

      cheerful character, mild ichthyosis, length −4.7 SD, weight −2.6 SD, occipitofrontal circumference (OFC) −3.1 SD, recurrent infections, mild cognitive retardation without significant speech at 6 years of age.

      CaseNOTHPOs: No progressive deterioration at age 6

      CasePreviousTesting: None

      CaseGenotypingMethod: Sanger sequencing of the TFIIE subunits

      Variant: NM_002095.5(GTF2E2):c.559G>T (p.Asp187Tyr)

      ClinVar ID: 225841

      Pathogenic, non-LOF variant gnomAD: Not found in gnomAD

      AddCaseInfo: The parents of this individual were consanguineous and of Moroccan origin and were found to be heterozygous carriers of the variant. The individual's younger sister (TTD275HE) was also affected and homozygous for this variant. She also presented with brittle hair, dysmorphic features, mild developmental delay, microcephaly, mild difficulty swallowing, no failure to thrive, cheerful character, mild ichthyosis, additional left thumb, no recurrent infections and growth retardation

      VariantEvidence: This variant has been identified in two other individuals (other than this proband and her sibling) of Moroccan origin, giving rise to the question of a founder mutation. This proband is not being scored since the variant has already been awarded default points previously.

    1. The index patient (V-1)

      CaseV-1: Male, 27 yrs onset, China, Asian

      CasePresentingHPOs: HP:0002875, HP:0001639, HP:0002027, HP:0001712, HP:0001671, HP:0032092, HP:0001645 (Exertional dyspnea, Hypertrophic cardiomyopathy, Abdominal pain, Left ventricular hypertrophy, Abnormal cardiac septum morphology, Left ventricular outflow tract obstruction, Sudden cardiac death)

      HPOsFreeText: N/A

      CaseNotHPOs: N/A

      NotHPOsFreeText: N/A

      CaseAddInfo: Family is consanguineous, The MYPBC3 variant was the only one to segregate with the disease, with the CACNB2 variant also being present in individuals with "severe" forms of the disease. CACNB2+ MYH7- individuals showed no symptoms of cardiomyopathy, supporting a modifying effect leading to the clinical heterogeneity of this family, MYBPC3 variant leads to a premature termination and a loss of 49 amino acids which is predicted to undergo NMD but is also associated with incomplete penetrance

      CasePreviousTesting: Marked hypertrophic septum (27  mm) and a left-ventricular outflow obstruction (LVOTO) of 32  mmHg, Clinical features in Table 1, No members showed Brugada syndrome phenotypes, Proband also has polymorphisms in TGFB1 and AKAP9 but no other affected family member contains them suggesting a benign pathogenicity

      CaseGenotypingMethod: Genomic DNA was extracted from peripheral blood. PCR amplification was performed and sanger sequencing was performed for MYH7 and MYPBC3 mutations. After positive confirmation of the MYBPC3 mutation, RAAS genes were genotyped for a possible modifying effect. Negative findings led to a targeted NGS for the index patient using all known 104 causing/closely related genes of cardiomyopathy and chanelopathy. These variants were then filtered and analyzed for pathogenicity and confirmed in family members via Sanger sequencing.

      Variant: NM_201597.3:c.1598C>T (p.Ser533Leu)

      ClinVar: 190730 https://www.ncbi.nlm.nih.gov/clinvar/variation/190730/

      gnomAD: 0.01004, https://gnomad.broadinstitute.org/variant/10-18828340-C-T

      MultipleGeneVariants

      MYBPC3 Variant

      Variant: NM_000256.3(MYBPC3):c.3624del (p.Lys1209fs)

      ClinVar: 42727 https://www.ncbi.nlm.nih.gov/clinvar/variation/42727/

      gnomAD: 0.00005140, https://gnomad.broadinstitute.org/variant/11-47354119-TG-T

      DSP Variant

      Variant: NM_004415.4(DSP):c.3923G>A (p.Arg1308Gln)

      ClinVar: 178028 https://www.ncbi.nlm.nih.gov/clinvar/variation/178028/

      gnomAD: 0.01680, https://gnomad.broadinstitute.org/variant/6-7580346-G-A

    1. For each patient, the summary of clinical and molecular data is tabulated in Supplementary Table 3. The synonymous variants identified for each patient are given in Supplementary Table 4.

      Proband - Case 21

      Male, Dx at 22 yrs, MWT=30mm, LVM=148mg/m2, LVEF=75%

      HP:0001639, HCM

      Varient: NM_145046.4(CALR3):c.1036A>G (p.I346V)

      Not in Clinvar

      ExAC Score: Overall 1.647e-05

    1. The proband from Family B

      Case# Christensen B

      CasePresentingHPOs HP:0011675 Arrhythmia, HP:0010872 T-Wave Inversion, HP:0005133 Right Ventricular Dilation, HP:0031317 Fatty replacement of ventricular myocardial tissue

      CasePreviousTesting amplicons were pre‐screened on a LightScanner High‐Resolution Melting Curve Analysis System

      CaseMethod1 PCR

      CaseGenotypingMethod (PCR) amplification was performed for all TMEM43 exons and flanking introns.

      Variant NM_024334.2(TMEM43):c.1073C>T (p.Ser358Leu)

      ClinVar 734

      VariantEvidence Is there any??????

    2. He died of progressive heart failure aged 68 years. Genetic screening identified a splice site variant, c.705+ 7G> A. None of his family members carried the variant.

      Case# Christensen A, 59 diagnosis, male

      CasePresentingHPOs HP:0004756 Ventricular Tachycardia, HP:0010872 T-Wave Inversion, HP:0005133 Right Ventricular Dilation, HP:0031317 Fatty replacement of ventricular myocardial tissue

      CasePreviousTesting amplicons were pre‐screened on a LightScanner High‐Resolution Melting Curve Analysis System

      CaseMethod1 PCR

      CaseGenotypingMethod (PCR) amplification was performed for all TMEM43 exons and flanking introns.

      Variant NM_024334.2(TMEM43):c.705+7G>A

      ClinVar 46152

      gnomAD 0.0007554 link

      VariantEvidence N/A

    1. c.169G>A

      Case# Baskin AT, Male

      CasePresentingHPOs HP:0004756, HP:0002119, HP:0010872

      CasePreviousTesting patients referred to our high-risk hereditary heart disorders clinic for assessment of possible ARVC, as well as DNA-bearing blood or tissue samples sent for clinical ARVC gene-testing from other physicians, clinics or institutions to our CLIA-approved molecular genetics laboratory at the Hospital for Sick Children (listed on www.genetests.org).

      CaseMethod1 PCR

      CaseGenotypingMethod direct sequence analysis of all exons and flanking intron sequences of DSP (MIM 125647), PKP2 (MIM 602861), DSC2 (MIM 125645), DSG2 (MIM 125671) and TMEM43.

      Variant NM_024334.2(TMEM43):c.169G>A (p.Ala57Thr)

      ClinVar 88981

      gnomAD 0.001381 link

    1. DNA from two Syrian families with H syndrome was analyzed through direct sequencing, and the expression of hENT3 in normal human skin was investigated by in situ hybridization and immunostaining. Results: We identified two novel mutations in the SLC29A3 gene: a homozygous splice site mutation IVS1+2T>G predicted to cause a splicing error, and a homozygous missense mutation c.1157G>A (p.R386Q) which substituted highly conserved amino acid residue in a transmembrane domain of hENT3. Furthermore, we demonstrate that hENT3 is expressed in histiocytes as well as in endothelium of blood and lymphatic vessels in normal human skin.

      unable to annotate in PDF.

      Case: Farooq Family 1 Proband, Syrian, female, 11yo at report, onset at 5yo

      CasePresentingHPOs: HP:0004322, HP:0001730, HP:0030044, HP:0000953, HP:0000998, HP:0000969, HP:0100651, HP:0030084, HP:0002240, HP:0001395,

      CasePresentingHPOsFreeText: Hyperpigmentation on lower extremities symmetrically and bilaterally, later the genital area as well with edema.

      CaseNOTHPOs:

      CaseNOTHPOSFreeText:

      CasePreviousTesting:

      CaseGenotypingMethod: All 6 exons including exon-intron boundaries of the SLC29A3 gene were amplified by PCR from the genomic DNA. Direct sequencing analysis. Restriction enzyme digest.

      Variant: c.1+2T>G homozygous

      ClinVarID: or CAID: 213676/CA377128556

      gnomAD: This splice site variant, c.1+2T>G found in intron 1, is absent from gnomAD v2.1.1. It is present in gnomAD v4.0.0 with a MAF of 0.00001024 (3/292950 alleles) in the European NF population and 0 homozygotes, but there is low coverage so the AF is not reliable.

      AddCaseInfo: consanguineous, heterozygous parents

      PreviouslyPublished: n/a

      VariantEvidence: n/a

    2. DNA from two Syrian families with H syndrome was analyzed through direct sequencing, and the expression of hENT3 in normal human skin was investigated by in situ hybridization and immunostaining. Results: We identified two novel mutations in the SLC29A3 gene: a homozygous splice site mutation IVS1+2T>G predicted to cause a splicing error, and a homozygous missense mutation c.1157G>A (p.R386Q) which substituted highly conserved amino acid residue in a transmembrane domain of hENT3. Furthermore, we demonstrate that hENT3 is expressed in histiocytes as well as in endothelium of blood and lymphatic vessels in normal human skin.

      unable to annotate in PDF.

      Case: Farooq Family 2 Proband, Syrian, female, 16yo at report, onset at 1wk old

      CasePresentingHPOs: HP:0030148, HP:0001629, HP:0033190, HP:0004322, HP:0012785, HP:0001730, HP:0002240, HP:0001395

      CasePresentingHPOsFreeText: Hyperpigmentation on thighs and later genital area. Hearing started deteriorating progressively after an ear infection. Fasting blood glucose was elevated (350 mg/dl).

      CaseNOTHPOs:

      CaseNOTHPOSFreeText:

      CasePreviousTesting:

      CaseGenotypingMethod: All 6 exons including exon-intron boundaries of the SLC29A3 gene were amplified by PCR from the genomic DNA. Direct sequencing analysis. Restriction enzyme digest.

      Variant: p.R386Q homozygous

      ClinVarID: or CAID: 39870/CA130660

      gnomAD: The missense variant p.Arg386Gln is present in gnomAD v4.0.0 with a MAF=0.00003999 (3/75018 alleles) in the African/African American population and 0 homozygotes.

      AddCaseInfo: Consanguineous, heterozygous parents. Proband's younger sister was also reported by the parents to be affected, but was not examined by the authors or genotyped.

      PreviouslyPublished: n/a

      VariantEvidence: n/a

    1. 1 Hurler 3Y1M F (+) 704ins5/704ins5 (+) 89 (3YlM) hepatoinegaly (-) unknown

      Case#: Yamagishi Case 1, female, 3yo1mo, Japanese

      DiseaseAssertion: MPS1-Hurler

      FamilyInfo: consanguinity

      CasePresentingHPOs: HP:0001510, HP:0002240

      CaseHPOFreeText: mental delay, height -1.5SD

      CaseNotHPOs:

      CaseNotHPOFreeText: cardiac involvement

      PreviouslyPublished: n/a

      Variant: 704ins5 homozygous

      ClinVar: 11921

      CAID: CA256123

      SupplementalData: n/a

    1. 2.1.14 year/MDistended abdomen, developmental delayNo − PathogenicIDUAc.1882C > Tp. Arg628TerHomMPS I

      Case#: Patient 2.1.1, male, 4yo, Indian

      DiseaseAssertion: MPS1

      FamilyInfo: No family history reported, but said not to be consanguineous

      CasePresentingHPOs:

      CaseHPOFreeText: Distended abdomen, developmental delay

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: NGS, Sanger

      PreviouslyPublished:

      Variant: c.1882C > T p. Arg628Ter homozygous

      ClinVar: 550421

      CAID: CA2802462

      SupplementalData: n/a

    1. Family 5/Case 1/M/43 + +/+ + +/+ Diffuse myalgia + RRFs/COX - + NA c.1635 C > G (p.S545R)

      Case#: Family 5 Case 1, male, 43yo, south France

      DiseaseAssertion: OA plus

      FamilyInfo: mother and brother also had optic atrophy, but further details such as genotype and more phenotype information were not confirmed

      CasePresentingHPOs: HP:0000648, HP:0000508, HP:0000365, HP:0001251, HP:0002403, HP:0003326, HP:0009830, HP:0003200, HP:0000590, HP:0003688, HP:0003390,

      CaseHPOFreeText: visual impairment since childhood, colic occlusion without any evident mechanical cause, impaired sensation to all modalities predominantly in the lower limbs, atrophy of the corpus callosum and brainstem and a mild cerebellar atrophy, bilateral basal ganglia hypointensity was detected at T2-weighted MRI scan

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished:

      PreviousTesting: Direct sequencing of the complete coding region and the exon/intron boundaries of the genes POLG1, PEO1 (Twinkle) and SLC25A4 (ANT1). mtDNA multiple deletions present.

      GenotypingMethod: genomic DNA was amplified by PCR with specific primers designed to amplify all exons and flanking intronic regions and sequenced. Southern blot analysis, long-range PCR, sequencing in both directions, and quantitation of mtDNA relative to nuclear DNA was performed on mtDNA

      Variant: c.1635 C > G (p.S545R)

      ClinVar: 30461

      CAID: CA10575554

      SupplementalData:

    1. Four patients (2 males, 2 females)

      Case#: Fateen_P4

      Demographics: Egyptian

      CasePresentingHPOs: HP:0000768, HP:0000943, HP:0002857, HP:0000256, HP:0002808, HP:0001382, HP:0005072, HP:0009769 prominent proximal metaphyses

      CaseNotHPOs:

      CasePreviousTesting:

      CaseMethod1:

      CaseMethod2:

      CaseGenotypingMethod: single gene seq by Sanger of all 14 exons and restriction digest confirmation/ screening of parents and controls

      Variant: NM_000512.5(GALNS):c.119A>G (p.Asp40Gly)

      ClinVar: 1048369

      CAID: CA397100962

      gnomAD: n/a

      VariantEvidence: hydrophillic>hydrophobic substitution in putative active site and enzyme activity data shows low enzyme function compared to reference range

      CaseAddInfo:

      CasePMIDs:

    1. o determine the frequency of MYOZ2 mutation in HCM, we screened all exons and exon–intron boundaries of MYOZ2 in 516 probands by direct sequencing. We detected another heterozygous missense A→G mutation at nucleotide 50 278 in a white proband who had 2 deceased siblings with HCM. The mutation changed amino acid isoleucine 246, a conserved amino acid, to methionine

      Case 2: male, Dx = n/a, variant identified via direct sequencing

      HP:0001712 (left ventricular hypertrophy)

      Variant: NM_016599.4(MYOZ2):c.738A>G (p.Ile246Met)

      non-LOF

      ClinVar ID: 30509, conflicting interpretations of pathogenicity,<br /> https://www.ncbi.nlm.nih.gov/clinvar/variation/30509/

      ExAC Score: 0.001897, http://gnomad.broadinstitute.org/variant/4-120107298-A-G

    2. The index case presented at 12 years of age with symptoms of diastolic heart failure and episodes of syncope (supplemental Table I available in the online data supplement available at http://circres.ahajournals.org.). She had severe left ventricular hypertrophy with a septal thickness of 3.2 cm, atrial fibrillation, and runs of ventricular tachycardia.

      Case: Family 109, female, Dx = 12 yrs, septal thickness 3.2cm

      Family had 6 affected individuals sharing MYOZ2 haplotype 4q26-q27

      HP:0001635, HP:0001279, HP:0001712, HP:0005110, HP:0004755

      heart failure, syncope, left ventricular hypertrophy, atrial fibrillation, supraventricular tachycardia

      Variant: NM_016599.4(MYOZ2):c.142T>C (p.Ser48Pro)

      Pathogenic, non-LOF

      ClinVar ID: 30508 https://www.ncbi.nlm.nih.gov/clinvar/variation/30508/

      Not in ExAC or gnomAD

    1. The proposita (II-1 in Fig. 1A)

      Case# II-1, F, 13yo diagnosis, European

      CasePresentingHPOs HP:0001254, HP:0001137, HP:0025404, HP:0008936, HP:0002509, HP:0025430, HP:0003739, HP:0002353, HP:0001508, HP:0000297, HP:0010804, HP:0000218, HP:0000347, HP:0001212, HP:0001864, HP:0040082, HP:0012167, HP:0030820, HP:0000276, HP:0000268, HP:0000549, HP:0000678, HP:0012166, HP:0002465

      HPOcont: Lethargy, Alternating esotropia, Abnormal visual fixation, Muscular hypotonia of the trunk, Limb hypertonia, High-pitched cry, Myoclonic spasms, EEG abnormality, Failure to thrive, Facial hypotonia, Tented upper lip vermilion, High palate, Micrognathia, Prominent fingertip pads, Clinodactyly of the 5th toe, Happy demeanor, Hair-pulling, Hooded eyelid, Long face, Dolichocephaly, Abnormal conjugate eye movement, Skin-picking, Poor speech

      Free Text: "Birth weight, length and head circumference were 3.149 kg (−0.18SD), 51 cm (+0.99SD), and 33 cm (−0.74SD), respectively. Although she did not cry immediately and was described as sleepy and lethargic, her Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. She has had poor weight gain throughout life. By 2 months of age, she developed alternating esotropia, poor visual fixation, truncal hypotonia, upper and lower extremity hypertonia and a high-pitched cry. She also had myoclonic jerks and jerky movements of her extremities. Her weight, height and head circumference were 4.6 kg (−1.57SD), 51 cm (−3.81 SD) and 39.2 cm (+0.06SD), respectively. A head CT scan detected no anatomical anomalies. An EEG showed excessively slow background without epileptiform activity. Despite intervention, her weight gain continued to fall off, and she was diagnosed with failure to thrive. She rolled over at age 6 months, sat unsupported at 1 year. A follow-up EEG at 14 months showed a slow dysrhythmic background compatible with a seizure predisposition and diffuse cerebral dysfunction. A brain MRI at 18 months of age showed normal anatomy and myelination. In the ensuing months, she demonstrated a happy disposition, low truncal muscle tone and distal hypertonia as well as a myopathic facial appearance, a tented upper lip, a high arched palate, micrognathia, prominent finger pads and mild fifth toe clinodactyly. At age 4 years and 1 month, a developmental assessment defined her overall functioning at no more than a 12-month-old equivalent; she was not autistic. At age 6 years and 11 months, she manifested sparse hair (trichotillomania), hooded eyelids, high arched palate, thin long face and mild micrognathia. At age 12 years, she walked with the support of splints. Her height, weight and head circumference were 127 cm (−3.64 SD), 22.6 kg (−4.06 SD), and 52 cm (−0.94SD), respectively. Her features included dolicocephaly, hooded eyelids, intermittently disconjugate gaze, sparse hair, high palate and crowded dentition. Developmental assessment documented behavioral difficulties including repetitive and self-stimulatory behaviors, sensory issues such as repetitively rubbing her hands on the floor and/or licking them and mouthing objects, rigidity, communication deficits, difficulties with emotional regulation and aggression when frustrated. Her aggression included the self-injurious behaviors of dermatillomania, biting and trichotillomania. She communicated with a few words, signs, gestures and a picture exchange communication system (PECS). She developed menses at age 13 years."

      CasePreviousTesting "Family history was negative for intellectual disability, multiple congenital anomalies and recurrent miscarriages. Normal genetic investigations included a karyotype (550 band resolution), subtelomeric FISH, methylation studies of SNRPN, sequence analysis of UBE3A, and DMPK repeat analysis. Normal metabolic tests included transferrin isoelectric focussing, CSF amino acids and neurotransmitters, plasma amino acids, urine organic acids, urine purines and pyrimidines, serum acylcarnitines, blood ammonia and blood lactate. She also had normal audiological testing."

      CaseMethod1 WES

      CaseMethod2 Sanger

      CaseGenotypingMethod SNP array and WES, confirmed with Sanger qt/rtPCR

      Variant (1) NM_032504.1:c.3983-3_3994delinsA (p.Ser1328Argfs19), (2) NM_032504.1:c.2431C>T (p.Arg811)

      CAID (1) CA658820714, (2) CA350137388

      VariantEvidence skin fibroblasts from affected sister showed no unc80 mRNA.

      CaseAddInfo nonconsanguineous, confirmed in trans. Affected sister with similar phenotypes died of respiratory distress at age 7.

    1. 11 years. Her

      Case# Postma 3:3, female, 11yo, white

      CasePresentingHPOs HP:0004758, HP:0001688

      CasePreviousTesting no

      CaseMethod1 PCR

      CaseGenotypingMethod amplified/screen of CASQ2, SCN5A, HRC, PLN, RYR2, KCNQ1, KCNH2, and KCNK1 genes

      Variant NM_001232.3(CASQ2):c.97C>T (p.Arg33Ter)

      ClinVar 41043 link

      gnomAD 0.000008968 link

      VariantEvidence not in this article

    1. Dutch patient

      Case1: Female, 12 yrs onset, Dutch

      CasePresentingHPOs: HP:0002093, HP:0001288, HP:0003690, HP:0010628, HP:0003722, HP:0003202, HP:0003798 (Respiratory insufficiency, Gait difficulties, Limb muscle weakness, Facial muscle weakness, Neck flexor weakness, Muscle hypotrophy, Nemaline rods)

      HPOsFreeText: Mild form of nemaline myopathy, Wheelchair from the age of 48, Selective hypotrophy of Type 1 muscle fibres

      CaseNotHPOs: N/A

      NotHPOsFreeText: N/A

      CaseAddInfo: No family history of neuromuscular disorders, Variant was not detected in healthy mother or 7 unaffected siblings, Father was deceased so no sample was available

      CasePreviousTesting: N/A

      CaseGenotypingMethod: Genomic DNA and RNA was extracted from blood or lymphoblastoid cell lines. SSCP was used to analyze all 10 exons of TPM2. After locating the mutations, RT-PCR was used to confirm the mutated allele expression and haplotype analysis was performed on the probands and their family.

      Variant: NM_003289.3:c.440A>C (p.Gln147Pro)

      ClinVar: 12461 https://www.ncbi.nlm.nih.gov/clinvar/variation/12461/

      gnomAD: Not in gnomAD

    1. two unrelated patients

      CaseRoma: France

      CasePresentingHPOs: HP:0006785, HP:0003236, (Limb-girdle muscular dystrophy, Elevated serum creatine kinase)

      HPOsFreeText: Wheelchair bound before 14 yrs

      CaseNotHPOs: N/A

      NotHPOsFreeText: N/A

      CaseAddInfo: Probands are from consanguineous gypsy families supporting a founder event, This mutation segregated with the disease in 18 patients and all asymptomatic parents were heterozygous, 15 siblings were heterozygous and asymptomatic except for a moderate increase in Serum CK in some

      CasePreviousTesting: Duchenne-like clinical presentation, Males and females equally affected, Normal dystrophin and decreased level of α- and γ-SG in muscle specimens

      CaseGenotypingMethod: DNA was isolated from peripheral blood leukocytes and subject to PCR amplification for linkage analysis. Total RNA was extracted from muscle biopsies and cDNA synthesis was performed and amplified. This was sequenced and analyzed for mutations.

      Variant: NM_000231.2(SGCG):c.848G>A (p.Cys283Tyr)

      ClinVar: 2006 https://www.ncbi.nlm.nih.gov/clinvar/variation/2006/

      gnomAD: 0.000008796, https://gnomad.broadinstitute.org/variant/13-23898652-G-A

      Affected: 18

      Unaffected: At least 29

      Segregations: N/A

      SegregationAddInfo: Candidate Gene Sequencing

    1. the Arg73Gln (exon 3) mutation was identified in the proband (II:1), a 28-year-old male who had been diagnosed with FHC at age 18 years and on echocardiography was found to have severe asymmetric septal hypertrophy. He has a family history of FHC, but other family members have not been willing to participate in further evaluation. Previous genetic screening of sarcomere genes identified two missense mutations in myosin-binding protein C (MyBPC3; Asp745Gly and Pro873His)

      Proband 1: male, Dx at 18 years, LV septal wall thickness = 30mm, family history of HCM with father and brother affected

      HP:0001639, HP:0001670

      Hypertrophic cardiomyopathy, asymmetric septal hypertrophy

      Variant: NM_145046.4(CALR3):c.218G>A (p.Arg73Gln).

      Not in ClinVar

      ExAC Score: Overall 1.624e-5

      http://gnomad.broadinstitute.org/variant/19-16601357-C-T

    1. Patient 2

      Case2: Female, Birth onset, Germany

      CasePresentingHPOs: HP:0003552, HP:0001558, HP:0002375, HP:0002747, HP:0004887, HP:0001385, HP:0001537, HP:0000023, HP:0012418, HP:0000278, HP:0000347, HP:0000470, HP:0001276, HP:0002808, HP:0001376, HP:0002063, HP:0011968, HP:0000975, HP:0003236, HP:0000938, HP:0009803, HP:0030084, HP:0001561, HP:0002828, HP:0005949, HP:0001284, HP:0003198, HP:0003557, HP:0003687, HP:0010602 (Muscle stiffness, Decreased fetal movement, Hypokinesia, Respiratory insufficiency due to muscle weakness, Respiratory failure requiring assisted ventilation, Hip dysplasia, Umbilical hernia, Inguinal hernia, Hypoxemia, Retrognathia, Micrognathia, Short neck, Hypertonia, Kyphosis, Limited joint motion, Rigidity, Feeding difficulties, Profuse sweating, Elevated serum creatine phosphokinase, Osteopenia, Shortened phalanges, Clinodactyly, Polyhydramnios, Multiple joint contractures, Apneic episodes in infancy, Areflexia, Myopathic changes, Increased variability in muscle fiber diameter, Centrally nucleated skeletal muscle fibers, Type 2 muscle fiber predominance)

      HPOsFreeText: Tracheostomy performed, Bladder catheter required, Inability to sit or roll, Increased echogenicity on muscle ultrasound, Treatment with carbamazepine, benzodiazepines, and baclofen reportedly provided no substantial benefit, Difficulty sitting due to hyperactivity of hip extensors, Mini rods and z-band broadening were seen in atrophic fibers

      CaseNotHPOs: HP:0100543, HP:0003730, HP:0002486, HP:0002353, HP:0002363, HP:0000496, HP:0003202, HP:0003798 (Cognitive impairment, EMG: myotonic runs, Myotonia, EEG abnormality, Abnormality of brainstem morphology, Abnormality of eye movement, Skeletal muscle atrophy, Nemaline bodies)

      NotHPOsFreeText: Abnormal metabolic screening, Muscle fiber type grouping

      CaseAddInfo: Case is de novo and confirmed via parental testing

      CasePreviousTesting: Negative ACTA1 and CRYAB

      CaseGenotypingMethod: Based on the Patient 1 results, the same region of TPM3 (Exon 6) was PCR amplified and sequenced in the proband and her parents via bidirectional Sanger sequencing.

      Variant: NM_152263.4(TPM3):c.654_656AGA[1] (p.Glu219del)

      ClinVar: 235144 https://www.ncbi.nlm.nih.gov/clinvar/variation/235144/

      gnomAD: Not in gnomAD

    1. Here, we report the identification and cDNA analysis of four intronic and three exonic OPA1 gene mutations that cause a variety of splicing defects including activation of cryptic splice sites in either flanking exon or intron sequences, and a leaky splicing mutation. Our results show that cDNA analysis is of prime importance for the full evaluation of the effect of putative splicing mutations in the OPA1 gene.

      Article is a PDF, so annotating here.

      Case#: OAK 96

      DiseaseAssertion: clinical dx of adOA based on ophthalmological examination

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: All 30 coding exons of the OPA1 gene were amplified from genomic DNA by means of PCR. PCR and RT-PCR products were sequenced employing BigDyeTerminator Chemistry (Applied Biosystems, Darmstadt, Germany) and separated on an ABI 3100 DNA Sequencer

      PreviouslyPublished: n/a

      Variant: c.1705+1G>T (p.V556fsX596)

      CAID: CA10576007

      SupplementalData:

      AdditionalInfo: Generation of minigene constructs and heterologous expression in COS7 cells allowed for cDNA analysis of the c.1705+1G>T mutation. This revealed a deletion of the last 40 nucleotides in exon 17 resulting from a splicing event that involves a cryptic splice donor site within exon 17 resulting in a frameshift and premature translation termination (p.V556fsX596).

    1. SD9 F I 25.2 (L) 90 c.850C>T (p.R284X) c.850C>T (p.R284X)

      Case: Zampieri SD9, Female

      DiseaseAssertion: Sandhoff Disease

      FamilyInfo: patient's genotype was confirmed in parents

      CasePresentingHPOs: HP:0000007, HP:0033978

      CaseHPOFreeText: neurological symptoms (unspecified)

      CaseNOTHPOs:

      CaseNOTHPOFreeText:

      CasePreviousTesting: Patients presented with neurological symptoms and diagnosis was confirmed by the demonstration of reduced Hex A and Hex B activity in peripheral white blood cells or cultured fibroblasts.

      GenotypingMethod: PCR

      PreviouslyPublished: n/a

      SupplementalData: n/a

      Variant: c.850C>T (p.R284X) same on both alleles

      CAID: CA116495

      gnomAD: MAF: 0.0002286 South Asian, gnomAD variant ID: 5-74009409-C-T

      VariantEvidence: PMID:8162015 previously reported this variant to be associated with the infantile form of SD. A fibroblast line from this patient with the infantile form of the disease was investigated for mutations by single strand conformation polymorphism analysis and direct sequencing of PCR products. A nonsense mutation was found which generated a stop codon at codon 284. The study investigated the steady-state level of mRNA produced by cells containing stop codons using a competitive polymerase chain reaction technique and found that at codon 284, the mRNA levels were 0.8%, as percent of normal per single gene dose.

    1. Patient historyWe present a Polish female patient current age 10 years, born at term by natural delivery at the 39th week of the mother’s first pregnancy. Parents were healthy, non-consanguineous, Caucasian in origin. At the time of birth, the mother was 29 years old; the father was 33 years old.Family history was negative for individuals with neurodevelopmental disorders. Patient birth body parameters were the following: body weight: 3380 g (50 pc); body length: 54 cm (<95 pc); occipital frontal circumference: 31 cm (<3 pc). Apgar scores were 10 points at 1 and 5 min of life.Presented girl displayed normal, uneventful postnatal adaptation and development from birth to 5 months of life.At 22 weeks, directly after third dose-vaccination with DTaP (Infanrix-Hexa), motor and cognitive regression, deterioration of eye contact, and the lack of a smile were noticed. Consequently, further vaccinations were suspended. At the age of 18 months, further developmental regression became apparent. She was intensively rehabilitated, but no progress was observed. In clinical evaluation, she could not stand up or walk independently and she could pronounce a few simple syllables and try to combine them into words. Detailed clinical observations from 1.5 to 10 years of age are described in supplementary data.At the age of 10 years, she had not acquired the ability to walk; cognitive development remains at a low level. Summary of neurological examinations showed global developmental delay, tetraparesis with hypotonia and symmetrical tendon reflexes, limited eye contact, postural defects including a “rounded” back, protruding shoulder blades, and funnel-shaped chest (Fig. ​(Fig.1aIII–IV).1aIII–IV). Phenotypic evaluation of the face revealed slight ptosis, a tendency to open the mouth and tilt the head back, without other specific features of dysmorphism (Fig. ​(Fig.11aI).Open in a separate windowFig. 1a Photographic documentation of the patient at age 10 years old. b COQ5 cDNA gel electrophoresis. c Graphical representation of the splicing products of the COQ5 gene in a patient, her parents, and healthy control. For more details, please see supplementary dataExploratory assaysMagnetic resonance imaging (MRI) of the brain at the age of 8 years revealed clear cortico-subcortical atrophy of the cerebellum–enlargement of the 4th ventricle and widening of cerebellar sulci (Supp.Fig.1a-d, arrows) as compared to the normal appearance in a healthy individual (Supp.Fig.1e-h, arrows). The cerebellar sulci were wider in our patient at age 8 years than at 18 months, as well as in comparison to an age-matched healthy control. This indicates progressive atrophy of cerebellar tissue. Atrophy involved both vermis and cerebellar hemispheres. The supratentorial structures are normal. Echocardiogram, abdominal ultrasonography, and ophthalmologic investigation were also uneventful.

      Case: Dawidziuk Proband, female, Polish, Caucasian, 10yo at report, onset at 22wks

      CasePresentingHPOs: HP:0033044, HP:0034332, HP:0000817, HP:0002540, HP:0001263, HP:0002273, HP:0001252, HP:0000508, HP:0001272, HP:0002470, HP:0001298, HP:0004322, HP:0001344, HP:0100710, HP:5200044, HP:0000252, HP:0002061, HP:0000767

      CasePresentingHPOsFreeText: lack of smile, “rounded” back, protruding shoulder blades, tendency to open the mouth and tilt the head back, cortico-subcortical atrophy of the cerebellum on MRI, enlargement of the 4th ventricle and widening of cerebellar sulci. Low COQ10 level tests showing 0.6 mg/l (normal range >0.67 mg/l); after 2-month treatment: 0.7 mg/l

      Cardiac echocardiogram, complete blood count, electrolyte levels, CPK, liver and renal function tests, carnitine and acyl-carnitine, copper, thyroid function tests, lactate, blood amino acid profile, homocysteine, as well as urine for protein and organic acids, were within normal limits.

      CaseNOTHPOs: HP:0025190, HP:0010865, HP:0001336, HP:0001250, HP:0000639, HP:0000514, HP:0000570, HP:0000657, HP:0001310, HP:0002174, HP:0002080, HP:0002353,

      CaseNOTHPOSFreeText: family history of neurodevelopmental disorders. The supratentorial structures are normal. Echocardiogram, abdominal ultrasonography, and ophthalmologic investigation were also uneventful. Encephalomyopathy

      CasePreviousTesting: The aCGH analysis did not show any pathogenic copy number variations. Genetic panel excluded congenital Rett, Rett-like and Angelman's syndromes, microdeletion / microduplication syndromes and genetically based lysosomal diseases

      CaseGenotypingMethod: Exome sequencing, Sanger sequencing of parents to confirm biallelic origin

      Variant: c.681+1G>A; c.352G>A (p.Gly118Ser) confirmed in trans

      ClinVarID: or CAID: CA386577420; CA244466459

      gnomAD: The splice-site variant, c.681+1G>A in exon /7, is present in gnomAD v4.1.0 with a MAF=0.00002229 (1/44868 alleles) in the East Asian population and 0 homozygotes. The missense variant, p.Gly118Ser, is present in gnomAD v4.1.0 with a MAF=0.0001650 (1/6062 alleles) in the Middle Eastern population and 0 homozygotes.

      AddCaseInfo: healthy, non-consanguineous parents

      PreviouslyPublished: n/a

      VariantEvidence: COQ5 mRNA (Supp.Fig.3) showed that its level is markedly diminished

    1. FSIP2_4

      CaseFSIP2_4 male, 43yo report, Tunisian

      CasePresentingHPOs HP:0003251, HP:0012207, HP:0012868

      (male infertility, asthenospermia, sperm tail anomaly)

      HPOsFreeText Sperm volume: 1.7mL, sperm concentration: 49.5 million/mL, total motility: 5h, vitality: 52%, normal spermatozoa: 0%, absent flagella: 6%, short flagella: 70%, coiled flagella: 14%, flagella of irregular caliber: 80%

      CaseNotHPOs n/a

      CasePreviousTesting Previous genetic analysis of DNAH1, CFAP43, and CFAP44 did not end in diagnosis. "Normal somatic karyotypes 46,XY and were negative for Y chromosome microdeletions."

      Variant NM_173651.3(FSIP2):c.16393_16396del (p.Asn5465Glufs)

      ClinVar 586971

      gnomAD not in gnomAD

      CaseAddInfo Consanguineous parents

      CasePMIDs 29449551

    1. OA-16c.1635C>Gp.S545R333.71.0-5.020/117020/200 - HM

      Case#: Pedigree OA-16, North of England

      DiseaseAssertion: optic atrophy

      FamilyInfo: 2 additional affected individuals

      CasePresentingHPOs: HP:0000648

      CaseHPOFreeText: Snellen BCVA 20/200 - hand movement, mean age of onset= 3.7yrs

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: Cautious that they may overlap with the individuals from Hudson et al since both are from England, but the author notes that they "checked against the eOPA1 database (http://lbbma.univ-angers.fr/eOPA1/, Accessed 10-12-09) to determine whether they had been described in previous mutational reports."

      GenotypingMethod: The entire coding region of the OPA1 and OPA3 genes was amplified by PCR and sequenced. Variants were confirmed by reverse sequencing.

      Variant: c.1635C>G; p.S545R

      ClinVar: 30461

      CAID: CA10575554

      SupplementalData:

    1. STGD1 was determined according to initial symptoms of VA loss; fundus images showing orange-yellow flecks in the retina, a beaten-bronze appearance; and normal or cone-altered ffERG results

      Case#: MD-0242, onset at 18yo, 24yo at report

      DiseaseAssertion: STGD1

      FamilyInfo: Segregation noted, but no specific details provided

      CasePresentingHPOs:

      CaseHPOFreeText: VA loss, BCVA=0.1/0.1, "STGD1 was determined according to initial symptoms of VA loss; fundus images showing orange-yellow flecks in the retina, a beaten-bronze appearance; and normal or cone-altered ffERG results"

      CaseNotHPOs:

      CaseNotHPOFreeText: VF loss, abnormal ERG

      GenotypingMethod:

      PreviouslyPublished: n/a

      Variant: c.1715G>C p.(Arg572Pro); c.5242G>A p.(Gly1748Arg)

      ClinVar: 99073

      CAID: CA226919

      SupplementalData: Table S1

    1. Patients with RPE atrophy areas ≥0.05 mm2 secondary to STGD1 or AMD were included. RPE atrophy was defined as clearly demarcated definitely decreased fundus autofluorescence (FAF) under short-wavelength excitation light (488 nm) in combination with hypertransmission in optical coherence tomography (OCT).31,32 Insufficient pupil dilation, additional retinal pathology, previous retinal treatment, or other ocular comorbidities substantially affecting visual function or image quality (e.g., significant media opacity, amblyopia or optic nerve disease) led to exclusion from the study. The diagnosis of AMD was based on soft drusen and other retinal alterations consistent with the disease,9 while the diagnosis of STGD1 was based on (1) a compatible phenotype (yellow-white flecks that correlated with hyperautofluorescent flecks on FAF imaging) and (2) the presence of at least one mutated ABCA4 allele as well as the absence of mutations in peripherin-2 (PRPH2). To avoid potential confounding, patients exhibiting “diffuse-trickling geographic atrophy” were not included, as choroidal insufficiency has been previously implicated in the pathogenesis.33–37  Genetic testing was conducted at the Institute of Human Genetics, University of Regensburg (n = 7), and at the Center for Human Genetics Bioscientia, Ingelheim (n = 6). Analysis of all coding exons of the ABCA4 and PRPH2 genes was done by either direct chain-terminating dideoxynucleotide Sanger sequencing, a custom-designed GeneChip CustomSeq Resequencing Array (RetChip; Affymetrix, Santa Clara, CA, USA), or next-generation sequencing (Regensburg, n = 5; Bioscientia, n = 6). Two patients (#1 and #3) were screened for known mutations/polymorphisms using the Asper Ophthalmics ABCR400 microarray followed by Sanger sequencing to confirm selected variants.38 Only STGD1 patients with a minimum age of onset (first reported subjective symptoms) of 45 years were included as defined previously.38,39 Healthy subjects without retinal pathology served as controls.

      Case#: Patient #13

      DiseaseAssertion: STGD1

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: RPE atrophy (clearly demarcated definitely decreased fundus autofluorescence (FAF) under short-wavelength excitation light (488 nm) in combination with hypertransmission in optical coherence tomography (OCT)) areas ≥0.05 mm2 secondary to STGD1 or AMD. diagnosis of STGD1 was based on (1) a compatible phenotype (yellow-white flecks that correlated with hyperautofluorescent flecks on FAF imaging) and (2) the presence of at least one mutated ABCA4 allele as well as the absence of mutations in peripherin-2 (PRPH2). Minimum age of onset (first reported subjective symptoms) of 45 years.

      CaseNotHPOs:

      CaseNotHPOFreeText: Insufficient pupil dilation, additional retinal pathology, previous retinal treatment, or other ocular comorbidities substantially affecting visual function or image quality (e.g., significant media opacity, amblyopia or optic nerve disease) led to exclusion from the study. “diffuse-trickling geographic atrophy”

      GenotypingMethod: Analysis of all coding exons of the ABCA4 and PRPH2 genes was done by either direct chain-terminating dideoxynucleotide Sanger sequencing, a custom-designed GeneChip CustomSeq Resequencing Array, or NGS

      PreviouslyPublished: possible since the study was at the same university with the same first author as PMID: 33214501

      Variant: c.3468C>G/p.(Tyr1156*) and c.5059A>T/p.(Ile1687Phe)

      ClinVar: n/a

      CAID: CA341290648

      SupplementalData: supplement 1 has the genotype for probands

    1. STGD102 R572Q-2588G→C IVS35+2T→A Yes

      Case#: STGD102, 10-14yo at onset, German

      DiseaseAssertion: STGD

      FamilyInfo: segregation in family

      CasePresentingHPOs:

      CaseHPOFreeText: "The diagnosis of STGD was based on the demonstration of bilateral impairment of central vision and the appearance of perimacular and/or peripheral yellow-white flecks, with or without atrophy of the central retinal-pigment epithelium and a normal or only mildly abnormal flash electroretinogram when recorded in early stages of the disease."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: denaturing gradient gel electrophoresis, dHPLC, and SSCP analysis, PCR amplification of individual coding exons and flanking intron sequences, direct DNA sequencing

      PreviouslyPublished: n/a

      Variant: R572Q-2588G→C IVS35+2T→A in trans "Correct segregation of disease alleles was demonstrated in all 39 cases in which family samples were available for study"

      ClinVar: 7900

      CAID: CA226918

      SupplementalData: n/a

    1. Mutation scanning and direct DNA sequencing of all 50 exons of ABCR were completed for 150 families segregating recessive Stargardt disease (STGD1). ABCR variations were identified in 173 (57%) disease chromosomes, the majority of which represent missense amino acid substitutions. These ABCR variants were not found in 220 unaffected control individuals (440 chromosomes) but do cosegregate with the disease in these families with STGD1, and many occur in conserved functional domains. Missense amino acid substitutions located in the amino terminal one-third of the protein appear to be associated with earlier onset of the disease and may represent misfolding alleles. The two most common mutant alleles, G1961E and A1038V, each identified in 16 of 173 disease chromosomes, composed 18.5% of mutations identified. G1961E has been associated previously, at a statistically significant level in the heterozygous state, with age-related macular degeneration (AMD). Clinical evaluation of these 150 families with STGD1 revealed a high frequency of AMD in first- and second-degree relatives. These findings support the hypothesis that compound heterozygous ABCR mutations are responsible for STGD1 and that some heterozygous ABCR mutations may enhance susceptibility to AMD.

      Annotating here since the full text is a PDF.

      Case#: Family AR263 proband, male, US, 9yo at onset

      DiseaseAssertion: Stargardt

      FamilyInfo: 3 generations, no other affected members in the pedigree

      CasePresentingHPOs:

      CaseHPOFreeText: The essential and defining features of STGD were (1) pedigrees with at least one living affected individual compatible with autosomal recessive inheritance; (2) an ophthalmoscopically characteristic retinal disorder in families with both parents living; (3) bilateral central visual loss with both “beaten metal” elliptical foveal dystrophy and temporal pallor of the optic discs, documented by retinal color photography, with or without yellow-pigment epithelial flecks in the macular and/or retinal “near periphery”; and (4) the characteristic fluorescein angiographic feature of a dark choroid (Blacharski 1988).

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: c.6445C>T (p.Arg2149Ter); c.6079C>T (p.Leu2027Phe). Heteroduplex and SSCP analyses were used to screen the 50 exons of ABCA4

      ClinVar: 99460

      CAID: CA227404

      SupplementalData: n/a

    1. Among 161 patients with a Stargardt-related phenotype previously assessed with the commercial ABCA4 mutation microarray, we analyzed the ABCA4 gene with High-resolution melting (HRM) in patients in whom the array analysis identified either a heterozygous mutation (n = 50) or no mutation (n = 30).

      annotating here since the article is a PDF

      Case#: Duno Patient D015, Danish

      DiseaseAssertion: Stargardt flavimaculatus phenotype

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: The diagnosis was based on standard ophthalmological examinations including fundus photography, colour vision assessment, dark adaptometry, and full field ERG.

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: ABCA4 mutation microarray and High-resolution melting (HRM) in patients in whom the array analysis identified either a heterozygous mutation (n = 50) or no mutation (n = 30).

      PreviouslyPublished: n/a

      Variant: c.1654G>A p.V552I; c.6478A>G p.K2160E; c.3380G>A p.G1127E phase unknown

      CAID: CA239745

      SupplementalData:

    1. The study included index patients with ABCA4-related retinopathy and their parents. ABCA4-related retinopathy was diagnosed based on characteristic findings on indirect ophthalmoscopy, optical coherence tomography, and conventional fundus AF imaging. The clinical diagnosis was confirmed by the presence of biallelic mutations in ABCA4, and segregation analysis was carried out with samples of the parents. All index patients and their parents underwent a complete ophthalmologic examination including best-corrected visual acuity (BCVA), slit-lamp examination, and indirect ophthalmoscopy with dilated pupils. Axial length and corneal curvature were measured using the IOL-Master 500 (Carl Zeiss Meditec, Jena, Germany). Healthy subjects without ocular disease served as controls. To minimize an influence of factors known to alter qAF measurements,22 exclusion criteria were age ≥ 65 years, ethnicity other than Caucasian, significant lens opacities, dilated pupil diameter below 7 mm, unstable fixation, refractive error > ±6 diopters (spherical equivalent), and any other additional known ocular pathology or prior intraocular surgery.

      Case#: Muller Subject #8, 34yo, qAF=590

      DiseaseAssertion: ABCA4-related retinopathy

      FamilyInfo: mother was 59yo at report with qAF=399

      CasePresentingHPOs:

      CaseHPOFreeText: "ABCA4-related retinopathy was diagnosed based on characteristic findings on indirect ophthalmoscopy, optical coherence tomography, and conventional fundus AF imaging. The clinical diagnosis was confirmed by the presence of biallelic mutations in ABCA4, and segregation analysis was carried out with samples of the parents."

      CaseNotHPOs:

      CaseNotHPOFreeText: age ≥ 65 years, ethnicity other than Caucasian, significant lens opacities, dilated pupil diameter below 7 mm, unstable fixation, refractive error > ±6 diopters (spherical equivalent), and any other additional known ocular pathology or prior intraocular surgery.

      GenotypingMethod: ABCA4 sequence analysis of all coding exons and flanking splice junctions was performed either by Sanger chain-terminating dideoxynucleotide sequencing after PCR amplification, by multiplex ligation-dependent probe amplification (MLPA) analysis (performed when only a single mutation was detected), or by next-generation sequencing (NGS) including a quantitative readout to detect large structural rearrangements using a gene panel covering 120 genes associated with inherited retinal disease as described previously.23 Validation of identified putatively pathogenic variants and segregation analysis were carried out by conventional sequencing

      PreviouslyPublished: n/a

      Variant: maternal allele: [c.1622T>C (p.Leu541Pro); c.3113C>T (p.Ala1038Val)]; paternal allele: c.1654G>A (p.Val552Ile); c.4771G>A (p.Gly1591Arg)

      CAID: CA239745

      SupplementalData:

  2. Sep 2026
    1. Thirty-Three Truncated and 98 Amino Acid–Changing Variants in the ABCA4 Gene

      This variant was found on one allele of a Stargardt patient, but no additional details are provided about the patient or the other allele. A combination of single-strand conformation polymorphism (SSCP) and automated DNA sequencing was used to evaluate the entire exonic and flanking intron sequence of the ABCA4 gene

    2. Thirty-Three Truncated and 98 Amino Acid–Changing Variants in the ABCA4 Gene

      c.1989G>CA (p.Trp663Ter) variant was found on one allele of a Stargardt patient, but no additional details are provided about the patient or the other allele. A combination of single-strand conformation polymorphism (SSCP) and automated DNA sequencing was used to evaluate the entire exonic and flanking intron sequence of the ABCA4 gene

    3. Thirty-Three Truncated and 98 Amino Acid–Changing Variants in the ABCA4 Gene

      This variant was found on one allele of a Stargardt patient, but no additional details are provided about the patient or the other allele. A combination of single-strand conformation polymorphism (SSCP) and automated DNA sequencing was used to evaluate the entire exonic and flanking intron sequence of the ABCA4 gene

    1. Patient 1, a 40-year-old Caucasian woman, presented in July 1998 with a history of progressive decline in visual acuity since the age of 15.

      PMID: 10612508

      Gene: ABCA4

      Case#: Patient 1, 40-year-old female

      DiseaseAssertion: STGD1

      FamilyInfo: One of four affected siblings in a family of eight. Segregation consistent with autosomal recessive inheritance.

      CasePresentingHPOs: HP:0000545 — Decreased visual acuity HP:0000612 — Central scotoma HP:0007754 — Macular atrophy HP:0030638 — Retinal flecks HP:0000512 — Abnormal fundus morphology

      CaseHPOFreeText: Progressive decline in visual acuity since age 15. Best-corrected visual acuity RE 20/400, LE 20/150. Central scotomas reported. Fundus exam showed bilateral central macular atrophy (worse in right eye), pigment deposits at the level of the retinal pigment epithelium, and numerous yellow flecks in the midperiphery. Fluorescein angiography demonstrated central hypofluorescence corresponding to atrophy with surrounding hyperfluorescence and peripheral dark choroid.

      CaseNotHPOs: HP:0000662 — Night blindness (absent)

      CaseNotHPOFreeText: Patient denied nyctalopia.

      GenotypingMethod: PCR amplification and direct sequencing of all 50 exons of ABCA4 following SSCP screening.

      PreviouslyPublished: Yes

      Variant: NM_000350.2:c.2588G>C (p.Gly863Ala) NM_000350.2:c.161G>A (p.Cys54Tyr)

      ClinVar: Not reported

      CAID: Not reported

      SupplementalData: Segregation demonstrated in pedigree (Figure 1); mutation confirmation by sequencing (Figure 4)

    2. Patient 4, a 33-year-old Caucasian woman, presented in July 1998 with a gradual decline in visual acuity over the last 9 years and a best-corrected visual acuity of 20/300 in both eyes.

      Case#: Patient 4, Female, Caucasian, 33yo

      DiseaseAssertion: STGD1

      FamilyInfo: One of eight siblings; four affected. Disease segregates with ABCA4 variants consistent with autosomal recessive inheritance. Parents are deceased and can't be tested.

      CasePresentingHPOs: HP:0007663, HP:0007754, HP:0025147, HP:0007924, HP:0011507

      CaseHPOFreeText: gradual decline in visual acuity over 9 years, BCVA 20/300 OU, bilateral beaten-bronze appearance of the macula, numerous perimacular yellow flecks, fluorescein angiography showing hyperfluorescence in the posterior pole and dark choroid in the periphery

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: absence of central hypofluorescence on fluorescein angiography (present in affected siblings but not this patient)

      Genotyping Method: SSCP analysis; Taq Dyedeoxy Terminator Cycle Sequencing kit

      PreviouslyPublished: N/A

      Variant: NM_000350.3(ABCA4):c.2588G>C (p.Gly863Ala), NM_000350.3(ABCA4):c.161G>A (p.Cys54Tyr)

      ClinVar: ClinVarID:7879, ClinVarID:99065

      CAID: N/A

      SupplementalData: Segregation and sequencing data (Figures 1, 4)

    1. STGD113 L541P-A1038V 2588G→C Yes

      Case#: STGD113, 20-24yo at onset, German

      DiseaseAssertion: STGD

      FamilyInfo: segregation in family

      CasePresentingHPOs:

      CaseHPOFreeText: "The diagnosis of STGD was based on the demonstration of bilateral impairment of central vision and the appearance of perimacular and/or peripheral yellow-white flecks, with or without atrophy of the central retinal-pigment epithelium and a normal or only mildly abnormal flash electroretinogram when recorded in early stages of the disease."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: denaturing gradient gel electrophoresis, dHPLC, and SSCP analysis, PCR amplification of individual coding exons and flanking intron sequences, direct DNA sequencing

      PreviouslyPublished: n/a

      Variant: L541P-A1038V; 2588G→C in trans "Correct segregation of disease alleles was demonstrated in all 39 cases in which family samples were available for study"

      ClinVar: 7879

      CAID: CA119128

      SupplementalData: n/a

    2. STGD138 IVS13+1GA 2588G→C Yes

      Case#: STGD138, 15-19yo at onset, German

      DiseaseAssertion: STGD

      FamilyInfo: segregation in family

      CasePresentingHPOs:

      CaseHPOFreeText: "The diagnosis of STGD was based on the demonstration of bilateral impairment of central vision and the appearance of perimacular and/or peripheral yellow-white flecks, with or without atrophy of the central retinal-pigment epithelium and a normal or only mildly abnormal flash electroretinogram when recorded in early stages of the disease."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: denaturing gradient gel electrophoresis, dHPLC, and SSCP analysis, PCR amplification of individual coding exons and flanking intron sequences, direct DNA sequencing

      PreviouslyPublished: n/a

      Variant: IVS13+1G→A; 2588G→C in trans "Correct segregation of disease alleles was demonstrated in all 39 cases in which family samples were available for study"

      ClinVar: 7879

      CAID: CA119128

      SupplementalData: n/a

    3. STGD87 2588G→C Q1750X Yes

      Case#: STGD87, 10-14yo at onset, German

      DiseaseAssertion: STGD

      FamilyInfo: segregation in family

      CasePresentingHPOs:

      CaseHPOFreeText: "The diagnosis of STGD was based on the demonstration of bilateral impairment of central vision and the appearance of perimacular and/or peripheral yellow-white flecks, with or without atrophy of the central retinal-pigment epithelium and a normal or only mildly abnormal flash electroretinogram when recorded in early stages of the disease."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: denaturing gradient gel electrophoresis, dHPLC, and SSCP analysis, PCR amplification of individual coding exons and flanking intron sequences, direct DNA sequencing

      PreviouslyPublished: n/a

      Variant: Q1750X; 2588G→C in trans "Correct segregation of disease alleles was demonstrated in all 39 cases in which family samples were available for study"

      ClinVar: 7879

      CAID: CA119128

      SupplementalData: n/a

    1. 413; 19c.1804C>T; c.2828G>Ap.R602W (D); p.R943Q (U)16c.2453G>Ap.G818E (D)Compound heterozygous

      Case#: Sporadic Case #4, Mexican

      DiseaseAssertion: Stargardt

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: STGD diagnosis based on: "onset of symptoms in childhood or early adulthood (before 20 years of age), bilateral central vision loss (central and peripheral visual field computerized testing), a retinal “beaten-bronze” foveal appearance and/or yellow-whitish flecks from the posterior pole to the mid periphery, normal caliber of the retinal vessels, no pigmented bone spicules in the retinal periphery, a normal to subnormal electroretinogram, and a typical dark choroid in fluorescein angiography."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: allele 1: c.1804C>T (p.R602W) and c.2828G>A (p.R943Q) allele 2: c.2453G>A (p. G818E); direct sequencing of exons of ABCA4

      ClinVar: 99135

      CAID: CA227000

      SupplementalData: n/a

    2. 816c.2453G>Ap.G818E (D)28c.4249_4251 delTTCp.F1417del (D; N)Compound heterozygous

      Case#: Familial Case #8, Mexican

      DiseaseAssertion: Stargardt

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: STGD diagnosis based on: "onset of symptoms in childhood or early adulthood (before 20 years of age), bilateral central vision loss (central and peripheral visual field computerized testing), a retinal “beaten-bronze” foveal appearance and/or yellow-whitish flecks from the posterior pole to the mid periphery, normal caliber of the retinal vessels, no pigmented bone spicules in the retinal periphery, a normal to subnormal electroretinogram, and a typical dark choroid in fluorescein angiography."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: allele 1: c.2453G>A (p. G818E) allele 2: c.4249_4251 delTTC (p.F1417del); direct sequencing of exons of ABCA4

      ClinVar: 99135

      CAID: CA227000

      SupplementalData: n/a

    3. 1016c.2453G>Ap.G818E (D)16c.2453G>Ap.G818E (D)Homozygous

      Case#: Sporadic Case #10, Mexican

      DiseaseAssertion: Stargardt

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: STGD diagnosis based on: "onset of symptoms in childhood or early adulthood (before 20 years of age), bilateral central vision loss (central and peripheral visual field computerized testing), a retinal “beaten-bronze” foveal appearance and/or yellow-whitish flecks from the posterior pole to the mid periphery, normal caliber of the retinal vessels, no pigmented bone spicules in the retinal periphery, a normal to subnormal electroretinogram, and a typical dark choroid in fluorescein angiography."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: c.2453G>A (p. G818E) homozygous; direct sequencing of exons of ABCA4

      ClinVar: 99135

      CAID: CA227000

      SupplementalData: n/a

    4. 616; 41c.2453G>A; c.5824G>Cp. G818E (D); p. E1942Q (B;N)46c.6384A>Gp.H2128R (D)Compound heterozygous

      Case#: Sporadic Case #16, Mexican

      DiseaseAssertion: Stargardt

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: STGD diagnosis based on: "onset of symptoms in childhood or early adulthood (before 20 years of age), bilateral central vision loss (central and peripheral visual field computerized testing), a retinal “beaten-bronze” foveal appearance and/or yellow-whitish flecks from the posterior pole to the mid periphery, normal caliber of the retinal vessels, no pigmented bone spicules in the retinal periphery, a normal to subnormal electroretinogram, and a typical dark choroid in fluorescein angiography."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: allele 1: c.2453G>A (p. G818E); c.5824G>C (p. E1942Q) allele 2: c.6384A>G (p.H2128R) direct sequencing of exons of ABCA4

      ClinVar: 867010

      CAID: CA957117

      SupplementalData: n/a

    1. MD-0560ABCA423c.3386G>Tp.Arg1129Leu47c.6410G>Ap.Cys2137Tyr16NPABCR400

      Case#: Family MD-0560 Proband, 16yo at onset

      DiseaseAssertion: AR Stargardt

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: STGD diagnosed based on "bilateral central vision loss; fundus presenting with a beaten-bronze appearance and/or the presence of orange-yellow flecks in the retina from the posterior pole to the mid-periphery; fluorescein angiography showing typical dark choroid; and normal electroretinogram (ERGs)." VA loss, VF loss, BCVA=0.1/0.1

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: c.6410G>A (p.Cys2137Tyr); c.3386G>T (p.Arg1129Leu) found by ABCR400

      ClinVar: 2202779; 99224

      CAID: CA341277358; CA227116

      SupplementalData:

    2. MD-0170ABCA430c.4457C>Tp.Pro1486Leu9c.1222C>Tp.Arg408*14YesABCR400

      Case#: MD-0170 Proband, 14yo at onset

      DiseaseAssertion: STGD

      FamilyInfo: Family MD-0170

      CasePresentingHPOs:

      CaseHPOFreeText: STGD diagnosed based on "bilateral central vision loss; fundus presenting with a beaten-bronze appearance and/or the presence of orange-yellow flecks in the retina from the posterior pole to the mid-periphery; fluorescein angiography showing typical dark choroid; and normal to subnormal electroretinogram (ERGs)."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: Haplotype analysis, ABCR400

      PreviouslyPublished: unclear

      Variant: c.4457C>T (p.Pro1486Leu); c.1222C>T (p.Arg408*)

      ClinVar: 99283

      CAID: CA227192

      SupplementalData: n/a

    3. MD-0084ABCA447c.6410G>Ap.Cys2137Tyr47c.6410G>Ap.Cys2137Tyr7YesABCR400 + dHPLC + HRM + MLPAValverde et al. 2006 (6); Aguirre-Lamban et al. 2010 (16)

      Case#: Family MD-0084 Proband, 7yo at onset

      DiseaseAssertion: AR Stargardt

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: STGD diagnosed based on "bilateral central vision loss; fundus presenting with a beaten-bronze appearance and/or the presence of orange-yellow flecks in the retina from the posterior pole to the mid-periphery; fluorescein angiography showing typical dark choroid; and normal to subnormal electroretinogram (ERGs)." VA loss, VF loss, BCVA=<0.05/<0.05

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: PMID: 16917483 (variant not found in this paper); PMID: 19959634

      Variant: c.6410G>A (p.Cys2137Tyr) homozygous, found by ABCR400 + dHPLC + HRM + MLPA

      ClinVar: 2202779

      CAID: CA341277358

      SupplementalData:

    4. MD-0242ABCA412c.1715G>Cp.Arg572ProNot detected18YesABCR400

      Case#: Family MD-0242 Proband, 18yo at onset, Spanish

      DiseaseAssertion: AR Stargardt

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: STGD diagnosed based on "bilateral central vision loss; fundus presenting with a beaten-bronze appearance and/or the presence of orange-yellow flecks in the retina from the posterior pole to the mid-periphery; fluorescein angiography showing typical dark choroid; and normal to subnormal electroretinogram (ERGs)."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: Haplotype analysis, ABCR400 microarray, direct sequencing for confirmation

      PreviouslyPublished: n/a

      Variant: c.1715G>C p.Arg572Pro

      ClinVar: 99073

      CAID: CA226919

      SupplementalData:

    1. Sixty-six individuals representing 54 families were studied (Supplementary Material, Table S1). All individuals were found to harbor two ABCA4 variants likely to cause the retinal disease (18,20–26). In 40 families (74%), independent segregation of the two alleles was demonstrated. The ages at the time of their first visit ranged from 9 to 74 years (mean = 35.9, median = 35.2 years); in the majority of individuals (36/66=55%), data were available from a second visit that occurred on average 8.7 years (range=2–20 years, median = 6.9 years) after the first visit.

      This variant was found in 6 different families (F32, F33, F40, F41, F42, and F43).

      PP4: F32: Patient #37 is a 31yo male, ADI=4yo, dx of CRD F33: Patient #38 is a 32yo female, ADI=>32yo, dx of STGD, segregation in the family but no further details F40: Patient #45 is a 65yo male, ADI=26yo, dx of CRD, segregation of homozygous alleles with disease was demonstrated in 2 affected siblings in Family 40. F41: Patient #46 is a 38yo female, ADI=>38yo, dx of STGD F42: Patient #47 is a 45yo female, ADI=>53yo, dx of STGD F43: Patient #48 is a 55yo female, ADI=46yo, dx of STGD

      PM3: In family 40, the proband was homozygous. In the other families, the variant was in compound heterozygosity with p.A1038V;p.L541P (F32); p.A1038V (F33); p.V1686M (F41); p.G1961E (F42); p.K2172R (F43).

    2. Sixty-six individuals representing 54 families were studied (Supplementary Material, Table S1). All individuals were found to harbor two ABCA4 variants likely to cause the retinal disease (18,20–26). In 40 families (74%), independent segregation of the two alleles was demonstrated. The ages at the time of their first visit ranged from 9 to 74 years (mean = 35.9, median = 35.2 years); in the majority of individuals (36/66=55%), data were available from a second visit that occurred on average 8.7 years (range=2–20 years, median = 6.9 years) after the first visit.

      Case#: Patient #35, male, 35yo at report, 14yo at onset,

      DiseaseAssertion: STGD

      FamilyInfo: family 30, segregation was noted as "yes" but no other details provided

      CasePresentingHPOs:

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod:

      PreviouslyPublished: n/a

      Variant: allele 1: A1038V;L541P allele 2: G818E

      ClinVar: 99135

      CAID: CA227000

      SupplementalData: supplemental table 1

    1. The latter finding suggests that loss of significance is likely due to lack of statistical power caused by the reduced number of individuals in the subsequent analyses (from n = 335 to n = 247 to n = 197 patients, Supplementary Table S5).

      3 STGD patients have this variant but no specific clinical details (supplemental table s5).

      Patient 79: c.1654G>A p.(V552I); c.5196+1013A>G

      Patient 265: c.1654G>A p.(V552I) only

      Patient 320: c.1654G>A p.(V552I); c.4254-1G>C; c.6230G>A p.(R2077Q)

    1. RP-0298 CRD 8 c.950del p.(Gly317Alafs*57) 33 c.4720G>T p.(Glu1574*) yes 10 10 8 36y - HM/HM This stud

      This variant is found in compound heterozygosity with c.950del p.(Gly317Alafs*57) in family RP-0298 in this study. Proband is 10yo at onset of VA loss and VF loss, 8yo at night blindness, and 36yo at opthalmological exam. BCVA=HM/HM.

    2. MD-1146 STGD1 14 c.2023G>A p.(Val675Ile) 47 c.6410G>A p.(Cys2137Tyr) Yes 46 - - 46y Normal 1/1 This study

      This variant is found in compound heterozygosity with c.2023G>A p.(Val675Ile) in family MD-1146 in this study. Proband is 46yo at onset of VA loss. 46yo at opthalmological exam. Normal ERG. BCVA=1/1. Not eligible for PP4 due to age of onset.

    3. MD-0740 STGD1 47 c.6410G>A p.(Cys2137Tyr) IVS28 c.4253+43G>A p.[=, Ile1377Hisfs*3] - 61 No - 62y - 0.8/0.16 This study

      This variant is found in compound heterozygosity with c.4253+43G>A p.[=, Ile1377Hisfs*3] in family MD-0740 in this study. Proband is 61yo at onset of VA loss with no VF loss. 62yo at opthalmological exam. Cone pattern on ERG. BCVA=0.8/0.16. Not eligible for PP4 due to age of onset.

    1. ARDM-133 32T→C L11P 2888delG Frameshift Cosegregates

      Case#: Family ARDM-133 Proband, Spanish Retinal Dystrophy Investigation Network (EsRetNet), 8yo at onset, 42yo at report

      DiseaseAssertion: arCRD

      FamilyInfo: cosegregates

      CasePresentingHPOs: HP:0007663, HP:0000575, HP:0007641, HP:0000613

      CaseHPOFreeText: "The diagnosis of CRD was based on the following criteria: initial complaints of blurred central vision without a history of night blindness, poor visual acuity (typically 20/100 or worse, with progressive decline from an early age), impairment of color vision, funduscopic evidence of atrophic macular degeneration, peripheral disturbances including pigment clumping and/or pigment epithelial thinning, and greater or earlier loss of cone than rod ERG amplitude."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: ABCR400 microarray, PCR amplification

      PreviouslyPublished: n/a

      Variant: 32T→C, L11P; 2888delG

      ClinVar: 99217

      CAID: CA227106

      SupplementalData:

    1. Our case-control association study included 116 patients with atrophic AMD, 77 with RP, 86 with STGD, and 100 healthy controls. All the patients were evaluated by a standard ophthalmologic examination and OCT. ERG was performed on STGD and RP patients. All the subjects underwent a blood drawing for genetic testing and the CFHY402H polymorphism was genotyped with the TaqMan real-time polymerase chain reaction single nucleotide polymorphism assay.

      annotating here since unable to annotate on PDF.

      Case#: Stargardt patient 22, Italian

      DiseaseAssertion: STGD

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: STGD criteria: "(1) juvenile to adult onset of symptoms; (2) bilateral central vision loss; (3) macular dystrophy and/or atrophy (beaten bronze appearance or large patch of atrophy); (4) normal caliber of retinal vessels; (5) absence of pigmented bone spicules. The presence of yellow-white flecks was not considered obligatory inclusion criteria, even though they could be found in most of the patients of our series. Similarly, the possible presence of the “dark choroid” phenomenon could be identified in the fluorescein angiography examinations carried out on some patients in previous clinical settings, but it was not considered significant for the recruitment."

      CaseNotHPOs:

      CaseNotHPOFreeText: "myopia >6 diopters, hyperopia and astigmatism >3 diopters, ocular disorders other than RP, STGD, or AMD, significant systemic diseases, a history of inflammation-associated diseases and media opacities preventing fundus examination"

      GenotypingMethod: all coding exons, including intron-exon boundaries of the ABCA4 gene (NM 000350) were sequenced. PCR

      PreviouslyPublished: n/a

      Variant: c.5882G>A (p.Gly1961Glu); c.4450C>T (p.Pro1484Ser); c.203C>T (p.Pro68Leu)

      ClinVar: 99113

      CAID: CA226972

      SupplementalData: Table S2

    1. Finally, we examined whether the phenotype‐associated known/candidate pathogenic variants could explain the patient's disease, andif the MAF in population‐matched control data (8.3kJPN) was relatedto disease prevalence. Patients were classified as “Solved” if theirgenotype was consistent with their clinical phenotype. Patients wereclassified as “Partially solved” when a heterozygous known/candidatepathogenic variant was detected in a recessive allele, but without anadditional variant in trans. Patients were categorized as “Unsolved” iftheir genotypes exhibited either no candidate pathogenic variants ormultiple heterozygous pathogenic variants that did not explain thephenotype clearly. Variants annotated as causal for solved patients arelisted in Supporting Information: Table S2. Novel variants identified inthis study are listed in the second sheet of Table S2. SupportingInformation: Table S3 shows the phenotypes and genotypes of solvedpatients.2.4 | Statistical analysisBefore counting the allele frequency in our cohort, the list ofpatients was modified to contain only the proband to avoid theoverrepresentation of pedigrees with larger numbers of affectedindividuals. Inter‐pedigree comparisons of genetic diagnoses evaluat-ing proband only and proband with family members were performedby the chi‐square test. Enrichments of the pathogenic variants ingenetically solved and unsolved patients were compared by the one‐sided binominal test. Allele frequencies were compared with thehighest allele frequencies among the 8.3KJPN, HGVD, ExAC_EAS, andgnomAD_EAS databases. Statistical analyses were performed byR (ver. 4.0.3).2.5 | Detection of RP1:c.4052‐4053ins328(Alu insertion)Previously reported primers were used to amplify the expectedAlu‐inserted region (Nikopoulos et al., 2019). Genomic DNA wasamplified with Prime Star (TAKARA) following the manufacturer'sSUGA ET AL . | 310981004, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/humu.24492 by Mie University, Wiley Online Library on [07/11/2022]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

      This variant is listed in supplementary tables S2 and S3. Proband TM-319 is a "solved" patient, meaning the phenotype matches the genotype. Compound heterozygous (c.5318C>T p.A1773V) female with Stargardt disease- all that is provided.

    2. Finally, we examined whether the phenotype‐associated known/candidate pathogenic variants could explain the patient's disease, andif the MAF in population‐matched control data (8.3kJPN) was relatedto disease prevalence. Patients were classified as “Solved” if theirgenotype was consistent with their clinical phenotype. Patients wereclassified as “Partially solved” when a heterozygous known/candidatepathogenic variant was detected in a recessive allele, but without anadditional variant in trans. Patients were categorized as “Unsolved” iftheir genotypes exhibited either no candidate pathogenic variants ormultiple heterozygous pathogenic variants that did not explain thephenotype clearly. Variants annotated as causal for solved patients arelisted in Supporting Information: Table S2. Novel variants identified inthis study are listed in the second sheet of Table S2. SupportingInformation: Table S3 shows the phenotypes and genotypes of solvedpatients.2.4 | Statistical analysisBefore counting the allele frequency in our cohort, the list ofpatients was modified to contain only the proband to avoid theoverrepresentation of pedigrees with larger numbers of affectedindividuals. Inter‐pedigree comparisons of genetic diagnoses evaluat-ing proband only and proband with family members were performedby the chi‐square test. Enrichments of the pathogenic variants ingenetically solved and unsolved patients were compared by the one‐sided binominal test. Allele frequencies were compared with thehighest allele frequencies among the 8.3KJPN, HGVD, ExAC_EAS, andgnomAD_EAS databases. Statistical analyses were performed byR (ver. 4.0.3).2.5 | Detection of RP1:c.4052‐4053ins328(Alu insertion)Previously reported primers were used to amplify the expectedAlu‐inserted region (Nikopoulos et al., 2019). Genomic DNA wasamplified with Prime Star (TAKARA) following the manufacturer'sSUGA ET AL . | 310981004, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/humu.24492 by Mie University, Wiley Online Library on [07/11/2022]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

      This variant is listed in supplementary tables S2 and S3. Proband TI-50 is a "solved" patient, meaning the phenotype matches the genotype. Homozygous female with MD/CORD- all that is provided.

    3. Finally, we examined whether the phenotype‐associated known/candidate pathogenic variants could explain the patient's disease, andif the MAF in population‐matched control data (8.3kJPN) was relatedto disease prevalence. Patients were classified as “Solved” if theirgenotype was consistent with their clinical phenotype. Patients wereclassified as “Partially solved” when a heterozygous known/candidatepathogenic variant was detected in a recessive allele, but without anadditional variant in trans. Patients were categorized as “Unsolved” iftheir genotypes exhibited either no candidate pathogenic variants ormultiple heterozygous pathogenic variants that did not explain thephenotype clearly. Variants annotated as causal for solved patients arelisted in Supporting Information: Table S2. Novel variants identified inthis study are listed in the second sheet of Table S2. SupportingInformation: Table S3 shows the phenotypes and genotypes of solvedpatients.

      This variant is listed in supplementary tables S2 and S3. Proband KN-187 is a "solved" patient, meaning the phenotype matches the genotype. Compound heterozygous (c.6290C>T p.P2097L; c.6445C>T p.R2149X) male with Stargardt disease- all that is provided.

    1. In 20 patients (19 STGD and 1 CRD), 18 different genotypes were identified (Table 1). Except p.Arg187His and p.Tyr954Ser variants, the rest of changes were previously reported as disease-associated allele. 14 The p.Arg187His and p.Tyr954Ser variants were not found in 100 ethnically matched control chromosomes. All the mutations identified in the 20 patients except one were detected by HRM for sensitivity of 95%; however, only 16 variants were identified by dHPLC for sensitivity of 80%.  Table 1. View Table Mutations AnalyzedTable 1. Mutations Analyzed Family Exon Genotype Mutation Detected by dHPLC Mutation Detected by HRM Nucleotide Change Amino Acid Change ARDM-167 5 c.560G>A p.Arg187His No Yes ARDM-257 5 c.560G>A p.Arg187His No Yes ARDM-164 6 c.700C>T p.Gln234X Yes Yes ARDM-135 8 c.1029_1030insT p.Asn344fsX Yes No ARDM-240 15 c.2285C>A p.Ala762Glu Yes Yes ARDM-248 19 c.2861A>C p.Tyr954Ser Yes Yes ARDM-90 — IVS21-2A>T — Yes Yes ARDM-40 27 c.3943C>T p.Gln1315X Yes Yes ARDM-158 30 c.4537delC p.Gln1513fsX1525 Yes Yes ARDM-38 33 c.4739delT p.Leu1580fs Yes Yes ARDM-163 36 c.5172G>T p.Trp1724Cys Not Yes ARDM-197 36 c.5172G>T p.Trp1724Cys Yes Yes ARDM-181 — IVS38+5G>A — Yes Yes ARDM-125 40 — p.KNLFA1876dup Yes Yes ARDM-183 43 c.5929G>A(False −) p.Gly1977Ser(False −) Yes Yes ARDM-146 44 c.6140T>A p.lle2047Asn Yes Yes ARDM-174 — IVS44+2T>A — Yes Yes ARDM-247 47 c.6410G>A p.Cys2137Tyr* Yes Yes ARDM-84 47 c.6410G>A p.Cys2137Tyr† No Yes ARDM-225 48 c.6559C>T p.Gln2187X Yes Yes  Previously unreported mutations are shown in bold. *  Mutation in heterozygous. †  Mutation in homozygous. Homozygous sequence alteration (p.Cys2137Tyr) could be identified from wild-type by HRM analyses (Fig. 1). In contrast, dHPLC did not distinguish any homozygous mutation, except when we mixed it, in a 1:1 proportion, with a previously sequenced wild-type sample at the end of each PCR session and before heteroduplex formation.

      Case#: Family MD-0084/ARDM-84 Proband, 7yo at onset

      DiseaseAssertion: AR Stargardt

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: STGD diagnosed based on "bilateral central vision loss; fundus presenting with a beaten-bronze appearance and/or the presence of orange-yellow flecks in the retina from the posterior pole to the mid-periphery; fluorescein angiography showing typical dark choroid; and normal to subnormal electroretinogram (ERGs)." VA loss, VF loss, BCVA=<0.05/<0.05

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: c.6410G>A (p.Cys2137Tyr) homozygous, found by ABCR400 + dHPLC + HRM + MLPA

      ClinVar: 2202779

      CAID: CA341277358

      SupplementalData: n/a

    1. V1 H1 Exon 36.1–3 G>A chr1:94,484,001 c.5196+1137G>A 4 4 0 0

      Case#: Braun Family 6 Proband (from left to right, top to bottom of available pedigrees), male

      DiseaseAssertion: Stargardt

      FamilyInfo: Genotypes not provided for parents. No siblings

      CasePresentingHPOs:

      CaseHPOFreeText: "five or more of the following features of ABCA4-associated retinal disease: decreased visual acuity before age 20, decreased visual acuity as the first visual symptom, symmetrical fundus findings, pisciform flecks, beaten metal macular atrophy, bulls-eye maculopathy, peripapillary sparing, vermillion fundus, masked choroid on fluorescein angiography, nummular pigment overlying extensive macular atrophy, central outer retinal atrophy on optical coherence tomography and central scotomas on Goldmann perimetry."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: one plausible disease-causing mutation detected in ABCA4 after assessing the entire coding sequence and canonical retinal splice junctions with automated bidirectional Sanger sequencing using an ABI 3730 sequencer

      PreviouslyPublished: n/a

      Variant: c.5196+1137G>A; c.454C>T (p.R152X)

      ClinVar: 438100

      CAID: CA26843511

      SupplementalData: pedigree in fig s2

    2. V1 H1 Exon 36.1–3 G>A chr1:94,484,001 c.5196+1137G>A 4 4 0

      Case#: Braun Family 8 Proband (from left to right, top to bottom of available pedigrees), female

      DiseaseAssertion: Stargardt

      FamilyInfo: Unaffected carrier parents. c.5196+1137G>A maternally inherited; c.4577C>T (p.T1526M) paternally inherited

      CasePresentingHPOs:

      CaseHPOFreeText: "five or more of the following features of ABCA4-associated retinal disease: decreased visual acuity before age 20, decreased visual acuity as the first visual symptom, symmetrical fundus findings, pisciform flecks, beaten metal macular atrophy, bulls-eye maculopathy, peripapillary sparing, vermillion fundus, masked choroid on fluorescein angiography, nummular pigment overlying extensive macular atrophy, central outer retinal atrophy on optical coherence tomography and central scotomas on Goldmann perimetry."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: one plausible disease-causing mutation detected in ABCA4 after assessing the entire coding sequence and canonical retinal splice junctions with automated bidirectional Sanger sequencing using an ABI 3730 sequencer

      PreviouslyPublished: n/a

      Variant: c.5196+1137G>A; c.4577C>T (p.T1526M)

      ClinVar: 438100

      CAID: CA26843511

      SupplementalData: pedigree in fig s2

    1. 5 4514 S 12 1/10 / 1/10 c.32T>C(1) / c.[1A>G(1)]+[6089G>A(44)] p.Leu11Pro [12]/p.(Met1Val [6])+(Arg2030Gln [9])

      Case#: Maia-Lopes Family 5 Proband 4514, Portuguese, 12yo at onset

      DiseaseAssertion: STGD

      FamilyInfo: Family 5

      CasePresentingHPOs:

      CaseHPOFreeText: severe central fundus changes, vision: 1/10 / 1/10

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: ABCR400 microarray, dHPLC

      PreviouslyPublished: n/a

      Variant: c.32T>C(1) / c.[1A>G(1)]+[6089G>A(44)]; p.Leu11Pro/p.(Met1Val)+(Arg2030Gln)

      ClinVar: 99217

      CAID: CA227106

      SupplementalData: n/a

    2. 11 4613 S 9 FC / FC c.[4926C>G(35)]+[5041_5055del(36)] / c.32T>C(1) p.(Ser1642Arg [10])+(Val1681_Cys1685del [10])/p.Leu11Pro

      Case#: Maia-Lopes Family 11 Proband 4613, Portuguese, 9yo at onset

      DiseaseAssertion: STGD

      FamilyInfo: Family 11

      CasePresentingHPOs:

      CaseHPOFreeText: severe central fundus changes, vision: FC/FC

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: ABCR400 microarray, dHPLC

      PreviouslyPublished: n/a

      Variant: c.[4926C>G(35)]+[5041_5055del(36)] / c.32T>C(1); p.(Ser1642Arg [10])+(Val1681_Cys1685del [10])/p.Leu11Pro

      ClinVar: 99217

      CAID: CA227106

      SupplementalData: n/a

    3. 18 5709 Mi 9 2/10 / 2/10 c.32T>C(1) / c.1804C<T(13) p.Leu11Pro/p.Arg602Thr

      Case#: Maia-Lopes Family 18 Proband 5709, Portuguese, 9yo at onset

      DiseaseAssertion: STGD

      FamilyInfo: Family 18

      CasePresentingHPOs:

      CaseHPOFreeText: mild central fundus changes, vision: 2/10 / 2/10

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: ABCR400 microarray, dHPLC

      PreviouslyPublished: n/a

      Variant: c.1804C<T/ c.32T>C(1); p.Arg602Thr/p.Leu11Pro

      ClinVar: 99217

      CAID: CA227106

      SupplementalData: n/a

    1. Thirty-eight sporadic cases (60%) were resolved, of which 34 presented mutations in AR inheritance genes, three in AD inheritance genes, and one in XL inheritance. According to the genetic results, five initially AD retinitis pigmentosa (adRP) cases were reclassified to AR retinitis pigmentosa (arRP; fRPN-110) and to XL RP (fRPN-GB, fRPN-45, fRPN-97, fRPN-174), two arRP families to adRP (fRPN-AP, fRPN-168), one autosomal dominant MD family to late-onset retinal degeneration (LORD; fRPN-100), one Best MD case to CRD (fRPN-125), and one STGD case to Best MD (fRPN-39) (Supplemental Table S5).

      Case#: Proband RPN-290, Male, 43yo at genetic testing, 27yo at dx, onset in 30s, Spanish

      DiseaseAssertion: Nonsyndromic Inherited Retinal Dystrophies. Stargardt

      FamilyInfo: Family RPN-133

      CasePresentingHPOs:

      CaseHPOFreeText: decreased visual acuity, photophobia, BCVA (logMAR) 28y: 0,0/0,0 35y: 0,4/0,1 43y: 1,0/1,0, central scotoma (56/ 63), yellow-white deposits around the macula, central and peripheral neuroepithelium thinning; 43y: without significant changes, 27y: normal visual evoked potentials, normal : full field electroretinography, abnormal electrooculogram (Arden index); 36y: delayed latency right eye visual evoked potentials, decreased cone and rod ffERG.

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: NGS; MLPA and array CGH

      PreviouslyPublished: n/a

      Variant: c.4457C>T; p.(Pro1486Leu) homozygous

      ClinVar: 99283

      CAID: CA227192

      SupplementalData: supplemental table S2 has phenotype, S4 and S5 have genotype information

    1. 32-year-old woman

      Case#: 32-year old woman, onset in early twenties

      DiseaseAssertion: STGD1

      FamilyInfo: n/a

      CasePresentingHPOs: HP:0011462, HP:0011507, HP:0000505, HP:0007722, HP:0030500, HP:0030329, HP:0030610, HP:0000575, HP:0030602

      CaseHPOFreeText: Patient’s best-corrected visual acuity was OD: 20/200 and OS: 20/40. Refractive error was OD: −5.25/−0.75 × 4° and OS: −5.75/−0.50 × 133°. Flecks in macular area extended anterior to the vascular arcades and the optic disc in both eyes. Atrophic lesion in the macula with flecks observed across the posterior pole. IS/OS junction loss central macular area bilaterally. Absolute scotoma in left eye (ie total deviation −20 dB). Defect in the RPE/Bruch membrane complex was observed on SD-OCT in both eyes in the central macula. The defects in the RPE-Bruch membrane complex measured OD: 332 um and OS: 266 um in maximum horizontal diameter. Herniation of the retina through these defects into the sub-RPE/choroidal space. Abnormal thickening of the RPE in the parafoveal region. Normal amplitudes and implicit times in both rod and cone photoreceptor systems were detected by ERG.

      CaseNotHPOs: HP:0000510, HP:0007984

      CaseNotHPOFreeText: Normal amplitudes and implicit times in both rod and cone photoreceptor systems were detected by ERG. There was no evidence of sub-RPE choroidal neovascularization (CNV), pigment epithelial defects (PED) or subretinal fluid.

      Genotyping Method: ABCR 600 micro-array chip

      PreviouslyPublished: n/a

      Variant: NM_000350.3(ABCA4):c.5714+5G>A

      ClinVar: 99403

      SupplementalData: n/a

    1. Flow of individuals. A schematic representation showing the outcome of the 677 individuals with IRD participating in the study. *Supplementary Table 4. Indiv: individuals.

      Case#: Patient #330

      DiseaseAssertion: Stargardt

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: "Patients clinically suspected of having a retinal dystrophy were selected for the targeted analysis based on evaluation of available clinical records (clinical diagnosis, clinical history, fundus changes, OCT imaging, ERG, visual acuity, visual fields, family history)."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: NGS panel of 125 genes known to be associated with: retinitis pigmentosa, Bardet-Biedl syndrome, cone-rod dystrophy, Leber congenital amaurosis, Usher syndrome and congenital stationary night blindness (some genes cause more than one eye disorder).

      PreviouslyPublished: n/a

      Variant: 2453G>A (p.Gly818Glu)

      ClinVar: 99135

      CAID: CA227000

      SupplementalData: supplemental table s4

    1. Seven hundred and fifty-six patients (98%) had inherited retinal diseases (IRD), and the remaining 17 (2%) had other etiologies, such as optic atrophy (6) and coloboma (4). Four hundred and eighty-three patients (62%) had a diagnosis of non-syndromic retinitis pigmentosa (RP), 41 (5%) of early-onset severe retinal dystrophy (EOSRD), 40 (5%) of Stargardt disease, 39 (5%) of Usher syndrome, 38 (5%) of macular dystrophy (MD), 19 (2%) of cone-rod dystrophy (CORD), 19 (2%) of choroideremia (CHM), and the remaining patients had less frequent conditions (Fig. ​(Fig.22 and Supplementary Table 1).

      Case#: Patient 339, Argentinian

      DiseaseAssertion: macular dystrophy

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: c.6383A>G (p.His2128Arg); c.4457C>T (p.Pro1486Leu) NGS

      ClinVar: 99455

      CAID: CA227399

      SupplementalData: supplemental table 1 contains phenotype info

    1. A 69-year-old female patient complained of progressive vision loss. Her parents were first cousins. She had been diagnosed with retinitis pigmentosa 27 years previously.

      Case#: Female, 69yo, Puerto Rican

      DiseaseAssertion: STDG1

      FamilyInfo: Parents were first cousins (consanguinity), no other family history reported

      CasePresentingHPOs: HP:0030603, HP:0007754, HP:0000512, HP:0008020, HP:0000603

      CaseHPOFreeText: progressive vision loss, severe reduction in visual acuity (counting fingers at 5’ and 3’), bilateral central scotoma, extensive central macular atrophy, retinal pigment epithelium atrophy and pigment hyperplasia, multifocal retinal atrophy, central hypoautofluorescence with peripheral expansion, reduced macular thickness and volume on OCT, abnormal visual field (marked mean deviation)

      CaseNotHPOs: HP:0000510

      CaseNotHPOFreeText: normal rod response on full-field electroretinogram

      Genotyping Method: Next-generation sequencing (Invitae Corporation, San Francisco, California)

      PreviouslyPublished: N/A

      Variant: NM_000350.3(ABCA4):c.5714+5G>A

      ClinVar: ClinVarID:99403

      CAID: N/A

      SupplementalData: N/A

    1. The 1,000 probands in this study came to our clinic from 40 different states, the District of Columbia and seven foreign countries (Supplemental Figure 1). Four hundred eighty-nine were female and 511 were male. The average age at entry into the study was 37.3 years (36.3 years for males and 38.5 years for females); the range was 8 months to 88 years. Plausible disease-causing genotypes were identified in 760 of these probands, 393 males and 367 females (Supplemental Table 1). The average age at entry into the study was very slightly younger for those in whom a disease-causing genotype was identified (34.9 years for males and 37.7 years for females).

      Case#: Patient 817, female, 33yo at entry

      DiseaseAssertion: Stargardt disease

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: category IIA (autosomal recessive stargardt disease)

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: one or more of the following approaches: automated Sanger sequencing with an ABI 3730xl sequencer, allele-specific genotyping with a Fluidigm EP1, amplification refractory mutation system (ARMS 17), chromosomal microarray analysis, and/or plasmid cloning of PCR products followed by Sanger sequencing. WES, WGS

      PreviouslyPublished: n/a

      Variant: c.1654G>A (p.Val552Ile); second variant not identified

      CAID: CA239745

      SupplementalData: supplemental table 1

    2. Four hundred eighty-nine were female and 511 were male. The average age at entry into the study was 37.3 years (36.3 years for males and 38.5 years for females); the range was 8 months to 88 years. Plausible disease-causing genotypes were identified in 760 of these probands, 393 males and 367 females (Supplemental Table 1). The average age at entry into the study was very slightly younger for those in whom a disease-causing genotype was identified (34.9 years for males and 37.7 years for females).

      Case#: Patient 721, male, 41yo at entry

      DiseaseAssertion: Stargardt disease

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: category IIA (autosomal recessive stargardt disease)

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: one or more of the following approaches: automated Sanger sequencing with an ABI 3730xl sequencer, allele-specific genotyping with a Fluidigm EP1, amplification refractory mutation system (ARMS 17), chromosomal microarray analysis, and/or plasmid cloning of PCR products followed by Sanger sequencing. WES, WGS

      PreviouslyPublished: n/a

      Variant: c.6416G>C p.Arg2139Pro; c.2588G>C p.Gly863Ala. confirmed in trans

      CAID: CA10611614

      SupplementalData: supplemental table 1

    1. The patients’ demographic and genetic characteristics are provided in eTable 1 in Supplement 1.

      Proband can genotype and some phenotype information can be found in eTable 1.

      Case#: Patient 601691#46, male, Italian, 32yo

      DiseaseAssertion: ABCA4-Associated Retinopathy

      GenotypingMethod: sequencing with Illumina NexSeq500 platform, confirmation with Sanger sequencing

      PreviouslyPublished: n/a

      Variant: c.5018+2T>C; c.6415C>T (p.Arg2139Trp)

      CAID: CA227402

      SupplementalData: eTable 1

    1. In the German cohort of 46 patients with single heterozygous ABCA4 variants, none of the known or any novel variant was found in the regions analyzed (Supp. Table S3).

      Case#: Bauwens Case ID #20864, German

      DiseaseAssertion: Simplex Retinitis Pigmentosa

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: Screening for V1-V7 (deep intronic variants) negative, sequencing of the coding exons and intron–exon boundaries of ABCA4, Sanger sequencing

      PreviouslyPublished:

      Variant: c.1654G>A p.(Val552Ile), no second allele

      CAID: CA239745

      SupplementalData: supplemental table s3

    1. We performed diagnostic NGS testing for 537 patients (287 males and 250 females) referred with clinical indications of IRD. All of the 537 individuals were initially referred on a singleton basis.Phenotype classification IRDs have a diverse spectrum of overlapping clinical presentation, which can vary by age of onset, extent of visual impairment, nature of disease progression and involvement of additional clinical features. We grouped all referred patients into 10 distinct clinical classifications (see online supplementary table S3). The most common referral was non-syndromic RCD/RP (n=250). The most common referral of syndromic disease was Usher syndrome (n=38), a disorder characterised by neurosensory hearing loss and visual impairment. There were eight cases of suspected syndromic ciliopathies referred, including seven cases of BBS.

      Case#: Case #82863

      DiseaseAssertion: CRD

      FamilyInfo: n/a

      CasePresentingHPOs: n/a

      CaseHPOFreeText: n/a

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      CasePreviousTesting: n/a

      GenotypingMethod: NGS panel of 105 genes

      PreviouslyPublished: possible since this is an international cohort

      Variant: c.3098delA; c.4139C>T p.(Pro1380Leu)

      ClinVar: 236516

      CAID: CA10581650

      SupplementalData: supplemental table S3 has genotype info and phenotype

    1. man in hismid-40s

      Case#: Male, mid-40s

      DiseaseAssertion: STGD1

      FamilyInfo: Retinal disease reported in sibling and material grandfather. Mother exhibited decreased visual acuity, BEM in right eye, and tapetal reflex in both eyes.

      CasePresentingHPOs: HP:0000622, HP:0000613, HP:0000662, HP:0011504, HP:0007663, HP:0011463

      CaseHPOFreeText: n/a

      CaseNotHPOs: HP:0007843, HP:0011507

      CaseNotHPOFreeText: Autofluorescence(qAF): 381.5. The Case's qAF was noted to be in the range observed in healthy eyes, and also lower than many other STGD1 patients with the same age. There were no flecks, intraretinal pigment migration, retinal vessel attenuation, or optic nerve pallor (Figure 1).

      Genotyping Method: Sanger Sequencing

      PreviouslyPublished: n/a

      Variant: NM_000350.3(ABCA4):c.1411G>A (p.Glu471Lys), NM_001034853.2(RPGR):c.3070G>T (p.Glu1024Ter)

      ClinVar: 99052, 1275798

      SupplementalData: n/a

    1. STGD in 48 patients (55%) was explained by recessive ABCA4 mutations (supplemental table S2). Only 22 patients could be solved using previously known STGD causing mutations. However, we identified 35 novel mutations in ABCA4 contributing to the diagnosis of 25 STGD patients. This contained 10 novel mutations leading to amino acid substitutions already known to cause disease and mutations known to cause diseases other than STGD. In addition, we identified 13 novel nonsense mutations. The remaining 12 novel mutations are well justified, and novel mutations were either completely absent or extremely rare in controls.

      Case#: Patient #126, Chinese

      DiseaseAssertion: Stargardt

      FamilyInfo: n/a

      CasePresentingHPOs: "Clinical diagnosis of STGD was made when the patient, usually a child, developed central visual acuity loss with an atrophic maculopathy with or without flecks." No individual details

      CaseHPOFreeText: n/a

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      GenotypingMethod: shotgun sequencing; Sanger sequencing; CNV analysis using CGH microarray

      PreviouslyPublished: n/a

      Variant: c.6119G>A p.(R2040Q); c.5776C>T p.(Q1926X)

      CAID: CA232815

      SupplementalData: info found in table S2

    2. STGD in 48 patients (55%) was explained by recessive ABCA4 mutations (supplemental table S2). Only 22 patients could be solved using previously known STGD causing mutations. However, we identified 35 novel mutations in ABCA4 contributing to the diagnosis of 25 STGD patients. This contained 10 novel mutations leading to amino acid substitutions already known to cause disease and mutations known to cause diseases other than STGD. In addition, we identified 13 novel nonsense mutations. The remaining 12 novel mutations are well justified, and novel mutations were either completely absent or extremely rare in controls.

      Case#: Patient #133, Chinese

      DiseaseAssertion: Stargardt

      FamilyInfo: n/a

      CasePresentingHPOs: n/a "Diagnosis of STGD was based on the clinical manifestations" is all that is stated

      CaseHPOFreeText: n/a

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      PreviouslyPublished: n/a

      Variant: c.6289 C>T p.(P2097S); c.4605_4606insT p.(V1535fs)

      ClinVar: 2202780

      CAID: CA341277622

      SupplementalData: info found in table S2

    1. Table S9. List of unique causative variants detected in 858 STGD probands mmc8.xlsx (19.3KB, xlsx) Table S11. STGD1 cases with at least two (likely) causal ABCA4 variants mmc9.xlsx (39.6KB, xlsx)

      Case#: DNAID 071549/Pat23, male

      DiseaseAssertion: STGD1

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: "In classic STGD1, loss of central vision starts around the second decade of life, but both early- and late-onset subtypes have been extensively described." No patient-specific details provided

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: smMIPs sequencing of the complete ABCA4 locus

      PreviouslyPublished: n/a

      Variant: c.6416G>C (p.Arg2139Pro); c.1648G>A (p.Gly550Arg)

      CAID: CA10611614

      SupplementalData: tables s9 and s11

    2. able S9. List of unique causative variants detected in 858 STGD probands mmc8.xlsx (19.3KB, xlsx) Table S11. STGD1 cases with at least two (likely) causal ABCA4 variants

      Case#: DNAID 072884/Pat255, female

      DiseaseAssertion: STGD1

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: "In classic STGD1, loss of central vision starts around the second decade of life, but both early- and late-onset subtypes have been extensively described." No patient-specific details provided

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: smMIPs sequencing of the complete ABCA4 locus

      PreviouslyPublished: n/a

      Variant: c.1519G>T (p.Asp507Tyr); c.5312+3A>T (p.Asn1734Glyfs*14) phase not confirmed

      CAID: CA958508

      SupplementalData: tables s9 and s11

    3. Table S9. List of unique causative variants detected in 858 STGD probands mmc8.xlsx (19.3KB, xlsx) Table S11. STGD1 cases with at least two (likely) causal ABCA4 variants mmc9.xlsx (39.6KB, xlsx)

      Case#: DNAID 072888/Pat258, female

      DiseaseAssertion: STGD1

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: "In classic STGD1, loss of central vision starts around the second decade of life, but both early- and late-onset subtypes have been extensively described." No patient-specific details provided

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: smMIPs sequencing of the complete ABCA4 locus

      PreviouslyPublished: n/a

      Variant: c.6416G>C (p.Arg2139Pro); c.3323G>A (p.Arg1108His)

      CAID: CA10611614

      SupplementalData: tables s9 and s11

    1. Among the 390 probands and 16 pseudodominant relatives in the cohort, 736 instances of 241 different alleles of the ABCA4 gene were observed (Table S2, available at www.aaojournal.org). A total of 10% of these alleles harbored terminating variants, 22% harbored splice-altering variants, and 61% harbored missense variants. No disease-causing variants could be found on 7% of the probands' alleles.

      Case#: Proband P399, Family F345, male, 8yo at onset, US

      DiseaseAssertion:

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: phenotypically focused tiered testing strategy beginning with allele-specific testing of the most common disease alleles and progressing through Sanger sequencing of candidate genes and, in many cases, to next generation sequencing of whole exomes and whole genomes

      PreviouslyPublished: n/a

      Variant: Pro1380Leu (c.4139C>T); Glu2031Lys (c.6091G>A) phase unconfirmed

      ClinVar: 866538

      CAID: CA341279017

      SupplementalData: table s2 (listed as table 1 when you open it)

    1. Table 1shows the age, sex, vision at the most recent visit, fluorescein angiographic findings, and clinical phenotype for 29 patients with a possible disease-causing mutation in the ABCRgene. Each of the 29 patients were from different pedigrees. However, the mother of patient 12 and the father of patient 29 were also found to have compound heterozygous sequence variations in the ABCRgene.

      Case#: Fishman Patient #22, male, 28yo

      DiseaseAssertion: Stargardt dystrophy or fundus flavimaculatus

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: dark choroid, diffuse yellowish white flecks in the fundus, 20/400 OU, central scotoma

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: only one variant found: c.6383A>G (p.His2128Arg) Single-strand conformation polymorphism analysis and DNA sequencing were used to identify variations in coding sequences of the ABCRgene.

      ClinVar: 99455

      CAID: CA227399

      SupplementalData:

    1. Eighty-four unrelated STGD1 patients were found to carry two or more disease-causing ABCA4 mutations, and cosegregation analyses were performed in 54 (64.3%). (See Supplementary Table S3 for a summary of clinical phenotype of STGD1 patients). The mean disease onset age of the patients was 13.1 years (range, 2–44 years), and half of these patients experienced their symptoms of visual impairment in their first decade. We classified the patients into three groups by their disease onset age. For the patients in the first group, whose disease onset ages were between 1 and 10 years, the fraction (45.3%, 19/42) of patients carrying compound heterozygous or homozygous deleterious mutations (nonsense, frameshift insertion or deletion, or splicing mutations) or complex alleles was much higher than those observed for the patients in the group 2 (24.1%, 7/29) and group 3 (15.4%, 2/13), whose disease onset ages were from 11 to 20 years or older than 20 years, respectively. In contrast, the percentage of patients carrying compound heterozygous or homozygous missense mutations was higher in group 3 than in group 1 or group 2 (Table 2). The most common mutation (p.Y808X) was detected in 12 patients, and all were heterozygous compound with missense (6 patients), splicing (1 patient), and insertion or deletion (5 patients) mutations. The two most frequent missense mutations (p.F2188S and p.N965S) were identified as heterozygous. In 84 patients, 9 patients carried complex mutations, and 4 of those 9 patients carried a common complex allele p.E328V/p.E1036K. All these patients had early onset age and relatively severe visual acuity defects. One patient (010222) also carried three heterozygous mutations (p.E328, p.E1036K, and p.R1843W); however, he did not harbor the common complex allele p.E328V/p.E1036K, as only p.E1036K was detected in his son in the subsequent cosegregation analysis. Compared to the four patients carrying the common complex alleles (p.E328V/p.E1036K), patient 010221 had a late onset age (44 years old).

      Case#: Patient#010046, Chinese, 28yo at onset

      DiseaseAssertion: stargardt

      FamilyInfo: n/a

      CasePresentingHPOs: STGD1 diagnosis based on the following criteria: "a bilateral central vision defect; fundus displaying a beaten-bronze appearance and/or orange-yellow flecks in the retina from the macula to the midperiphery; fluorescein angiography presenting with a typical dark choroid; and normal to subnormal ERG results." stage 2( numerous yellow-whitish flecks throughout the posterior pole) BCVA=0.05/ 0.05

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: p.P2097S; p.A1773V phase unknown

      ClinVar: 2202780

      CAID: CA341277622

      SupplementalData: supplementary table S3 has phenotype information

    1. 93RECRDrecessive ABCA4 c.3988G>Tp.E1330XHet[a]c.6410G>Ap.C2137YHet[a]

      Case#: 93RE proband, Spanish

      DiseaseAssertion: cone rod dystrophy

      FamilyInfo: 1 affected sibling with the same genotype. het, carrier parents

      CasePresentingHPOs: n/a

      CaseHPOFreeText:

      CaseNotHPOs: n/a

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: c.6410G>A (p.C2137Y); c.3988G>T (p.E1330X) found on WES. Cosegregation with GNAT2, ZNF513, OPA1, RP1L1

      ClinVar: 2202779

      CAID: CA341277358

      SupplementalData: pedigree with genotype in supplemental file

    1. Case 3A 15-year-old female presented with complaints of difficulty reading materials held greater than 6 inches from her eyes. She was clinically diagnosed with STGD 4 years prior and noted decreased visual acuity since age seven, which stabilized over the past few years. Family history was not significant for ocular disease. Best-corrected visual acuity was 20/150 OU. Anterior segment exam was unremarkable with applanation tonometry measuring 16 mmHg OU. Posterior segment exam and autofluorescence was significant for bilateral central atrophy and pisciform fleck atrophy involving the peripapillary, macular, and peripheral regions OU (Figure 3, A and B). Genotyping was significant for ABCA4 mutations P1380L and R2030Q.Open in a separate windowFig. 3A and B, Case 3. STGD mutations P1380L and R2030Q. Autofluorescence OD and OS demonstrate atrophic fleck lesions involving the macula and periphery with an area of confluent atrophy superotemporal to the fovea OD. Hyperautofluorescent flecks are also present in the periphery OU. The peripapillary regions reveal atrophic flecks OU without areas of confluent atrophy.

      Case#: Hwang Case 3, female, 15yo at report, 7yo at onset

      DiseaseAssertion: Stargardt

      FamilyInfo: Family history was not significant for ocular disease.

      CasePresentingHPOs: HP:0500087, HP:0011507

      CaseHPOFreeText: difficulty reading materials held greater than 6 inches from her eyes, decreased visual acuity since age seven. BCVA was 20/150 OU. Posterior segment exam and autofluorescence was significant for bilateral central atrophy and pisciform fleck atrophy involving the peripapillary, macular, and peripheral regions OU (Figure 3, A and B).

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: Genotyping was performed by the ABCR400 microarray followed by direct sequencing to confirm identified variants.

      PreviouslyPublished: n/a

      Variant: P1380L and R2030Q

      ClinVar: 7904

      CAID: CA129033

      SupplementalData: n/a

    2. Case 2A 19-year-old female referred for consultation for difficulty reading, particularly in dim light. She was clinically diagnosed with STGD 3 month prior, after complaining of gradual difficulty in focusing. Family history was not significant for ocular disease. Visual acuity measured 20/40 OD and 20/150 OS. Slit-lamp examination was unremarkable with normal anterior segments and applanation tensions of 14 mmHg OU. Funduscopic exam revealed bilateral central atrophy, multiple fleck lesions, multiple clumps of yellowish deposits at the level of the retinal pigment epithelium in the posterior pole surrounded with some pigment clumping, and no evidence of atrophy of the retinal pigment epithelium. Autofluorescence imaging revealed multifocal atrophic lesions involving the central macula and peripheral hyperautofluorescent flecks OU. The peripapillary regions demonstrated atrophic flecks OU without confluent atrophy (Figure 2, A and B). Genotyping revealed homozygous ABCA4 mutations, P1380L and P1380L.Open in a separate windowFig. 2Case 2. STGD mutations P1380L and P1380L. A, Autofluorescence OD. B, Autofluorescence OS show multifocal hypoautofluorescent (atrophic) lesions involving the central macula OU and peripheral hyperautofluorescent flecks OU. The peripapillary regions have atrophic flecks OU but there is not confluent peripapillary atrophy.

      Case#: Hwang Case 2, female, 19yo at report, 18yo at onset

      DiseaseAssertion: Stargardt

      FamilyInfo: Family history was not significant for ocular disease

      CasePresentingHPOs: HP:0007663, HP:0500087, HP:0011507

      CaseHPOFreeText: difficulty reading, particularly in dim light; gradual difficulty in focusing. Visual acuity measured 20/40 OD and 20/150 OS. bilateral central atrophy, multiple fleck lesions, multiple clumps of yellowish deposits at the level of the retinal pigment epithelium in the posterior pole surrounded with some pigment clumping, and no evidence of atrophy of the retinal pigment epithelium. Autofluorescence imaging revealed multifocal atrophic lesions involving the central macula and peripheral hyperautofluorescent flecks OU. The peripapillary regions demonstrated atrophic flecks OU without confluent atrophy (Figure 2, A and B).

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: Genotyping was performed by the ABCR400 microarray followed by direct sequencing to confirm identified variants.

      PreviouslyPublished: n/a

      Variant: P1380L homozygous

      ClinVar: 7904

      CAID: CA129033

      SupplementalData: n/a

    3. Case 4A 52-year-old male was examined for declining vision OS over the past few months. He was previously clinically diagnosed with STGD 7 years before presentation. Family history was not significant for ocular disease. Best-corrected visual acuity measured 20/100 OD and 20/70 OS. Spherical refractive error measured −3.00 OD and −3.25 OS. Anterior segment examination was unremarkable and applanation tonometry measured 17 mmHg OD and 14 mmHg OS. Posterior segment examination was significant for central atrophy and classic peripheral pisciform flecks sparing the peripapillary regions OU (Figure 4, A and B). Autofluorescence imaging demonstrated inner atrophic flecks and outer hyperautofluorescent flecks. Moderate peripapillary hypoautofluorescence, but not atrophy, was present, likely secondary to the patient’s myopia (Figure 4, C and D). Genotyping revealed two heterozygous ABCA4 mutations, P1380L and S1696N.Open in a separate windowFig. 4Case 4. STGD mutation IVS40 + 5G>A. A, Color Photo OU. B, Red-Free Photo OU reveal central atrophy and classic peripheral pisciform flecks sparing the peripapillary regions OU. C, Autofluorescence OD. D, Autofluorescence OS show that the innermost flecks are hypoautofluorescent, consistent with atrophy, whereas the outermost flecks are hyperautofluorescent, demonstrating excess lipofuscin. There is moderate peripapillary hypoautofluorescence that is not as dark as this patient’s central atrophy or the peripapillary atrophy of Case 1. This finding may thus be due to the patient’s myopia.

      Case#: Hwang Case 4, male, 52yo at report, 45yo at onset

      DiseaseAssertion: Stargardt

      FamilyInfo: Family history was not significant for ocular disease.

      CasePresentingHPOs: HP:0000545

      CaseHPOFreeText: declining vision OS, BCVA was 20/100 OD and 20/70 OS. Spherical refractive error measured −3.00 OD and −3.25 OS. Posterior segment examination was significant for central atrophy and classic peripheral pisciform flecks sparing the peripapillary regions OU (Figure 4, A and B). Autofluorescence imaging demonstrated inner atrophic flecks and outer hyperautofluorescent flecks. Moderate peripapillary hypoautofluorescence, but not atrophy, was present (Figure 4, C and D).

      CaseNotHPOs: HP:0500087

      CaseNotHPOFreeText:

      GenotypingMethod: Genotyping was performed by the ABCR400 microarray followed by direct sequencing to confirm identified variants.

      PreviouslyPublished: n/a

      Variant: P1380L and S1696N

      ClinVar: 7904

      CAID: CA129033

      SupplementalData: n/a

    1. Patient 8, a 13-year-old individual carrying two mutations, the p.Leu541Pro and p.Ala1038Val, most likely as a complex allele, had an early disease onset with 20/200 VA and stage 4 FC (Table 1). Previous reports have documented the severity and early age of onset associated with the p.[Leu541Pro;Ala1038Val] complex variant.36,38 Our screening studies failed to detect an additional mutation in ABCA4 in patients 6, 8, or 12.

      Case#: Patient 8, 13yo at report, British Columbia, Canada

      DiseaseAssertion: Stargardt disease

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: stage 4 Fishman classification (extensive choroid and RPE atrophy throughout the fundus, decreased ERG cone and rod amplitudes, and moderate to severe peripheral field restriction). Visual acuity= 20/200

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: exons and exon-intron boundaries of ABCA4, CNGB3, and ELOVL4 were sequenced

      PreviouslyPublished: n/a

      Variant: L541P; A1038V phase unknown, but likely a complex allele

      ClinVar:

      CAID: CA226911

      SupplementalData: n/a

    1. 6Mc.4720G>Tp.Glu1574*not detected 20/15020/2006/38/32

      Case#: Patient #16, male, 6yo at onset, Brazilian

      DiseaseAssertion: stargardt

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: type II (an area of foveal hypofluorescence surrounded by an area with a heterogeneous appearance and hyperautofluorescent and hypoautofluorescent points that extend to the temporal arcades, giving the retina a reticulate appearance). visual acuity: OD=20/150, OS=20/200

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: c.4720G>T p.(Glu1574*), no second variant. NGS and conclusive molecular testing regarding other Stargardt genes were excluded

      ClinVar: 1460063

      CAID: CA341283936

      SupplementalData: n/a

    1. We identified 255 patients (87.9 %) harboring biallelic ABCA4 variants, 27 probands (9.3 %) with two or three variants but lacking familial segregation analysis, and eight patients (2.8 %) with monoallelic ABCA4 variants (Supplemental Table S4). We detected 268 distinct ABCA4 variants, consisting of 114 missense, 35 nonsense, 34 frameshift deletion or insertion, 31 canonical splice variants, 13 noncanonical splice site variants, 9 in-frame deletion or insertion, 9 DIVs, 4 structural variations, and 19 complex variants (Fig. 2).

      Case#: Patient#010477, Chinese, male, 18yo at onset

      DiseaseAssertion: stargardt

      FamilyInfo: n/a

      CasePresentingHPOs: STGD1 diagnosis based on the following criteria: "a bilateral central vision defect; fundus displaying a beaten-bronze appearance and/or orange-yellow flecks in the retina from the macula to the midperiphery; fluorescein angiography presenting with a typical dark choroid; and normal to subnormal ERG results." BCVA=0.4/ 0.5

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: p.P2097S; c.2255G>T p.(Ser752Ile) phase unknown

      ClinVar: 2202780;

      CAID: CA341277622;

      SupplementalData: supplementary table S4 has phenotype information

    2. We identified 255 patients (87.9 %) harboring biallelic ABCA4 variants, 27 probands (9.3 %) with two or three variants but lacking familial segregation analysis, and eight patients (2.8 %) with monoallelic ABCA4 variants (Supplemental Table S4). We detected 268 distinct ABCA4 variants, consisting of 114 missense, 35 nonsense, 34 frameshift deletion or insertion, 31 canonical splice variants, 13 noncanonical splice site variants, 9 in-frame deletion or insertion, 9 DIVs, 4 structural variations, and 19 complex variants (Fig. 2).

      Case#: Patient#010382, Chinese, male, 29yo at onset

      DiseaseAssertion: stargardt

      FamilyInfo: n/a

      CasePresentingHPOs: STGD1 diagnosis based on the following criteria: "a bilateral central vision defect; fundus displaying a beaten-bronze appearance and/or orange-yellow flecks in the retina from the macula to the midperiphery; fluorescein angiography presenting with a typical dark choroid; and normal to subnormal ERG results." BCVA=0.4/ 0.6

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: p.P2097S; c.6050G>A p.(Cys2017Tyr) phase unknown

      ClinVar: 2202780;

      CAID: CA341277622;

      SupplementalData: supplementary table S4 has phenotype information

    3. We identified 255 patients (87.9 %) harboring biallelic ABCA4 variants, 27 probands (9.3 %) with two or three variants but lacking familial segregation analysis, and eight patients (2.8 %) with monoallelic ABCA4 variants (Supplemental Table S4). We detected 268 distinct ABCA4 variants, consisting of 114 missense, 35 nonsense, 34 frameshift deletion or insertion, 31 canonical splice variants, 13 noncanonical splice site variants, 9 in-frame deletion or insertion, 9 DIVs, 4 structural variations, and 19 complex variants (Fig. 2).

      Case#: Patient#010455, Chinese, male, 18yo at onset

      DiseaseAssertion: stargardt

      FamilyInfo: n/a

      CasePresentingHPOs: STGD1 diagnosis based on the following criteria: "a bilateral central vision defect; fundus displaying a beaten-bronze appearance and/or orange-yellow flecks in the retina from the macula to the midperiphery; fluorescein angiography presenting with a typical dark choroid; and normal to subnormal ERG results." BCVA=0.01/ 0.01

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: p.P2097S; c.4906_4908del p.(Asn1636del) phase unknown

      ClinVar: 2202780;

      CAID: CA341277622;

      SupplementalData: supplementary table S4 has phenotype information

    1. The proband (II-1), a 43-year-old man

      Case#: 43-year old man, German descent, onset within first decade of life

      DiseaseAssertion: STGD1

      FamilyInfo: Family pedigree shown in Figure 1.

      CasePresentingHPOs: HP:0011463, HP:0000533, HP:0000580, HP:0030500, HP:0011507, HP:0000548, HP:0000510, HP:0007703, HP:0007663, HP:0000512, HP:0000610

      CaseHPOFreeText: Retinal vessels were visibly attenuated.

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: Peripapillary region around the optic nerve had no disease related changes.

      Genotyping Method: Illumina MiSeq platform, Array-CGH analysis

      PreviouslyPublished: n/a

      Variant: NM_000350.3(ABCA4):c.161G>A (p.Cys54Tyr), NM_000350.3(ABCA4):c.4539+2028C>T

      ClinVar: 99065, 236116

      SupplementalData: n/a

    1. 92 RHO c.180C>A p.Tyr60* – [a] ROM1: f 31 RP ad no Ger c.178C>A p.Pro60Thr; – [42], [43] c.323C>T p.Thr108Met rs146358003 [42], [43] ABCA4: c.1654G>A p.Val552Ile rs145525174 [44] c.5714+5G>A RP2: splice rs61751407 [45] c.844C>T RPGRIP1: c.2510C>G p.Arg282Trp rs1805147 [17], [18] p.Ala837Gly – [22]

      Case#: Eisenberger Patient 92, female, 31yo, German

      DiseaseAssertion: Autosomal dominant RP

      FamilyInfo: non-consanguineous

      CasePresentingHPOs:

      CaseHPOFreeText: "The diagnoses of all patients were established by medical history, family history and detailed clinical evaluation of vision. Ophthalmological examination included stereoscopic funduscopy, standard ERG, perimetry, measurement of dark adaptation, and determination of best-corrected visual acuity in most patients."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: NGS for the exons of 55 RP and LCA genes, Sanger for confirmation

      PreviouslyPublished: n/a

      Variant: Allele 1: RHO c.180C>A p.Tyr60; Allele 2*: ROM1: c.178C>A p.Pro60Thr; c.323C>T p.Thr108Met;

      ABCA4: c.1654G>A p.Val552Ile; c.5714+5G>A; <br /> RP2: c.844C>T p.Arg282Trp; <br /> RPGRIP1: c.2510C>G p.Ala837Gly

      ClinVar:

      CAID: CA239745

      SupplementalData: n/a

    1. Case 3 showed a p.Ala643Gly variant in the PROM1 gene and a single variation in the ABCA4 gene, but molecular testing results were inconclusive.

      Annotating here since unable on the PDF.

      Case 3 is a 6yo male. VA: OD: 20/150, OS: 20/200. Proband had macular atrophy and flecks at the posterior pole. In the autofluorescence exam, there was peripapillary sparing of the hyper-autofluorescent flecks. On OCT images the atrophic areas at the macula correlated to disruption of the elipsoid layer and decrease in the foveal thickness. OCT showed loss of the photoreceptor layer and EPR layer. Proband has only 1 ABCA4 variant, so not eligible for PP4. Also has a variant in PROM1 (p.Ala643Gly). ABCA4, PROM1, and ELOVL4 genes sequenced by next-generation sequencing (NGS) test.

    1. ABCA4 whole-gene sequencing, subsequent WGS, and segregation analysis identified a complex deep-intronic allele (NM_000350.2(ABCA4):c.[1555-5882C>A;1555-5784C>G]) in trans to the missense variant.

      PMID: 39421326 (PMCID: PMC11675205)

      Gene: ABCA4

      HGNC ID: 34

      Case#: Patient 24 (male)

      DiseaseAssertion: STGD (Stargardt disease)

      FamilyInfo: Caucasian family from Germany. Patient has two siblings carrying the variant but they are not clinically affected according to pedigree information.

      CasePresentingHPOs: Decreased central visual acuity (HP:0000545) Macular atrophy (HP:0007754) Retinal flecks (HP:0030638) Abnormal fundus autofluorescence (HP:0030647) Macular degeneration (HP:0007754) Abnormal electroretinogram (HP:0000763)

      CaseHPOFreeText: Male patient diagnosed before age 50 with Stargardt disease. Best corrected visual acuity (BCVA) approximately 0.05–0.2. Fundus imaging shows paracentral scotoma, macular atrophy, and hyperfluorescent flecks with sparing of the fovea. Autofluorescence demonstrates hyperreflective spots and patchy lesions with parafoveal involvement.

      CaseNotHPOs: None explicitly reported.

      CaseNotHPOFreeText: Pattern-like distribution of lesions noted on clinical examination.

      Genotyping Method: Whole-exome sequencing (WES) with an in-house RD-associated gene panel including 619 candidate and disease-associated genes.

      PreviouslyPublished: No (novel complex deep-intronic allele described in this study).

      Variant: c.[1555-5882C>A;1555-5784C>G]

      ClinVar: Not reported in ClinVar in the provided information.

      CAID: CA272741; CA227172

      SupplementalData: Segregation data and functional splicing analysis available in the supplemental data (Table S1, Figure S1) of the article.

    1. D023{"type":"entrez-protein","attrs":{"text":"STG00205","term_id":"1440289030"}}STG00205FPlano9January 21, 1985May 5, 201328.3

      Case#: Bertelsen Patient D023, female, 9yo at onset

      DiseaseAssertion: generalized choriocapillaris dystrophy

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: end-stage generalized choriocapillaris dystrophy characterized by semiconfluent multifocal areolar outer retinal atrophy, the severity of which decreases with increasing eccentricity. Central patches of visible sclera are surrounded by coarse confluent hyperpigmentation. The periphery shows isolated or clustered hyperpigmentation. In and around the fovea there is pronounced atrophy of the retinal pigment epithelium, the photoreceptor layer, and the outer nuclear layer and intraretinal hyperreflective material corresponding to the hyperpigmentation

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: microarray

      PreviouslyPublished: n/a

      Variant: c.203C>T p.P68L; c.3329-2A>G

      ClinVar: 99113

      CAID: CA226972

      SupplementalData: n/a

    1. Disease-causing or likely disease-causing mutations were identified in 185 out of 251 patients (74%) with MD/CCRD (Supplementary Table 1).

      Case#: Patient #43, male, 9yo at onset, 16yo at report, German

      DiseaseAssertion: macular dystrophy or cone-rod dystrophy

      FamilyInfo: inheritance= sporadic. phase not confirmed, but no other affected family members and no parental consanguinity

      CasePresentingHPOs:

      CaseHPOFreeText: reduced visual acuity, erg scotopic= reduced, erg-photopic=reduced

      CaseNotHPOs:

      CaseNotHPOFreeText: syndromic retinal disease, age-related macular degeneration, central serous retinopathy, autoimmune retinopathy, retinal vascular disease, achromatopsia, X-linked retinoschisis, North Carolina macular dystrophy

      CasePreviousTesting: n/a

      GenotypingMethod: Sanger sequencing of ABCA4

      PreviouslyPublished: n/a

      Variant: c.3098del (p.Lys1033Serfs*51); c.3243G>T (p.Lys1081Asn)

      ClinVar: 236516

      CAID: CA10581650

      SupplementalData: Supplementary table 1

    1. We found two variants or more in ABCA4 in 69/95 (73%) probands (Supplementary Tables 2, 3); a single ABCA4 variant was found in 9/95 (9.5%) probands with STGD1 phenotype. A second variant could be found in four of these nine patients by Khan et al. (2020) (Figure 1 and Supplementary Tables 2, 4). Therefore, a total of 73/95 (77%) probands of our cohort ended up having two or more ABCA4 variants. In 17/95 (18%) probands, no variant was found in any of the sequenced genes.

      Case#: Patient STG-16, 13yo at onset, Argentina

      DiseaseAssertion: STGD1

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: BCVA=0.7/0.7, FA=3B, AF pattern=2, OCT showed decreased retinal thickness with disruption of external layers

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: NGS of ABCA4 (NM_000350.2), ELOVL4 (NM_022726.3), PROM1 (NM_006017.2), and CNGB3 (NM_019098.4)

      PreviouslyPublished: n/a

      Variant: c.4457C>T (p.Pro1486Leu); c.1804C>T (p.Arg602Trp)

      ClinVar: 99283

      CAID: CA227192

      SupplementalData: supplementary table 2 has genotype/phenotype info

    1. RP-029895-0103 ABCA4 c.4720G>Tp.E1574*known [44]

      Case#: Proband 95-0103, Spanish, onset at 8yo

      DiseaseAssertion: cone-rod dystrophy

      FamilyInfo: Family RP-0298. Affected sister, 95-0101, with same genotype

      CasePresentingHPOs: HP:0001133, HP:0000529, HP:0000662, HP:0000512, HP:0000543, HP:0007737, HP:0007641, HP:0007787

      CaseHPOFreeText: BCVA=0.1/0.1; ERG: scotopic-Low amplitude, normal latency, photopic-abolished, mixed-diminished a and b waves; dense pigment accumulation at macular region;, bilateral posterior subcapsular cataract.

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: 19365591

      Variant: c.4720G>T p.E1574; c.950delG p.G317Afs57. WES, All patients were previously tested and all resulted to be negative for known autosomal recessive retinitis pigmentosa (ARRP) or Leber Congenital Amaurosis (LCA) mutations by microarray screening

      ClinVar: 1460063

      CAID: 341283936

      SupplementalData: Table S2 has phenotype details

    1. 534-05STGD2461 T→AW821RMissense4139 C→TP1380LMissense5682 G→CNoneSilent5814 A→GNoneSilent

      Case#: Family AR534 Proband 05

      DiseaseAssertion: Stargardt

      FamilyInfo: Three paternal cousins are affected with STGD, with onset between the ages of 8 and 10 (unaffected het parents). The proband’s parents reported no visual impairment (father has P1380L/wt, mother has W821R/wt), but the paternal grandmother had been diagnosed previously with age-related macular degeneration at age 68 (het for P1380L). Subsequently, she developed hemorrhagic detachment of the macula, and a diagnosis of exudative AMD was made at age 74

      CasePresentingHPOs:

      CaseHPOFreeText: central visual impairment at age 11, retinal atrophy of the macula and a few peripheral flecks, A dark choroid was observed on fluorescein angiography,

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: Direct DNA sequencing of the 50 exons and flanking intronic regions of ABCR. Heteroduplex analysis

      PreviouslyPublished: n/a

      Variant: c.2461T>A (p.W821R); c.4139C>T (p.P1380L). Phase confirmed. Also has 2 synonymous variants (c.5682G>C and c.5814A>G)

      ClinVar: 7904

      CAID: CA129033

      SupplementalData: n//a

    1. P023 ABCA4 20 c.3035_3037delACA p.Asn1012Ile ATP-binding domain novel deletion – DCABCA4 24 c.3547G>T p.Gly1183Cys – reported – – –ABCA4 46 c.6289C>T p.Pro2097Ser ATP-binding domain novel missense probablydamagingDC

      Case#: Patient #P023, Korean

      DiseaseAssertion: stargardt

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: no individual phenotype information, group only

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: exome sequencing: c.6289C>T p.Pro2097Ser; c.3547G>T p.Gly1183Cys; c.3035_3037delACA p.Asn1012Ile

      ClinVar: CA341277622

      CAID: 2202780

      SupplementalData: n/a

    1. In this study, we summarized the phenotypic and genotypic characteristics of 129 Chinese patients with ABCA4-RD.

      paper not publicly available, but is said to contain this variant based on LOVD entry. requested from library.

      Update: Received paper from library. 1 proband in Figure 1 has this variant, but cannot access the supplementary info to see the individual phenotype information. Affected maternal aunt with homozygous c.4605_4606ins-non-segregation.

    1. Additionally, one novel change in exon 12 (p.Val552Ile) was found in one STGD patient by means of the dHPLC technique. This variant was detected in two alleles out of 200, suggesting a polymorphism.

      Case#: Aguirre-Lamban Unlabeled Proband, Spanish

      DiseaseAssertion: STGD

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: "Diagnosis of STGD was determined according to a bilateral central vision loss with a beaten-bronze appearance and/or the presence of orange-yellow flecks in the retina from the posterior pole to the mid-periphery; typical dark choroid observed by fluorescein angiography; and normal to subnormal electroretinograms (ERGs)."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: ABCR400 microarray, direct sequencing, dHPLC, haplotype analysis

      PreviouslyPublished: n/a

      Variant: c.1654G>A p.Val552Ile, interpreted as non-pathogenic, suggested to be a polymorphism

      CAID: CA239745

      SupplementalData: n/a

    2. Interestingly, we identified one 30-year-old patient (ARDM-247), double heterozygous for the p.Arg1129Leu and p.Cys2137Tyr alleles, who presented a CRD phenotype. This p.Cys2137Tyr change was located more towards the amino terminus. Moreover, in other study, the results showed that the changes located in this zone appear to result in altered processing of the protein and to be associated with an earlier onset of disease.16 The p.Cys2137Tyr change in combination with the p.Arg1129Leu allele produced a CRD phenotype. Therefore, we speculate that the novel p.Cys2137Tyr variant could be a severe allele which is modifying the patient’s phenotype.

      Case#: Family MD-0247/ARDM-247 Proband, 12yo at onset

      DiseaseAssertion: AR cone rod dystrophy

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: STGD diagnosed based on "bilateral central vision loss; fundus presenting with a beaten-bronze appearance and/or the presence of orange-yellow flecks in the retina from the posterior pole to the mid-periphery; fluorescein angiography showing typical dark choroid; and normal to subnormal electroretinogram (ERGs)." VA loss, VF loss, BCVA=0.05/0.1, cone-pattern on ERG

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: c.6410G>A (p.Cys2137Tyr); c.3386G>T (p.Arg1129Leu) found by ABCR400 + dHPLC + HRM

      ClinVar: 2202779

      CAID: CA341277358

      SupplementalData: n/a

    1. 16P36M198426217–50.300.10 P37F198913817–40.22

      Case#: Family 16, P37, female, Netherlands 13yo at onset

      DiseaseAssertion: Stargardt

      FamilyInfo: 1 affected sibling with same genotype

      CasePresentingHPOs:

      CaseHPOFreeText: visual acuity: OD=0.22, FAF images consistent with STGD1

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: Sanger

      PreviouslyPublished: n/a

      Variant: c.5196+1137G>A; c.859-506G>C

      ClinVar: 438100

      CAID: CA26843511

      SupplementalData:

    1. ABCA4

      In supplemental table S2, Case LL345 is listed as "likely solved" with a clnical diagnosis of Stargardt disease. Proband is compound heterozygous for c.4139C>T p.(Pro1380Leu) and c.4918C>T p.(Arg1640Trp).

      In Supplemental table S1, this proband is a female, 25yo at report, 11yo at onset. Decreased VA: 0.08/0.05, emmetropia OU

    2. ABCA4

      In supplemental table S2, Case LL291 is a female listed as "likely solved" with a clinical diagnosis of CRD. Proband is compound heterozygous for c.32T>C p.(Leu11Pro) and c.5196+1137G>A.

      In Supplemental table S1, this proband is a female, 54yo at report, 50yo at onset. Nyctalopia, visual acuity=0.05/0.6, OD: extremely high myopia OS: high myopia, no family information

    1. A 25-year-old White man presented with bilateral central vision loss due to foveal lesions consisting of vitelliform fluid.

      Case#: Patient 1, male, Caucasian, onset at 20yo, USA

      DiseaseAssertion: ABCA4

      FamilyInfo: No family history of retinal disease.

      CasePresentingHPOs: HP:0007677, HP:0030603, HP:0030500, HP:0030636, HP:0004328, HP:0012372

      CaseHPOFreeText: Bilateral central vision loss, progressive decline in visual acuity (20/60 both eyes), foveomacular vitelliform lesions with fluid accumulation, optical gap lesions progressing to cavitated appearance after fluid resorption, thinning and abnormal reflectivity of photoreceptor layers, near-infrared autofluorescence abnormalities in lesion-adjacent regions

      CaseNotHPOs: HP:0000510, HP:0000511

      CaseNotHPOFreeText: No generalized rod or cone dysfunction on full-field electroretinogram, EOG findings not consistent with bestrophinopathy (Arden ratio 1.62)

      Genotyping Method: Exome sequencing

      PreviouslyPublished: None

      Variant: NM_000350.3(ABCA4):c.5882G>A (p.Gly1961Glu), NM_000350.3(ABCA4):c.4139C>T (p.Pro1380Leu)

      ClinVar: ClinVarID:7888, ClinVarID:7904

      CAID: N/A

      SupplementalData: N/A

    1. RP-087M30c.6397T>Cp.C2133RD1D2D322.80Y

      Case#: Sporadic RP Patient 087, male, Chinese, 30yo at report

      DiseaseAssertion: RP

      FamilyInfo: n/a, sporadic case

      CasePresentingHPOs:

      CaseHPOFreeText: "The sporadic RP patients generally showed pubertal night blindness, restricted peripheral vision, progressive vision loss, overall bone-spicule pigmentation of the retina, attenuation of retinal vessels, and the flattening of the rod and cone ERG responses."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: WES with Sanger sequencing confirmation

      PreviouslyPublished: no

      Variant: c.6397T>C p.(C2133R)

      ClinVar: 2021273

      CAID: CA341277387

      SupplementalData:

    1. Carrier frequency analysis of mutations causing autosomal-recessive-inherited retinal diseases in the Israeli population

      PMID: 29706639

      Gene: ABCA4

      HGNCID: HGNC:34

      MonDO: MONDO:0019353

      Bioinformatic analyses of an SQL-based database containing 12272 variants that appear in 178 IRD genes in 5706 individuals of Ashkenazi Jewish origin based on the gnomAD database (version 2) and variants that were published in the scientific literature that was extracted from HGMD. Authors extracted information regarding IRD variants from various sources (including data of 5706 Ashkenazi Jewish (AJ) samples and a large cohort of Israeli patients with IRDs) to estimate carrier frequency of IRD mutations in different subpopulations in Israel. Two major databases aiming to estimate carrier frequency of IRD mutations in the Israeli population (Fig. 1): “gnomAD-AJ-IRD DB” containing data of 5706 AJ controls extracted from gnomAD and “HW-IRD DB” containing data extracted from our cohort of Israeli patients with IRDs.

      See Fig 2 for breakdown of variants analyzed.

      The final DB (IRDB) (Fig. 1 and Table S7) includes all 399 variants from “gnomAD-AJ-IRD DB” and “HW-IRD DB” that were considered here as pathogenic mutations in 111 known IRD genes.

      To establish the “HW-IRD DB” (Fig. 1), we collected data on Israeli IRD patients with a known cause of disease (a cohort of >2000 IRD families). The HW-IRD DB includes 289 pathogenic mutations (Fig. 1) that were identified in IRD patients who have biallelic variants.

      SupplementalData: S7, carrier frequency data for each mutation in all nine studied subpopulations. Carrier frequency was calculated as 2pq where p = 1 − q and q was calculated as the root square of the number of homozygous patients plus half the number of compound heterozygous patients divided by the population size

      Variant: NM_000350.2:c.4895dup,p.Asn1632fs

      CAID: CA915941330

      Case: Ashkenazi Jewish patient with inherited retinal disease, STGD, CRD

      CasePresentingHPOs: HP:0000548 (Cone/cone-rod dystrophy, CRD)

      CaseHPOFreeText: Stargardt disease (STGD)

    1. 15 MEH c.5196+1137G>A p.[=,M1733Efs∗78] c.[1715G>A;2588G>C] p.[(R572Q;G863A,G863del] Y U 20546

      Case#: Patient #15, Moorfields Eye Hospital, London, UK, female, 39yo at onset, 51yo at report,

      DiseaseAssertion: ABCA4-Associated Retinopathy, clinical diagnosis of STG

      FamilyInfo: no additional family-member WGS data available

      CasePresentingHPOs:

      CaseHPOFreeText: BCVA= OD: 6/9, OS: 6/9, Fishmann Classification=2 (fleck-like lesions anterior to the vascular arcades and/or nasal to the optic disc), early changes to foveal photoreceptors, Extent of FAF abnormalities with Regard to Vascular Arcades: beyond. ffERG Group: 1(normal). PERG: Abnormal. FAF in Fig. 1B. characteristic yellow-white pisciform flecks in the RPE of the posterior pole that were hyperautofluorescent on FAF imaging or progressive atrophy of the macular RPE

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: Haplotype analysis, ABCA4 mutation screening was performed by next-generation sequencing, sequenced as part of the retinal panel at the Molecular Vision Lab

      PreviouslyPublished:

      Variant: c.5196+1137G>A p.[=,M1733Efs∗78] c.[1715G>A;2588G>C] p.[(R572Q;G863A,G863del]

      ClinVar: 7900

      CAID: CA226918

      SupplementalData:

    1. The third patient was a 27-year-old man who was the son of third-degree consanguineous parents.

      Case#: Case 3, male, onset at 24yo, Italy

      DiseaseAssertion: STGD1

      FamilyInfo: third-degree consanguineous parents; both parents healthy heterozygous carriers of the ABCA4 variant

      CasePresentingHPOs: HP:0000529, HP:0007754, HP:0000518

      CaseHPOFreeText: progressive deterioration of vision at age 24. Bilateral macular dystrophy and diffuse lens opacities on ophthalmologic examination. OCT, ERG, and VEP consistent with Stargardt maculopathy.

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      Genotyping Method: NGS (custom enrichment panel), Illumina NextSeq550; variant confirmed by Sanger sequencing.

      PreviouslyPublished: n/a

      Variant: NM_000350.3(ABCA4):c.2828G>A (p.Arg943Gln), homozygous; rs1801581

      ClinVar: Variation ID: 7913

      CAID: n/a

      SupplementalData: n/a

    1. A total of 42 unrelated patients (28 men and 14 women) were included in this study. Two patients (A002 and A035) were from consanguineous families (Figure 1). The detailed clinical findings are presented in Data S1.

      Case#: Liu Proband A034, Chinese, female

      DiseaseAssertion: Stargardt

      FamilyInfo: Mother has the Pro68Leu variant, but the father was not genotyped to know the phase of the second variant. Proband's daughter also has the Pro68Leu variant, but is unaffected.

      CasePresentingHPOs:

      CaseHPOFreeText: no individual details provided

      CaseNotHPOs:

      CaseNotHPOFreeText: patients with other ocular diseases, such as choroidal neovascularization, glaucoma, and diabetic retinopathy, or were undergoing treatments/therapeutic trials were excluded.

      GenotypingMethod: Either eye gene-enriched (from 36 to 450 target genes) panel-based next-generation sequencing (NGS). Sanger bi-directional sequencing was conducted to confirm the rare candidate variants (allele frequency: less than 1.0% of the general population) and to perform the co-segregation analysis

      PreviouslyPublished: n/a

      Variant: c.203C>T p.(Pro68Leu); c.3883_3884del p.(Glu1295Lysfs*126)

      ClinVar: 99113

      CAID: CA226972

      SupplementalData: S1 only provides group demographics for the different clinical classifications (fundus grade, FAF type, etc)

    1. Supplementary data. bjophthalmol-2018-312064supp004.pdf

      This variant is found on pg 16 in proband 14075. Compound heterozygous for c.6817-2A>C. MEH institute (UK). Said to have Stargardt based on the following criteria: "(1) patients (at least 6 years old) with at least two ABCA4 variants or one ABCA4 variant associated with a typical STGD1 phenotype and (2) presence of a well-defined atrophic lesion with/without flecks at the most recent visit of at least 300 µm in diameter (the total area of all lesions <12 mm2)." No additional details provided

    2. Supplementary data. bjophthalmol-2018-312064supp004.pdf

      This variant is found on pg 11 in proband 18034. Compound heterozygous for c.2588G>C p.Gly863Ala. Said to have Stargardt based on the following criteria: "(1) patients (at least 6 years old) with at least two ABCA4 variants or one ABCA4 variant associated with a typical STGD1 phenotype and (2) presence of a well-defined atrophic lesion with/without flecks at the most recent visit of at least 300 µm in diameter (the total area of all lesions <12 mm2)." No additional details provided

    1. Pt-75Mc.4539 + 2028C > Tp.[= ,Arg1514Leufs*36]c.2453G > Ap.(Gly818Glu)

      Case#: Pt 7, male, 60yo at report, onset between 6-49yo, Irish

      DiseaseAssertion: Stargardt

      FamilyInfo: family 5

      CasePresentingHPOs:

      CaseHPOFreeText: VA: OD=6/36 OS=6/120, FAF and OCT in figure 2, FAF WRT vascular arcades=beyond, beaten bronze appearance, yellow flecks centrally, peripapillary sparing, central retinal thickness: OD=100 microns OS=117 microns, optical coherence tomography (OCT) atrophy horizontal width: OD=6000 microns OS=5446 microns

      CaseNotHPOs:

      CaseNotHPOFreeText: bulls eye pattern, flecks peripherally

      GenotypingMethod: Target capture NGS of the exons and known pathogenic intronic regions of ABCA4, whole-gene single molecule molecular inversion probe (smMIP) based sequencing of ABCA4 as well as 40 kb of flanking sequence, direct Sanger sequencing, or WGS

      PreviouslyPublished: n/a

      Variant: c.4539 + 2028C > T p.[= ,Arg1514Leufs*36]; c.2453G> A p.(Gly818Glu)

      ClinVar: 99135; 236116

      CAID: CA227000; CA10576057

      SupplementalData: n/a

    1. Patients and Methods The protocol of the study adhered to the provisions of the Declaration of Helsinki. After informed consent was obtained, blood samples were taken and molecular analysis on the ABCA4 gene was performed as described by Maugeri et al. 14 The charts of patients with ABCA4 mutations who originally had received diagnoses of isolated or autosomal recessive CRD were reviewed. All patients originated from the University Medical Centre Nijmegen (Nijmegen, The Netherlands) and the University of Heidelberg (Heidelberg, Germany). In this study the diagnosis of CRD was based on the following criteria: initial symptoms of blurred central vision without a history of night blindness, impairment of color vision, and fundoscopic evidence of maculopathy without or with mild peripheral retinopathy. 3 4 5 7 8 In patients with recordable ERGs a cone–rod pattern of degeneration had to be present (i.e., the photopic b-wave impairment had to be greater than or equal to the scotopic b-wave amplitude impairment). Patients 9250 and 13163, who had nonrecordable ERGs, were included because their histories and clinical features were similar to those of other patients with cone–rod degeneration and they were believed to represent advanced cases of CRD. In addition to an ophthalmic examination, Goldmann kinetic perimetry routinely was performed using III-4-e and I-4-e isopters. Color vision was tested with the Ishihara and Panel D15 tests, except in patients 9369, 9378, and 10125, who were tested under conditions described earlier. 18 Because these patients were examined in two different clinics and ERGs were recorded over a long period, the methods, instrumentation, and analysis techniques of the electroretinography varied. The ERGs in patients 9369, 9378, 10125, and 11872 were performed as described by Thijssen et al. 19 The ERG method used in patients 9370, 9553, 9633, and 13163 was described by Alexandridis and Krastel. 20 The ERGs of the remaining patients (9250, 9371, and 9650) are of a more recent date and were performed according to International Society for Clinical Electrophysiology of Vision (ISCEV) standards. 21 Fundus photographs were taken in most patients and some of the patients (9650, 9369, 9378, and 10125) also underwent fluorescein angiography.  Results The characteristics of 12 patients with ABCA4-associated retinal dystrophy resembling CRD are summarized in Table 1 . Most did not have affected family members, and therefore their retinal dystrophies could not be classified as autosomal dominant, autosomal recessive or X-linked. Four patients reported a brother or sister with subnormal vision. In view of the reputedly normal visual acuity of the parents and the molecular defects, the inheritance pattern of the gene defects in these patients (individuals 9303, 9369, 9553, and 13163) was classified as autosomal recessive.  The visual acuity of the patients did not exceed 20/200 and, on average, was much lower. With the exception of patient 9553, the age of onset was at or before the age of 12, and in each of the patients, blurred vision was the initial symptom. Night blindness did not occur except in patients 9378 and 10125, in the final stages of retinal degeneration. Evidence of maculopathy in the form of bull’s eye maculopathy or pigmentary changes was present in all the patients reported in this study (Fig. 1A) . The functional equivalent of the mainly centrally located retinal disease was a central scotoma, varying from 8° to more than 40°. In all but one patient, the scotoma was absolute. Only in patient 9378 was the central scotoma relative and surrounded by absolute scotomas. Fundoscopic evidence of early peripheral involvement of the retina was mild, and only in the later stages of the disease did peripheral changes characteristic of RP, such as narrowing of retinal vessels and bone spicula, occur in patients 9369 (Fig. 1B) and 10125. Similarly, mild constriction of the visual fields occurred only in two patients (9650 and 10125) and only in the advanced state. Color vision was tested in 10 patients. Six demonstrated a red–green defect, and in two of these (patients 11872 and 10125), it was accompanied by a blue-yellow defect. In the remaining four patients, color vision was so severely disturbed that the exact type of impairment could not be assessed.  The ERG recordings demonstrated degeneration of both rods and cones. When ERG responses could be elicited, the cones appeared to be affected as much as the rod photoreceptors and, in most of the patients, even more severely. The ERG responses in five patients progressively deteriorated until no photopic and scotopic responses could be recorded. In these patients, with exception of patients 9250 and 13163, ERG recordings of an earlier date were used in Table 1 . This applies to patient 9369, in whom an ERG was recorded at age 12 (all ERG responses had been nondetectable since the age of 21), patient 9378 at age 33 (all ERG responses at age 46 were nondetectable), and patient 10125 at age 8 (in 1998, at age 28, the ERG responses were no longer detectable). Recent ERG findings were not available for patients 9650 and 9371. Their ERGs were recorded in 1989 and 1985, respectively. The remaining ERG data were derived from ERG recordings performed in the past 4 years. Of patient 9371 only the ERG data in the left eye were available.  Two patients warrant a more detailed description, due to the unusual course of their retinal dystrophies. Patient 9378, at the age of 12, had blurred vision with fundoscopic evidence of irregular chorioretinal atrophy in the posterior pole. At that time, there were no peripheral abnormalities on ophthalmoscopy, and there was no history of night blindness. The ERG demonstrated an equal reduction of both cone- and rod-mediated responses. Later in life, however, fundoscopic changes developed that were characteristic of RP, and the patient reported a decrease in night vision. With fluorescein angiography partly confluent patches of chorioretinal atrophy were visible (Fig. 1C) .  The clinical picture of patient 10125 differed from that of the other patients, despite the mutation in the ABCA4 gene. Initially, disease in this patient was diagnosed as STGD because of the bull’s eye maculopathy, the granular pigment alterations in the macular area, and the pisciform flecks surrounding the posterior pole. At age 8 his visual acuity had decreased to 20/200 in both eyes. When he was referred to our clinic in 1998 at the age of 28, peripheral degeneration in the form of narrow retinal vessels and deposition of peripheral bone spicula had developed, in addition to the earlier described disease of the central retina. A fluorescein angiogram showed typical findings: a central small hypofluorescent spot enclosed by an ellipsoid—a markedly hyperfluorescent area that in turn was surrounded by hyperfluorescent dots against a dark background, most likely caused by obscuration of choroidal background fluorescence (Fig. 1D) . Early ERG recordings were not available, and the ERG tracings recorded at age 28 represent the final stage of the degenerative process, with absence of both cone and rod responses. This retinal dystrophy seemed to have evolved from STGD into more widespread retinal degeneration, resulting in loss of function of both rods and cones.  Discussion Progressive CRD is a clinically heterogeneous retinal disorder, but typical findings include reduced visual acuity, impairment of the central visual field, color vision deficits, and fundoscopic evidence of maculopathy, with no or few midperipheral retinal pigment deposits. 3 4 7 8 There is some dispute about typical ERG findings in CRD. Some state that the diagnosis of CRD must be based on the reduction or absence of cone responses in the presence of quantitatively less reduction in rod responses, whereas others state that an equal impairment of both photoreceptor systems, if accompanied by the characteristic features, suffices to justify the diagnosis of CRD. 3 7 8 22 Several propositions have been made in the past to classify cone–rod disorders. Some classification systems have focused on individual case reports and were based on nosologic aspects; others have made a distinction according to the various patterns of inheritance. 3 6 23 24 In recent studies, Szlyk et al. 7 and Yagasaki et al. 8 made use of full-field ERGs, dark adaptometry, and modified perimetric techniques to identify functionally distinct subtypes of CRD. Finally, over the past few years, a molecular genetic classification of CRD has emerged.  At the moment, four genes and three loci have been implicated in autosomal dominant CRD, whereas one X-linked locus has been described. 25 26 27 28 29 30 31 32 Thus far, two loci and one gene (ABCA4) have been associated with autosomal recessive CRD. 12 33 34 The genetic heterogeneity seen in CRD is matched by the range of the clinical findings attributed by various investigators to this type of retinal dystrophy.  Whatever the classification system used, some patients display retinal disorders that cannot be classified satisfactorily. Often, these retinal degenerations involve overlapping features. Krill et al. 5 reported that 9 of 45 patients with cone degenerations showed typical features associated with fundus flavimaculatus. Heckenlively 2 described 76 patients with cone–rod patterns on the ERG in whom retinal disease otherwise met the standard definition of RP (progressive peripheral visual field loss with ring scotoma). Alternatively, as seen in patient 10125 in this study, patients with STGD have been described who had progressive peripheral retinal degeneration with severe abnormalities in the ERG and electro-oculogram (EOG) later in life—a condition that has been described by Fishman 4 as secondary progressive cone–rod dysfunction.  The association of CRD and a dark choroid has also been described previously. 35 36 The atypical pattern of retinal degeneration with confluent patches of chorioretinal atrophy in patient 9378 resembles that in another previously described unrelated patient with CRD-like disease caused by mutations in ABCA4. 37 In the molecular genetic study by Maugeri et al., 14 in which 11 of the 12 patients with autosomal recessive CRD described in this study were analyzed, ABCA4 mutations were found in 13 of 20 unrelated patients, strongly suggesting that ABCA4 mutations are the major cause of this disorder. If this is true, the genetic heterogeneity in autosomal recessive CRD, compared with, for example, classic RP, is surprisingly low. Because autosomal recessive inheritance is believed to be the most frequent mode of inheritance of monogenic chorioretinal disorders, it is very possible that a large fraction of the patients with CRD who have been clinically studied previously carry ABCA4 mutations. In that case, the explanation for the high variability of the clinical findings in autosomal recessive CRD would not be genetic heterogeneity but rather the genotype–phenotype model for ABCA4. According to this model, there is an inverse relationship between the presumed residual ABCA4 function as an N-retinylidene-PE flippase and the severity of the disorder. 12 37 38 As a consequence, a continuum of phenotypes is to be expected, ranging from STGD to CRD to RP. Although this is probably a simplified representation of reality and needs corroboration by detailed biochemical studies of individual mutations, as described previously, this model explains why mutations in the ABCA4 gene could give rise to phenotypes that do not satisfy the standard classification of retinal dystrophies. 39   Two patients in this study may reflect borderline CRD phenotypes. Patient 9553 carries a combination of a mild (2588G>C) and severe ABCA4 mutation, which, according to the genotype–phenotype model described earlier, should be associated with STGD. We have previously discussed that most likely, one of the pathologic mutations has not yet been identified in this patient. 14 However, the age of onset in this patient (25 years) is relatively high, and although other features such as visual acuity, perimetry, and ERG findings are typical of CRD, this may indicate a relatively mild subtype. Another more convincing example of blending of ABCA4-associated phenotypes is patient 10125. The molecular findings in this patient have not yet been described elsewhere. He carries a severe splice site mutation (IVS30+1G→T) in combination with a nucleotide change leading to a stop codon at Gln1029. A patient with RP who was homozygous for the IVS30+1G→T mutation has been described, 12 whereas the Q1029X mutation has not been described. Both mutations can be considered to be null alleles. According to the proposed ABCA4 model, the clinical phenotype in patient 10125 should be RP. Instead, this patient exhibits a typical retinal dystrophy, which gradually progresses from STGD to a more widespread degeneration of photoreceptors in a cone–rod pattern later in life. At present, both rod and cone ERG responses are not detectable, indicative of a final stage similar to that in many patients with RP. Functional studies are necessary to clarify whether these specific ABCA4 mutations are responsible for the particular progression of the retinal degeneration in this patient, or whether other as yet unknown modifying factors play a role.  In this study we have described 12 unrelated patients with retinal dystrophy resembling CRD caused by mutations in the ABCA4 gene. In a previous study we described the ophthalmic features in five siblings with CRD-like retinal dystrophy who were carrying ABCA4 mutations. 37 From the clinical data of these patients and previous molecular studies in patients with autosomal recessive CRD, two important conclusions can be drawn. 12 14 First, the genetic basis of autosomal recessive CRD is less heterogeneous than was thought, based on the variability in clinical features, because mutations in the ABCA4 gene seems to be the major pathologic cause. Second, given the wide clinical spectrum of CRD-like phenotypes associated with ABCA4 mutations, detailed clinical subclassifications are difficult and may not be very useful.   Supported by the British Retinitis Pigmentosa Society, the Rotterdamse Vereniging Blindenbelangen, the Algemene Nederlandse Vereniging ter Voorkoming van Blindheid, the Stichting Blindenhulp, the Stichting de Drie Lichten, the Gelderse Blindenvereniging and the Landelijke Stichting voor Blinden en Slechtzienden and the Stichting voor Ooglijders.  Submitted for publication June 15, 2001; revised December 21, 2001; accepted January 2, 2002.  Commercial relationships policy: N.  The publication costs of this article were defrayed in part by page charge payment. This article must therefore be marked “advertisement” in accordance with 18 U.S.C. §1734 solely to indicate this fact.  Corresponding author: B. Jeroen Klevering, Department of Ophthalmology, University Medical Centre Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands; b.klevering@ohk.azn.nl. Table 1. View Table Patients with Cone–Rod Degeneration and ABCA4 MutationsTable 1. Patients with Cone–Rod Degeneration and ABCA4 Mutations Patient Sex Current Age (ys) ABCA4 Mutations* Visual Acuity Age of Onset (ys) Fundoscopy Color Vision Perimetry ERG Cone (μV), † ERG Rod (μV), † OD OS OD OS OD OS 9250 M 30 1622T→C; 3113C→T 194G→A CF CF 6 Pigment clumping in the macula NP Large central scotoma over 40° ND, ‡ ND, ‡ 9303 M 21 1622T→C; 3113C→T 20/400 20/400 7 Granular pigmentary changes in the macula Diffusely disturbed Central scotoma of 20° Severely decreased, § Severely decreased, § 9369 F 40 6601-6602deIAG LP LP 8 Irregular hypopigmentation, mainly in the posterior pole. In later stages: attenuated vessels and bone spicula temporal to the macula Red-green defect Central scotoma varying from 10–30° 65 (65%) 80 (80%), ∥ 140 (90%) 160 (nl), ∥ 9370 M 15 1622T→C; 3113C→T 20/200 20/200 7 Granular aspect of the macula NP Concentric central scotoma of 8° 10 (13%) 9 (13%), ¶ 29 (29%) 29 (23%), ¶ 9371 M 38 1622T→C; 3113C→T 1622T→C;3113C→T 20/400 20/400 10 Bull’s eye maculopathy Red-green defect Concentric central scotoma of 20° NP 29 (16%), ‡ NP 54 (30%), ‡ 9378 F 50 768G→T CF CF 12 Bull’s eye maculopathy, narrow vessels in periphery with mild granular changes of the pigment epithelium and confluent patches of chorioretinal atrophy Severely disturbed Large, absolute, paracentral scotomas, relative scotoma centrally 20 (20%) 30 (30%), ∥ 70 (47%) 90 (60%), ∥ 9553 F 45 2588G→C IVS35del-2→+2del4 20/400 20/400 25 Bull’s eye maculopathy. Peripheral diffuse motting of RPE Severely disturbed Large central scotoma over 40° 14 (14%) 19 (19%), ¶ 41 (41%) 24 (24%), ¶ 9633 M 22 1622T→C; 3113C→T 4469G→A 20/400 20/200 12 Atrophy of retinal pigment epithelium in posterior pole. Early stages of bull’s eye maculopathy Red-green defect Central scotoma of 20° 12 (16%) 12 (16%), ¶ 61 (62%) 39 (39%), ¶ 9650 F 20 3364G→A 20/400 20/400 5 Central granular aspect Red-green defect Large central scotoma of 30° and relative constriction of III-4 70 (39%) 106 (59%), ‡ 272 (nl) 115 (76%), ‡ 10125 M 30 IVS30+1G→T 3085C→T 20/200 20/200 8 Central hypopigmentation with dark surrounding, resembling bull’s eye. Later in life: peripheral changes characteristic of RP Severe red-green defect; mild blue-yellow defect Central scotoma of 10–15° with mild peripheral restriction 75 (75%) 80 (80%), ∥ 130 (87%) 140 (93%), ∥ 11872 M 30 634C→T 20/200 20/200 10 Bull’s eye pattern Severely disturbed; blue-yellow more than red-green Central scotoma of 25° 23 (23%) 35 (35%), ∥ 110 (73%) 95 (63%), ∥ 13163 M 15 1622T→C;3113C→T IVS36+1G→A 20/400 20/200 6 Granular aspect of retinal pigment epithelium in macula. Slightly pale optic disc Severely disturbed Central scotoma of 10–15,° no peripheral involvement ND, ¶ ND, ¶  CF, count fingers; LP, light perception; ND, not detectable; NP, not performed. *  Allele 1, first line; allele 2, second line. †  Between parentheses: percentage of the ERG value compared to the lower limit of the normality; normal ERG values are indicated nl. ‡  Minimal values for ERG recordings: 150 μV for the photopic ERG, 180 μV for the scotopic ERG. §  ERG performed with skin electrodes. ∥  Minimal values for ERG recordings: 100 μV for the photopic ERG, 150 μV for the scotopic ERG. ¶  Minimal values for ERG recordings: 99 μV for the photopic ERG, 75 μV for the scotopic ERG. Figure 1. View OriginalDownload Slide (A–D) Fundus photographs and fluorescein angiograms in eyes of patients with (atypical) CRD. (A) Patient 11872 with bull’s eye maculopathy. (B) Patient 9369, demonstrating CRD in the later stages with attenuation of the retinal arterioles and irregular pigmentation temporal to the macula. (C) Fluorescein angiograms in patient 9378 showing confluent patches of chorioretinal atrophy. (D) Patient 10125 with central hypofluorescence enclosed by an ellipsoid hyperfluorescent area. In the surrounding area, hyperfluorescent flecks are visible, and the choroidal background fluorescence seems blocked, as seen in STGD.

      Case#: Klevering Patient 9369, female, Netherlands, 40yo at report, 8yo at onset

      DiseaseAssertion: cone-rod degenerations/ ABCA4-associated retinal dystrophy resembling CRD

      FamilyInfo: "In view of the reputedly normal visual acuity of the parents and the molecular defects, the inheritance pattern of the gene defects in these patients (individuals 9303, 9369, 9553, and 13163) was classified as autosomal recessive."

      CasePresentingHPOs:

      CaseHPOFreeText: Visual acuity: light perception OU. Fundoscopy: Irregular hypopigmentation, mainly in the posterior pole. In later stages: attenuated vessels and bone spicula temporal to the macula. Red-green defect of color vision. Perimetry: Central scotoma varying from 10–30°. ERG Cone (μV): OD-80 (80%), OS-140 (90%) from 12 yo (all ERG responses had been non-detectable since the age of 21). ERG Rod (μV): 160 (nl). Fundus photographs and fluorescein angiograms show CRD in the later stages with attenuation of the retinal arterioles and irregular pigmentation temporal to the macula. Narrowing of retinal vessels and bone spicula (Fig 1B). Fundus description (PMID: 10958761): atrophy of the RPE around the optic disk, bone spicules along arteries and venules in the mid-periphery, and attenuated arterioles (Fig 1D)

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: single-strand conformation polymorphism (SSCP) and direct-sequencing techniques to look for mutations in the 50 exons and flanking intron sequences of the ABCA4 gene

      PreviouslyPublished: Maugeri et al (PMID: 10958761)

      Variant: c.6601_6602delAG

      CAID: CA227421

      SupplementalData: n/a

    1. 20/28/2/18/
female CRD c.1654 G>A
c.4363 T>C 35, 35 38,
34 52,
57 4,
5 45.0,
42.5 1.0,
0.7

      Case#: Subject 20, 28yo, 18yo at first ffERG, Sweden, female

      DiseaseAssertion: CRD, group 2

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: extensive atrophies in the posterior pole. peripheral pigmentations. few peripapillary changes. Normal thickness of the most central segment recorded on OCT. total absence of the PIL (photoreceptor integrity line) and RPE atrophy on the OCT B-scans. ETDRS VA score= 35, 35. Rod
ffERG= 38, 34 Ampl
(µV). Combined ffERG= 52, 57 Ampl
(µV). Cone
ffERG= 4, 5; 45.0, 42.5 Amp IT
(µV; ms). mERG sum= 1.0, 0.7 Ampl (µV). Group 2 with larger central scotomas from 10° to 35°

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: Sequence analysis of the entire coding region of the ABCA4 gene was performed.

      PreviouslyPublished: n/a

      Variant: c.1654G>A; c.4363T>C

      CAID: CA239745

      SupplementalData: n/a

    1. A cohort of 12 unrelated STGD families diagnosed on the basis of clinical manifestations underwent analysis by targeted exome or whole-exome sequencing. Bioinformatics analysis, Sanger sequencing, and cosegregation analysis of available family members were used to validate sequencing data and confirm the presence of disease-causing genes. Results: Using targeted exome and whole-exome sequencing, we found that eight families had disease-causing variants in the ABCA4 gene, one family had only one heterozygous variant in the ABCA4 gene, and the remaining three families have not been identified with any disease-causing variants for STGD. We identified 15 variants in the ABCA4 gene; of these, five variants have not been previously described for STGD.

      Unable to annotate on PDF, so annotating here.

      Case#: Proband #4, male, Chinese, onset at 12yo

      DiseaseAssertion: stargardt

      FamilyInfo: parents are deceased, so phase is unknown. daughter is an unaffected carrier of this variant

      CasePresentingHPOs: HP:0025147, HP:0011507, HP:0000608

      CaseHPOFreeText: BCVA=0.3/CF, mean retinal nerve fiber layer(µm)=167/154, Visual field(mean deviation)= 7.52/NA, fundus fluorescein angiography=type C (a pattern of speckled hypofluorescence and hyperfluorescence without central hypofluorescence)

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: c.6289C > T p.(Pro2097Ser); c.4720G > T p.(Glu1574*) on targeted exome sequencing or WES

      ClinVar: 2202780; 1460063

      CAID: CA341277622; CA341283936

      SupplementalData: n/a

    1. the model would predict foveal disease in the first decade of life for three alleles (P68L;G1961E, L541P;A1038V, and T1019M)

      Case#: Cideciyan Case #86, male, 20.5yo at report

      DiseaseAssertion: "clinical diagnosis within the spectrum of Stargardt disease or cone–rod dystrophy caused by ABCA4 mutations."

      FamilyInfo: Parental segregation of the reported alleles confirmed. P87 is the proband's sibling, affected, same genotype

      CasePresentingHPOs:

      CaseHPOFreeText: LDF eccentricity along principal meridians [deg]: superior=16.9, inferior=11.7, temporal=18.9, inner nasal=9.6, outer nasal=18.9

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: NGS

      PreviouslyPublished: PMID: 24550365

      Variant: c.203 C>T p.Pro68Leuc.5882 G>A p.(Gly1961Glu); c.5882 G>A p.(Gly1961Glu). Phase confirmed.

      ClinVar: 99113

      CAID: CA226972

      SupplementalData: table s1

    1. Patients older than 60 years or with ocular comorbidities such as diabetic retinopathy, uveitis, or glaucoma were excluded. From the remaining list, subjects for whom high-resolution SD-OCT imaging was available were selected. A review of the patient imaging and medical records was performed to identify those who received a clinical diagnosis of Stargardt macular dystrophy based on their clinical phenotype, including color fundus, infrared, FAF, and fluorescein angiography images and electroretinographic findings. 12

      Case#: P3, male, 16yo at report, 9yo at dx, US with Indian ethnicity

      DiseaseAssertion: Stargardt

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: BCVA (logMAR)= OD=20/160 (0.90), OS=20/125 (0.80)

      CaseNotHPOs:

      CaseNotHPOFreeText: ocular comorbidities such as diabetic retinopathy, uveitis, or glaucoma

      GenotypingMethod: "genetic testing"

      PreviouslyPublished: n/a

      Variant: c.2453G>A; c.4532C>A (p.Pro1511His)

      ClinVar: 99135

      CAID: CA227000

      SupplementalData: table 1

    1. STGD1 was determined according to initial symptoms of VA loss; fundus images showing orange-yellow flecks in the retina, a beaten-bronze appearance; and normal or cone-altered ffERG results

      Case#: MD-0790, Spanish

      DiseaseAssertion: STGD1

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: "STGD1 was determined according to initial symptoms of VA loss; fundus images showing orange-yellow flecks in the retina, a beaten-bronze appearance; and normal or cone-altered ffERG results"

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: Index cases were studied by different next-generation sequencing (NGS) strategies, including targeted gene panels, clinical exome, and/or whole-exome sequencing

      PreviouslyPublished: n/a

      Variant: c.1715G>C p.(Arg572Pro); c.4918C>T p.(Arg1640Trp)

      ClinVar: 99073

      CAID: CA226919

      SupplementalData: Table S1

    1. Each wave surveys a fresh sample of respondents rather than tracking the same individuals, so the results reflect population-level changes rather than changes within the same people.

      【局限】研究采用独立样本而非追踪同一组受访者,这意味着结果反映的是人群层面的变化而非个体变化。这种方法无法捕捉个人使用习惯的演变,也无法确定用户增长是来自新用户还是现有用户增加使用频率。

    1. Reviewers pointed out that the model does not follow individual workers, so it can only paint a very coarse picture of the costs of job displacement.

      【局限】模型无法追踪个体工人,只能提供粗略的就业市场变化图景,这一重要局限性意味着模型无法捕捉AI对特定人群的差异化影响,政策制定者需谨慎使用。

    1. ABCA4ARc.[1957C > T];[4605insT]WESHuang et al., 2013cHuang et al., 2013c, Rivera et al., 2000

      Case#: QT959, Chinese

      DiseaseAssertion: Cone-rod dystrophy

      FamilyInfo: no pedigree provided for this family in this paper

      CasePresentingHPOs:

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: 23776498-more phenotype information available there

      Variant: c.[1957C > T];[4605insT] on WES

      ClinVar: n/a

      CAID: CA645372205

      SupplementalData: n/a