Case 1: HP:0001639 KLF10 no family history NM_005655.3:c.34G>A (p.Ala 12Thr) gnomAD= 4.108e-6

Case 1: HP:0001639 KLF10 no family history NM_005655.3:c.34G>A (p.Ala 12Thr) gnomAD= 4.108e-6

Proband III:15, 47 yr old male, Dx = 37 yrs

HP:0001639, HP:0001681

HCM, chest tightness (angina)

Variant: NM_016599.4(MYOZ2):c.505A>C (p.L169G)

Not in ClinVar or EXAC

Proband III:15, 47 yr old male, Dx = 37 yrs

HP:0001639, HP:0001681

HCM, chest tightness (angina)

Variant: NM_016599.4(MYOZ2):c.505A>C (p.L169G)

Not in ClinVar or EXAC

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

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

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

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

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

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

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

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

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

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

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:

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:

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

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."

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

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."

Case# Fam2:II-4, M, 7yo onset, Finnish

CasePresentingHPOs HP:0001310, HP:0001260, HP:0001251, HP:0000639, HP:0009072, HP:0008969, HP:0003487

CaseMethod1 WES

Variant NM_152703.4(SAMD9L):c.2672T>C (p.Ile891Thr)

ClinVar 446529

CaseAddInfo previously in 28202457

Case# UW-AP:III-3, 60yo reported

CasePresentingHPOs HP:0001251, HP:0001310, HP:0001260, HP:0000639, HP:0007256

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

ClinVar 242372

CaseAddInfo only genotyping methods described are for extended Family 1 or in a previous study. Is this UW family also from another study?

Case# Fam2:II-4, M, 7yo onset, Finnish

CasePresentingHPOs HP:0001310, HP:0001260, HP:0001251, HP:0000639, HP:0009072, HP:0008969, HP:0003487

CaseMethod1 WES

Variant NM_152703.4(SAMD9L):c.2672T>C (p.Ile891Thr)

ClinVar 446529

CaseAddInfo previously in 28202457

Case# UW-AP:III-3, 60yo reported

CasePresentingHPOs HP:0001251, HP:0001310, HP:0001260, HP:0000639, HP:0007256

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

ClinVar 242372

CaseAddInfo only genotyping methods described are for extended Family 1 or in a previous study. Is this UW family also from another study?

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

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

Case# B1-4, Male, UK

CasePresentingHPOs HP:0001279

CasePreviousTesting re-sequenicing of genome

CaseGenotypingMethod genotyped for five microsatellite markers spanning TMEM43 on chromosome 3p25

Variant NM_024334.2(TMEM43):c.934C>T (p.Arg312Trp)

ClinVar 36873

gnomAD 0.03553 link

Case# A2, Male, UK

CasePresentingHPOs HP:0002119

CasePreviousTesting re-sequenicing of genome

CaseGenotypingMethod genotyped for five microsatellite markers spanning TMEM43 on chromosome 3p25

Variant NM_024334.2(TMEM43):c.934C>T (p.Arg312Trp)

ClinVar 36873

gnomAD 0.03553 link

Case# B4, Male, UK

CasePreviousTesting re-sequenicing of genome

CaseGenotypingMethod genotyped for five microsatellite markers spanning TMEM43 on chromosome 3p25

Variant NM_024334.2(TMEM43):c.424G>A (p.Glu142Lys)

ClinVar 46147

gnomAD 0.001121 link

Case# B1-4, Male, UK

CasePresentingHPOs HP:0001279

CasePreviousTesting re-sequenicing of genome

CaseGenotypingMethod genotyped for five microsatellite markers spanning TMEM43 on chromosome 3p25

Variant NM_024334.2(TMEM43):c.934C>T (p.Arg312Trp)

ClinVar 36873

gnomAD 0.03553 link

Case# A2, Male, UK

CasePresentingHPOs HP:0002119

CasePreviousTesting re-sequenicing of genome

CaseGenotypingMethod genotyped for five microsatellite markers spanning TMEM43 on chromosome 3p25

Variant NM_024334.2(TMEM43):c.934C>T (p.Arg312Trp)

ClinVar 36873

gnomAD 0.03553 link

Case# B4, Male, UK

CasePreviousTesting re-sequenicing of genome

CaseGenotypingMethod genotyped for five microsatellite markers spanning TMEM43 on chromosome 3p25

Variant NM_024334.2(TMEM43):c.424G>A (p.Glu142Lys)

ClinVar 46147

gnomAD 0.001121 link

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

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

Case# FamilyC:IV-13, 33 AoO, Female, USA

CasePresentingHPOs HP:0002064, HP:0001258, HP:0002355

CaseMethod1 WES

CaseMethod2 Sanger

Variant NM_005186.3(CAPN1):c.407delC (p.Pro136Argfs), NM_001198868.1(CAPN1):c.1605+5G>A

ClinVar 225767, 225768

gnomAD none, 0.0003171

CaseAddInfo nonconsanguineous family

Case# FamilyC:IV-13, 33 AoO, Female, USA

CasePresentingHPOs HP:0002064, HP:0001258, HP:0002355

CaseMethod1 WES

CaseMethod2 Sanger

Variant NM_005186.3(CAPN1):c.407delC (p.Pro136Argfs), NM_001198868.1(CAPN1):c.1605+5G>A

ClinVar 225767, 225768

gnomAD none, 0.0003171

CaseAddInfo nonconsanguineous family

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

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

Case# SAL-584-005, Female, 67yo, Italian

CasePresentingHPOs HP:0001258, HP:0002070, HP:0001260, HP:0002066

CaseMethod1 Exome

CaseMethod2 Sanger

Variant NM_005186.3:c.188dup

CAID CA6092966

gnomAD 0.000009815

VariantEvidence null

CaseAddInfo in supplement, possibly consanguineous family

Case# Family R III:1, Female, 43yo, Bangladesh

CasePresentingHPOs HP:0002066, HP:0001257, HP:0002015, HP:0001260, HP:0001272

CaseMethod1 DNA SNP array

CaseMethod2 Exome sequencing

Variant NM_005186.3:c.337+1G>A

CAID CA381241741

VariantEvidence predicted null

Case# SAL-584-005, Female, 67yo, Italian

CasePresentingHPOs HP:0001258, HP:0002070, HP:0001260, HP:0002066

CaseMethod1 Exome

CaseMethod2 Sanger

Variant NM_005186.3:c.188dup

CAID CA6092966

gnomAD 0.000009815

VariantEvidence null

CaseAddInfo in supplement, possibly consanguineous family

Case# Family R III:1, Female, 43yo, Bangladesh

CasePresentingHPOs HP:0002066, HP:0001257, HP:0002015, HP:0001260, HP:0001272

CaseMethod1 DNA SNP array

CaseMethod2 Exome sequencing

Variant NM_005186.3:c.337+1G>A

CAID CA381241741

VariantEvidence predicted null

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

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

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??????

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

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??????

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

Case# II-1, Female, Caucasian

CasePresentingHPOs HP:0001643

CaseMethod1 WES

CaseMethod2 PCR

Variant NM_001136239.3(PRDM6):c.1385A>G (p.Gln462Arg)

ClinVar 243051

gnomAD 0.00001728 (European (Non-Finnish))

VariantEvidence no variant evidence, computational

Case# II-1, Female, Caucasian

CasePresentingHPOs HP:0001643

CaseMethod1 WES

CaseMethod2 PCR

Variant NM_001136239.3(PRDM6):c.1385A>G (p.Gln462Arg)

ClinVar 243051

gnomAD 0.00001728 (European (Non-Finnish))

VariantEvidence no variant evidence, computational

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

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

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

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

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

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

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.

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.

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

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

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

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

Case# Patient 1, Male, 40do diagnosis

Variant NM_000320.2:c.525A>G (p.G149R)

CAID CA438712209

Case# Patient 16, Female, 2mo diagnosis

Variant NM_000320.2:c.277G>A (p.Gly93Ser)

CAID CA356450231

Case# P1, Pakistan,

CasePresentingHPOs reduced DHPR activity

CaseMethod1 PCR

CaseGenotypingMethod PCR

Variant NM_000320.2:c.570del

CAID CA658795210

VariantEvidence null

Case# Pat4, F, Chinese, 5day onset

CasePresentingHPOs HP:0008344, HP:0002013, HP:0011968, HP:0001250, HP:0001276, HP:0001279

CasePreviousTesting Tested serum BCAAs

CaseMethod1 PCR

CaseMethod2 Direct

CaseGenotypingMethod exons and flanking intronic regions of the BCKDHA, BCKDHB and DBT genes were amplified using PCR and sequenced

Variant NM_000709.3:c.178G>T, NM_000709.3:c.491T>C

CAID CA406004676(c.178), CA406010453(c.491)

CaseAddInfo mutations confirmed in parents by Sanger sequencing, Her elder brother was healthy. This patient presented with lethargy and feeding difficulty when she was 5 days old. She was admitted because of unconsciousness at the age of 5 months, and she was diagnosed with MSUD accompanied by metabolic acidosis, liver damage and hypermyotonia. Cerebral MRI showed abnormal signals in the left and right globus pallidus. Clinical improvement as well as improvement in the laboratory test results was observed after treatment. She is now 3 years and 11 months old with severe psychomotor retardation. She is still unable to walk or speak.

Case#: P15, F, 2 months (onset)

CasePresentingHPOs: HP:0001263, HP:0200134

CasePresentingHPOs (free text): TMS/GC-MS: Leu+Ile- 517, Val- 315. Diagnosed with intermediate form of MSUD.

CasePreviousTesting: Biochemical testing (elevated BCAAs) used to make diagnosis.

CaseMethod1: PCR

CaseMethod2: Sequencing

CaseGenotypingMethod: Genomic DNA extracted, coding regions (and flanking exon-intron boundaries) of BCKDHA, BCKDHB, and DBT were PCR-amplified, followed by bidirectional sequencing.

Variant: NM_001918.3(DBT):c.939G>C (p.Lys313Asn) (homozygous)

ClinVar: 94017

gnomAD: MAF (South Asian) 9.747e-5

VariantEvidence: None

Case# F3-2:5, Male, Pakistan, 13mon diagnosis

CasePresentingHPOs HP:0001987, HP:0001942, HP:0001993, HP:0003128

CasePreviousTesting meningo-encephalitis (cultures were negative). Further metabolic investigations are shown in Table 1.

CaseMethod1 Sanger

CaseGenotypingMethod Sanger of CA5A exons

Variant NM_001739.1(CA5A):c.619-3421_774+502del (p.Asp207_Gln258del)

ClinVar 127089

CaseAddInfo consanguineous, heterozygous parents checked with qtPCR

Wong, F., & Collins, J. J. (2020). Evidence that coronavirus superspreading is fat-tailed. Proceedings of the National Academy of Sciences, 117(47), 29416–29418. https://doi.org/10.1073/pnas.2018490117

Gomes, M. G. M., Corder, R. M., King, J. G., Langwig, K. E., Souto-Maior, C., Carneiro, J., Goncalves, G., Penha-Goncalves, C., Ferreira, M. U., & Aguas, R. (2020). Individual variation in susceptibility or exposure to SARS-CoV-2 lowers the herd immunity threshold. MedRxiv, 2020.04.27.20081893. https://doi.org/10.1101/2020.04.27.20081893

Frey, R. (2020, April 26). Psychological drivers of inter- and intraindividual differences in risk perception: A systematic case study on 5G. https://doi.org/10.31234/osf.io/7a3kg