1,573 Matching Annotations
  1. Last 7 days
    1. Arab

      Case2: Arab Patient (found in the GT database) gender and age are not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0000421, HP:0000225, HP:0002239, HP:0000132, HP:0000967, HP:0000979, HP:0006298

      (Epistaxis, gingival bleeding, GI bleeding, menorrhagia, petechiae/purpura, prolonged , bleeding after tooth extraction)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: <2% of normal GPIIIa and GPIIb surface expression

      PlateletAggregation: N/A

      CasePreviousTesting: N/A

      Gene: ITGA2B

      Variant: IVS(-3)-418del (May be registered; however, need to consult senior biocurator)

      LegacyVariant: ^

      ClinVar: ^

      CAiD: ^

      gnomAD: ^

      PreviouslyPublished: References 8-12

    2. PDJ

      Case28: Patient PDJ

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: N/A

      PlateletAggregation: N/A

      CasePreviousTesting: N/A

      Gene: ITGB3

      Variant: NM_000212.2:c.709_710del

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA8623029

      gnomAD: MAF in the European non Finnish population is 0.00001796 https://gnomad.broadinstitute.org/variant/17-45363717-CAG-C

      PreviouslyPublished: Reference 45

    3. NR

      Case19: Patient NR (found in the GT database as well) gender and age are not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: Menorrhagia HP:0000132

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: N/A Undetectable

      PlateletAggregation: N/A

      CasePreviousTesting: N/A

      Gene: ITGA2B

      Variant: NM_000419.3:c.2941C>T

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA399790399

      gnomAD: N/A

      PreviouslyPublished: Reference numbers 32,22 in this article

    4. Amsterdam

      PreviouslyPublished: PMID: 8471765

      This proband has been previously published in the PMID listed above --> see that paper to get patient information. This patient can also be found in the GT database

    5. 17

      Case17: Patient MO (patient found in the GT database as well) gender and age are not specified here

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0000978, HP:0000132 (Bruising, menorrhagia)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: N/A

      PlateletAggregation: N/A

      CasePreviousTesting: N/A

      Gene: ITGA2B

      Variant: NM_000419.3:c.1750C>T (p.Arg584Ter)

      LegacyVariant: N/A

      ClinVar: 2892

      CAiD: CA115834

      gnomAD: MAF in the East Asian population is 0.0002176 https://gnomad.broadinstitute.org/variant/17-42457372-G-A

      PreviouslyPublished: Reference numbers 29 and 30 in this article

    6. LeM

      Case10: Patient LeM (found in the GT database) gender and age are not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0000979, HP:0000967 (Purpura/petechiae)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: <5% of normal expression

      PlateletAggregation: N/A

      CasePreviousTesting: N/A

      Gene: ITGA2B

      Variant: NM_000419.3:c.1366_1371del

      LegacyVariant: N/A

      ClinVar: 2898

      CAiD: CA8603160

      gnomAD: MAF in the European (non-Finnish) population is 0.000008791 https://gnomad.broadinstitute.org/variant/17-42458268-TGTCTAC-T

      PreviouslyPublished: Reference number 21 in this article

    7. CG

      Case20: Patient CG (Found in GT database) also gender and age are not specified for this patient

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: Gingival bleeding and menorrhagia HP:0000225, HP:0000132

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: About 5% of normal GPIIIa and GPIIb surface expression

      PlateletAggregation: N/A

      CasePreviousTesting: N/A

      Gene: ITGA2B

      Variant: NM_000419.3:c.1787T>C and M_000419.3:c.3060+2T>C

      LegacyVariant: N/A

      ClinVar: 2900

      CAiD: CA115846 and CA290944108

      gnomAD: MAF in the European (non-Finnish) population is 0.0001325 https://gnomad.broadinstitute.org/variant/17-42457148-A-G and MAF in the European (non-Finnish) population is 0.00003876 https://gnomad.broadinstitute.org/variant/17-42451720-A-G

      PreviouslyPublished: References 34 and 35 in this article

    8. 4LW

      Case4: Patient LW (found in GT database)

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0000978, HP:0000421, HP:0006298

      (Bruising, Epistaxis, Prolonged bleeding after tooth extraction)

      CaseHPOFreeText: Blood transfusions were needed

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: 12% of normal GPIIIa and GPIIb surface expression

      PlateletAggregation: N/A

      CasePreviousTesting: N/A

      Gene: ITGA2B

      Variant: NM_000419.3:c.641T>C (p.Lue214Pro)

      LegacyVariant: (p.Leu183Pro)

      ClinVar: 2901

      CAiD: CA115848

      gnomAD: N/A

      PreviouslyPublished: References 14 and 15

    1. Supplementary Table S1 & S2 Proband and Variant Information:

      Case62: GT65, Female, 31 years old, French

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0000421, HP:0000225, HP:0000132, HP:0000790, HP:0002239, HP:0006298

      (Epistaxis, gingival bleeding, menorrhagia, hematuria, GI bleeding, bleeding after dental procedure)

      CaseHPOFreeText: Tonsil bleeding, muscle hematomas

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry showed <5% expression of αIIbβ3 (See Supplementary Table 1)

      PlateletAggregation: Absent platelet aggregation (See Supplementary Table 1)

      CasePreviousTesting: Sanger sequencing of ITGA2B and ITGB3

      Gene: ITGA2B

      Variant: NM_000419.3:c.574+1G>A and NM_000419.3:c.1946+3G>T

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA399805691 and CA626121071

      gnomAD: MAF in the European (non-Finnish) population is 0.00001235 https://gnomad.broadinstitute.org/variant/17-42462918-C-T and MAF in the African population is 0.000 https://gnomad.broadinstitute.org/variant/17-42456008-C-A

    2. Supplementary Table S1 & S2 Proband and Variant Information:

      Case13: GT14, Female, 10, French

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0000979 and HP:0006298

      (Purpura, prolonged bleeding after dental extraction)

      CaseHPOFreeText: Moderate cutaneous bleeding from birth

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry showed <5% variant expression of αIIbβ3 (See Supplementary Table 1)

      PlateletAggregation: Absent platelet aggregation (See Supplementary Table 1)

      CasePreviousTesting: Sanger sequencing of ITGA2B and ITGB3

      Gene: ITGA2B

      Variant: NM_000419.3:c.423G>T (p.Trp141Cys) and NM_000419.3:c.2902del (p.Tyr968Metfs*163)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA399806022 and CA915940332

      gnomAD: N/A

    3. Supplementary Table S1 & S2 Proband and Variant Information:

      Case51: GT51, Male, 29 years old, French/African

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0000421 (Epistaxis)

      CaseHPOFreeText: Mucocutaneous bleeding

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: N/A

      PlateletAggregation: Absent platelet aggregation (See Supplementary Table 1)

      CasePreviousTesting: Sanger sequencing of ITGA2B and ITGB3

      Gene: ITGB3

      Variant: NM_000212.2:c.861del (p.Arg287Serfs * 34) and NM_000212.2:c.1456del (p.Cys486Alafs * 183)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA915940375 and CA915940376

      gnomAD: N/A

    4. Supplementary Table S1 & S2 Proband and Variant Information:

      Case58: GT60, Male, 54 years old, French/Italian

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0000421, HP:0000978, HP:0002239, HP:0000225

      (Epistaxis, easy bruising, GI bleeding, gingival bleeding)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry showed <5% expression of αIIbβ3 (See Supplementary Table 1)

      PlateletAggregation: Absent platelet aggregation (See Supplementary Table 1)

      CasePreviousTesting: Sanger sequencing of ITGA2B and ITGB3

      Gene: ITGB3

      Variant: NM_000212.2:c.1801T>C (p.Cys601Arg)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA8623361

      gnomAD: MAF in the European (non-Finnish) population is 0.00001758 https://gnomad.broadinstitute.org/variant/17-45376784-T-C

    5. Supplementary Table S1 & S2 Proband and Variant Information:

      Case65: GT68, Male, 62 years old, French

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Occasional spontaneous bleeding and frequency decreased with age

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry showed <5% expression of αIIbβ3 (See Supplementary Table 1)

      PlateletAggregation: Absent platelet aggregation (See Supplementary Table 1)

      CasePreviousTesting: Sanger sequencing of ITGA2B and ITGB3

      Gene: ITGA2B

      Variant: NM_000419.3:c.1413C>G (p.Tyr471Ter) and "LR deletion" which is the only specification we are given

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA290950376

      gnomAD: MAF in the European (non-Finnish) population is 0.000008791 https://gnomad.broadinstitute.org/variant/17-42457994-G-C

    6. Supplementary Table S1 & S2 Proband and Variant Information:

      Case22: GT25, Male, 81, French

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0002239

      Gastrointestinal bleeding

      CaseHPOFreeText: Life-long bleeding disorder

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry showed <5% expression of αIIbβ3 (See Supplementary Table 1)

      PlateletAggregation: Absent platelet aggregation (See Supplementary Table 1)

      CasePreviousTesting: Sanger sequencing of ITGA2B and ITGB3

      Gene: ITGA2B

      Variant: NM_000419.3:c.1413C>G (p.Tyr471Ter) and NM_000419.3:c.1882C>T (p.Arg628Ter)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA290950376 and CA399801310

      gnomAD: MAF in the European (non-Finnish) population 0.000008791 http://gnomad.broadinstitute.org/variant/17-42457994-G-C and MAF in Latino population is 0.00003983 http://gnomad.broadinstitute.org/variant/17-42456075-G-A

    1. GT3

      Case3: GT-3, Male, Catalan, age not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Affected sisters (GT-1) and (GT-2)

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0000421

      (Epistaxis)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Standard glycoprotein analysis confirmed the absence of αIIbβ3 in their platelets but while western blotting failed to reveal αIIb, residual β3 was at about 10% of usual levels and of normal migration (illustrated for GT1 in supplemental Figure 1).

      PlateletAggregation: Platelets of all 3 patients failed to aggregate in response to a range of physiologic agonists but were agglutinated by ristocetin. Clot retraction was also defective.

      CasePreviousTesting: Screened ITGA2B and ITGB3 genes of all three probands. Direct sequencing of all coding regions and splice sites of ITGA2B (30 exons) showed mutation.

      Gene: ITGA2B

      Variant: NM_000419.3:c.131G>T and NM_000419.3:c.1440-13_1440-1del

      LegacyVariant: (p.Gly13Val)

      ClinVar: N/A

      CAiD: CA399806881 and CA913184940

      gnomAD: N/A

    2. GT2

      Case2: GT-2, Female, Catalan, age not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Affected sister (GT-1) and brother (GT-3)

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0011891

      (Post-partum hemorrhage)

      CaseHPOFreeText: N/A

      CaseNotHPOs:

      CaseNotHPOsFreeText:

      ProteinExpression: Standard glycoprotein analysis confirmed the absence of αIIbβ3 in their platelets but while western blotting failed to reveal αIIb, residual β3 was at about 10% of usual levels and of normal migration (illustrated for GT1 in supplemental Figure 1).

      PlateletAggregation: Platelets of all 3 patients failed to aggregate in response to a range of physiologic agonists but were agglutinated by ristocetin. Clot retraction was also defective.

      CasePreviousTesting: Screened ITGA2B and ITGB3 genes of all three probands. Direct sequencing of all coding regions and splice sites of ITGA2B (30 exons) showed mutation.

      Gene: ITGA2B

      Variant: NM_000419.3:c.131G>T and NM_000419.3:c.1440-13_1440-1del

      LegacyVariant: (p.Gly13Val)

      ClinVar: N/A

      CAiD: CA399806881 and CA913184940

      gnomAD: N/A

    1. Supplementary Tables 1 and 2 combined information:

      Case8: GT8, Male, 9 years old

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Not available per supplementary table 1

      ParentalGenotype: Parents are not consanguineous, no other genotype information available

      CasePresentingHPOs: HP:0000978, HP:0000979, HP:0031364, HP:0000421

      (Bruising, purpura, ecchymosis, epistaxis)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Showed <5% of αIIbβ3 expression measured by flow cytometry

      PlateletAggregation: Platelet aggregation showed no response to ADP and collagen but normal response to ristocetin

      CasePreviousTesting: All exons from ITGA2B and ITGB3 genes were amplified by PCR using intronic primers. DNA sequencing was determined by Sanger sequencing.

      Gene: ITGA2B

      Variant: NM_000419.3:c.1651C>T (p.Arg551Trp) and NM_000419.3:c.2236G>T (p.Glu746Ter)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA399802348 (p.Arg551Trp) and CA399798321 (p.Glu746Ter)

      gnomAD: N/A

    2. Supplementary Tables 1 and 2 combined information:

      Case38: GT38, Female, 23 years old

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Not available per supplementary table 1

      ParentalGenotype: Parents are not consanguineous, no other genotype information available

      CasePresentingHPOs: HP:0000978, HP:0000979, HP:0031364, HP:0000132

      (Bruising, purpura, ecchymosis, menorrhagia)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Showed <5% of αIIbβ3 expression measured by flow cytometry

      PlateletAggregation: Platelet aggregation showed no response to ADP and collagen but normal response to ristocetin

      CasePreviousTesting: All exons from ITGA2B and ITGB3 genes were amplified by PCR using intronic primers. DNA sequencing was determined by Sanger sequencing.

      Gene: ITGA2B and ITGB3

      Variant: NM_000419.3:c.2613del in ITGA2B (p.Leu872Cysfs*38) and NM_000212.2:c.1646G>C in ITGB3 (p.Cys549Ser)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA915940594 (p.Leu872Cysfs*38) and CA400030198 (p.Cys549Ser)

      gnomAD: MAF of (p.Cys549Ser) in the East Asian population: 0.00005453 https://gnomad.broadinstitute.org/variant/17-45369890-G-C

    3. Supplementary Tables 1 and 2 combined information:

      Case33: GT33, Female, 12 years old

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Not available per supplementary table 1

      ParentalGenotype: Parents are consanguineous, no other genotype information available

      CasePresentingHPOs: HP:0000978, HP:0000979, HP:0031364, HP:0000421

      (Bruising, purpura, ecchymosis, epistaxis)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Showed <5% of αIIbβ3 expression measured by flow cytometry

      PlateletAggregation: Platelet aggregation showed a small response to ADP, no response to collagen but normal response to ristocetin

      CasePreviousTesting: All exons from ITGA2B and ITGB3 genes were amplified by PCR using intronic primers. DNA sequencing was determined by Sanger sequencing.

      Gene: ITGB3

      Variant: NM_000212.2:c.719G>A (p.Arg240Gln)

      LegacyVariant: N/A

      ClinVar: 13553

      CAiD: CA123224

      gnomAD: N/A

    4. Supplementary Tables 1 and 2 combined information:

      Case31: GT31, Female, 13 years old

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Not available per supplementary table 1

      ParentalGenotype: Parents are not consanguineous, no other genotype information available

      CasePresentingHPOs: HP:0000978, HP:0000979, HP:0031364, HP:0000421, HP:0000225

      (Bruising, purpura, ecchymosis, epistaxis, gingival bleeding)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Showed <5% of αIIbβ3 expression measured by flow cytometry

      PlateletAggregation: Platelet aggregation showed no response to ADP and collagen but normal response to ristocetin

      CasePreviousTesting: All exons from ITGA2B and ITGB3 genes were amplified by PCR using intronic primers. DNA sequencing was determined by Sanger sequencing.

      Gene: ITGA2B and ITGB3

      Variant: NM_000419.3:c.1022C>T (p.Ala341Val) in ITGA2B and NM_000212.2:c.412G>A (p.Val138Met) in ITGB3

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA399804629 (p.Ala341Val) and CA400021826 (p.Val139Met)

      gnomAD: N/A

    5. Supplementary Tables 1 and 2 combined information:

      Case23: GT23, Female, 11 years old

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Not available per supplementary table 1

      ParentalGenotype: Parents are consanguineous, no other genotype information available

      CasePresentingHPOs: HP:0000978, HP:0000979, HP:0031364, HP:0000421, HP:0000225, HP:0000132

      (Bruising, purpura, ecchymosis, epistaxis, gingival bleeding, menorrhagia)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Showed <5% of αIIbβ3 expression measured by flow cytometry

      PlateletAggregation: Platelet aggregation showed a small response to ADP, no response to collagen but normal response to ristocetin

      CasePreviousTesting: All exons from ITGA2B and ITGB3 genes were amplified by PCR using intronic primers. DNA sequencing was determined by Sanger sequencing.

      Gene: ITGB3

      Variant: NM_000212.2:c.1980C>A (p.Tyr660Ter) and NM_000212.2:c.2147G>T (p.Gly716Val)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA400032983 (p.Tyr660Ter) and CA400033923 (p.Gly716Val)

      gnomAD: N/A

    6. Supplementary Tables 1 and 2 combined information:

      Case40: GT40, Male, 5 years old

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Not available per supplementary table 1

      ParentalGenotype: Parents are not consanguineous, no other genotype information available

      CasePresentingHPOs: HP:0000978, HP:0000979, HP:0031364, HP:0000421

      (Bruising, purpura, ecchymosis, epistaxis)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Showed <5% of αIIbβ3 expression measured by flow cytometry

      PlateletAggregation: Platelet aggregation showed no response to ADP and collagen but normal response to ristocetin

      CasePreviousTesting: All exons from ITGA2B and ITGB3 genes were amplified by PCR using intronic primers. DNA sequencing was determined by Sanger sequencing.

      Gene: ITGA2B

      Variant: NM_000419.3:c.1750C>T (p.Arg584Ter) and NM_000419.3:c.962G>T (p.Gly321Val)

      LegacyVariant: N/A

      ClinVar: 2892 (p.Arg584Ter)

      CAiD: CA115834 (p.Arg584Ter) and CA399804765 (p.Gly321Val)

      gnomAD: MAF for p.Arg584Ter in East Asian population 0.0002176 https://gnomad.broadinstitute.org/variant/17-42457372-G-A

    7. Supplementary Tables 1 and 2 combined information:

      Case3: GT3, Female, 12 years old

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Not available per supplementary table 1

      ParentalGenotype: Parents are not consanguineous, no other genotype information available

      CasePresentingHPOs: HP:0000978, HP:0000979, HP:0031364, HP:0000421, HP:0000225

      (Bruising, purpura, ecchymosis, epistaxis, gingival bleeding)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Showed <5% of αIIbβ3 expression measured by flow cytometry

      PlateletAggregation: Platelet aggregation showed no response to ADP and collagen but normal response to ristocetin

      CasePreviousTesting: All exons from ITGA2B and ITGB3 genes were amplified by PCR using intronic primers. DNA sequencing was determined by Sanger sequencing.

      Gene: ITGA2B

      Variant: NM_000419.3: c.1750C>T (p.Arg584Ter)

      LegacyVariant: N/A

      ClinVar: 2892

      CAiD: CA115834

      gnomAD: MAF in East Asian population: 0.0002176 https://gnomad.broadinstitute.org/variant/17-42457372-G-A

    8. Supplementary Tables 1 and 2 combined information:

      Case6: GT6, Male, 7 years old

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Not available per supplementary table 1

      ParentalGenotype: Parents are not consanguineous, no other genotype information available

      CasePresentingHPOs: HP:0000978, HP:0000979, HP:0031364, HP:0000421

      (Bruising, purpura, ecchymosis, epistaxis)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Showed 10-20% of αIIbβ3 expression measured by flow cytometry

      PlateletAggregation: Platelet aggregation showed a small amount of response to ADP and collagen but normal response to ristocetin

      CasePreviousTesting: All exons from ITGA2B and ITGB3 genes were amplified by PCR using intronic primers. DNA sequencing was determined by Sanger sequencing.

      Gene: ITGA2B

      Variant: NM_000419.3:c.812C>G (p.Ala271Gly) and NM_000419.3:c.2172G>A (p.Met724Gln)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA399805123 (p.Ala271Gly) and CA399798895 (p.Met724Gln)

      gnomAD: N/A

    1. 8

      Case8: Female, 3 years old, Indian

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0000421, HP:0000225, HP:0031364 (Epistaxis, gingival bleeding, ecchymosis)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      ProteinExpression: Diagnosis of GT was made on the basis of quantitive determination of receptor count by flow cytometric analysis of GPIIb-IIIa

      PlateletAggregation: Diagnosis of GT was made on the basis of impaired platelet aggregation (platelet aggregation was tested against ristocetin, ADP, collagen, epinephrine and arachidonic acid)

      CasePreviousTesting: Multiplex PCR by using GPIIb primers and CSGE analysis were performed

      Gene: ITGA2B

      Variant: NM_000419.3:c.1073del

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA915940580

      gnomAD: N/A

    2. 7

      Case7: Male, 1.5 years old, Indian

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0031364, HP:0000421 (Ecchymosis, epistaxis)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      ProteinExpression: Diagnosis of GT was made on the basis of quantitive determination of receptor count by flow cytometric analysis of GPIIb-IIIa

      PlateletAggregation: Diagnosis of GT was made on the basis of impaired platelet aggregation (platelet aggregation was tested against ristocetin, ADP, collagen, epinephrine and arachidonic acid)

      CasePreviousTesting: Multiplex PCR by using GPIIb primers and CSGE analysis were performed

      Gene: ITGA2B

      Variant: NM_000419.3:c.2315C>G (p.Pro772Arg)

      LegacyVariant: (p.Pro741Arg)

      ClinVar: N/A

      CAiD: CA8602740

      gnomAD: MAF in the South Asian population is 0.0002613 https://gnomad.broadinstitute.org/variant/17-42453709-G-C

    3. 6

      Case6: Female, 7 years old, Indian

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0000225 (Gingival bleeding)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      ProteinExpression: Diagnosis of GT was made on the basis of quantitive determination of receptor count by flow cytometric analysis of GPIIb-IIIa

      PlateletAggregation: Diagnosis of GT was made on the basis of impaired platelet aggregation (platelet aggregation was tested against ristocetin, ADP, collagen, epinephrine and arachidonic acid)

      CasePreviousTesting: Multiplex PCR by using GPIIb primers and CSGE analysis were performed

      Gene: ITGA2B

      Variant: NM_000419.3:c.1374C>G (p.Ile458Met)

      LegacyVariant: (p.Ile427Met)

      ClinVar: N/A

      CAiD: CA8603157

      gnomAD: MAF in the South Asian population is 0.003658 https://gnomad.broadinstitute.org/variant/17-42458266-G-C

    4. 5

      Case5: Female, 3 years old, Indian

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0000421, HP:0000225

      (Epistaxis, gingival bleeding)

      CaseHPOFreeText: Severe epistaxis and mild gum bleeding

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      ProteinExpression: Diagnosis of GT was made on the basis of quantitive determination of receptor count by flow cytometric analysis of GPIIb-IIIa

      PlateletAggregation: Diagnosis of GT was made on the basis of impaired platelet aggregation (platelet aggregation was tested against ristocetin, ADP, collagen, epinephrine and arachidonic acid)

      CasePreviousTesting: Multiplex PCR by using GPIIb primers and CSGE analysis were performed

      Gene: ITGA2B

      Variant: NM_000419.3:c.859G>C (p.Gly287Arg)

      LegacyVariant: (p.Gly256Arg)

      ClinVar: N/A

      CAiD: CA399805008

      gnomAD: N/A

    5. 4

      Case4: Female, 18 years old, Indian

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0000225, HP:0000132

      (Gingival bleeding, menorrhagia)

      CaseHPOFreeText: Menorrhagia only during puberty

      CaseNotHPOs: N/A

      CaseNotHPOFreeText:N/A

      ProteinExpression: Diagnosis of GT was made on the basis of quantitive determination of receptor count by flow cytometric analysis of GPIIb-IIIa

      PlateletAggregation: Diagnosis of GT was made on the basis of impaired platelet aggregation (platelet aggregation was tested against ristocetin, ADP, collagen, epinephrine and arachidonic acid)

      CasePreviousTesting: Multiplex PCR by using GPIIb primers and CSGE analysis were performed

      Gene: ITGA2B

      Variant: NM_000419.3:c.2264G>C (p.Arg755Pro)

      LegacyVariant: (p.Arg724Pro)

      ClinVar: N/A

      CAiD: CA8602772

      gnomAD: MAF in the European (non-Finnish) population is 0.00001060 https://gnomad.broadinstitute.org/variant/17-42454380-C-G

    6. 3

      Case3: Male, 40 years old, Indian

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0000421, HP:0002239, HP:0002248

      (Epistaxis, GI bleeding, hematemesis)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      ProteinExpression: Diagnosis of GT was made on the basis of quantitive determination of receptor count by flow cytometric analysis of GPIIb-IIIa

      PlateletAggregation: Diagnosis of GT was made on the basis of impaired platelet aggregation (platelet aggregation was tested against ristocetin, ADP, collagen, epinephrine and arachidonic acid)

      CasePreviousTesting: Multiplex PCR by using GPIIb primers and CSGE analysis were performed

      Gene: ITGA2B

      Variant: NM_000419.3:c.310+1G>A (IVS2(+1)G>A)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA8603502

      gnomAD: MAF in the European (non-Finnish) population is 0.00001771 https://gnomad.broadinstitute.org/variant/17-42463377-C-T

    7. 2

      Case2: Male, 3 years old, Indian

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0030137 (Prolonged bleeding following circumcision)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      ProteinExpression: Diagnosis of GT was made on the basis of quantitive determination of receptor count by flow cytometric analysis of GPIIb-IIIa

      PlateletAggregation: Diagnosis of GT was made on the basis of impaired platelet aggregation (platelet aggregation was tested against ristocetin, ADP, collagen, epinephrine and arachidonic acid)

      CasePreviousTesting: Multiplex PCR by using GPIIb primers and CSGE analysis were performed

      Gene: ITGA2B

      Variant: NM_000419.3:c.1652G>A (p.Arg551Gln)

      LegacyVariant: (p.Arg520Gln)

      ClinVar: N/A

      CAiD: CA8602986

      gnomAD: MAF in the South Asian population is 0.00006536 https://gnomad.broadinstitute.org/variant/17-42457470-C-T

    8. 10

      Case10: Female, 7 years old, Indian

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0000421, HP:0000790 (Epistaxis, hematuria)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      ProteinExpression: Diagnosis of GT was made on the basis of quantitive determination of receptor count by flow cytometric analysis of GPIIb-IIIa

      PlateletAggregation: Diagnosis of GT was made on the basis of impaired platelet aggregation (platelet aggregation was tested against ristocetin, ADP, collagen, epinephrine and arachidonic acid)

      CasePreviousTesting: Multiplex PCR by using GPIIb primers and CSGE analysis were performed

      Gene: ITGA2B

      Variant: NM_000419.3:c.2415del

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA915940581

      gnomAD: N/A

    1. GT31

      Case30: (GT31) Gender, age and ethnicity are not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Inclusion criteria were patients with a history of mucocutaneous bleeding (Figure 1 shows a bar diagram of all the clinical manifestations in the patient cohort in this article)

      CaseNotHPOs: N/A

      ProteinExpression: Platelet receptor alphaIIbbeta3 protein was analyzed by flow cytometry followed by western blotting

      Platelet Aggregation: Inclusion criteria for probands was absent or reduced platelet aggregation with agonists such as ADP, adrenaline, arachidonic acid, and collagen (no mention of ristocetin here-- this article does not tell us the specific aggregation for each proband in the paper)

      CasePreviousTesting: For mutation analysis of ITGA2B and ITGB3 genes, DNA extraction from whole blood, PCR, heteroduplex PCR followed by CSGE and DNA sequencing were performed. All 30 exons of ITGA2B and 15 exons of ITGB3, as well as their promoters, were analyzed by CSGE following heteroduplex PCR.

      Gene: ITGB3

      Variant: NM_000212.2:c.887_901del

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA626379036

      gnomAD MAF in the South Asian population is 0.00003266 https://gnomad.broadinstitute.org/variant/17-45364541-AATGACGGGCAGTGTC-A

    2. GT12

      Case6: (GT12) Gender, age and ethnicity not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Inclusion criteria were patients with a history of mucocutaneous bleeding (Figure 1 shows a bar diagram of all the clinical manifestations in the patient cohort in this article)

      CaseNotHPOs: N/A

      ProteinExpression: Platelet receptor alphaIIbbeta3 protein was analyzed by flow cytometry followed by western blotting

      Platelet Aggregation: Inclusion criteria for probands was absent or reduced platelet aggregation with agonists such as ADP, adrenaline, arachidonic acid, and collagen (no mention of ristocetin here-- this article does not tell us the specific aggregation for each proband in the paper)

      CasePreviousTesting: For mutation analysis of ITGA2B and ITGB3 genes, DNA extraction from whole blood, PCR, heteroduplex PCR followed by CSGE and DNA sequencing were performed. All 30 exons of ITGA2B and 15 exons of ITGB3, as well as their promoters, were analyzed by CSGE following heteroduplex PCR.

      Gene: ITGA2B

      Variant: NM_000419.3:c.641T>C (p.Leu214Pro)

      LegacyVariant: N/A

      ClinVar: 2901

      CAiD: CA115848

      gnomAD N/A

    3. GT20

      Case26: (GT20) Gender, age and ethnicity are not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Brother is homozygous for the mutation and the second brother is heterozygous

      ParentalGenotype: Mother and father are heterozygous for the mutation

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Inclusion criteria were patients with a history of mucocutaneous bleeding (Figure 1 shows a bar diagram of all the clinical manifestations in the patient cohort in this article)

      CaseNotHPOs: N/A

      ProteinExpression: Platelet receptor alphaIIbbeta3 protein was analyzed by flow cytometry followed by western blotting

      Platelet Aggregation: Inclusion criteria for probands was absent or reduced platelet aggregation with agonists such as ADP, adrenaline, arachidonic acid, and collagen (no mention of ristocetin here-- this article does not tell us the specific aggregation for each proband in the paper)

      CasePreviousTesting: For mutation analysis of ITGA2B and ITGB3 genes, DNA extraction from whole blood, PCR, heteroduplex PCR followed by CSGE and DNA sequencing were performed. All 30 exons of ITGA2B and 15 exons of ITGB3, as well as their promoters, were analyzed by CSGE following heteroduplex PCR.

      Gene: ITGA2B

      Variant: NM_000419.3:c.1424_1427dup

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA8603099

      gnomAD MAF in the South Asian population is 0.0001960 https://gnomad.broadinstitute.org/variant/17-42457979-C-CACCT

    4. GT14

      Case35: (GT14) Gender, age and ethnicity are not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Inclusion criteria were patients with a history of mucocutaneous bleeding (Figure 1 shows a bar diagram of all the clinical manifestations in the patient cohort in this article)

      CaseNotHPOs: N/A

      ProteinExpression: Platelet receptor alphaIIbbeta3 protein was analyzed by flow cytometry followed by western blotting

      Platelet Aggregation: Inclusion criteria for probands was absent or reduced platelet aggregation with agonists such as ADP, adrenaline, arachidonic acid, and collagen (no mention of ristocetin here-- this article does not tell us the specific aggregation for each proband in the paper)

      CasePreviousTesting: For mutation analysis of ITGA2B and ITGB3 genes, DNA extraction from whole blood, PCR, heteroduplex PCR followed by CSGE and DNA sequencing were performed. All 30 exons of ITGA2B and 15 exons of ITGB3, as well as their promoters, were analyzed by CSGE following heteroduplex PCR.

      Gene:

      Variant: NM_000419.3:c.188+8del

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA8603523

      gnomAD MAF in the South Asian population is 0.0002613 https://gnomad.broadinstitute.org/variant/17-42466645-AC-A

    1. GT-20b

      Case18: (GT-20) Female, age or ethnicity not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Probands GT15-GT19 are related to GT-20 see Table 1

      ParentalGenotype: Parents may be included in Table 1; however, not specified so no information

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Bleeding severity: Information not available on bleeding phenotype/severity (See Supplementary Table 3)

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry performed and CD41 and CD61 were observed (See Supplementary Table 3)

      PlateletAggregation: Minimal information (See Supplementary Table 3)

      CasePreviousTesting: DNA was extracted from peripheral blood samples from patients and family members, and Sanger sequencing and PCR was performed. Samples were processed for targeted sequencing using the available SHGp heme panel of 393 genes.

      Gene: ITGB3

      Variant: NM_000212.2:c.727G>C (p.Asp243His)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA400023600

      gnomAD: N/A

    2. GT-19b

      Case17: (GT-19) Male, carrier status, age or ethnicity not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Probands GT15-GT20 are related to GT-19 see Table 1

      ParentalGenotype: Parents may be included in Table 1; however, not specified so no information

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Bleeding severity: Information not available on bleeding phenotype/severity (See Supplementary Table 3)

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry performed and CD41 and CD61 were observed (See Supplementary Table 3)

      PlateletAggregation: Minimal information (See Supplementary Table 3)

      CasePreviousTesting: DNA was extracted from peripheral blood samples from patients and family members, and Sanger sequencing and PCR was performed. Samples were processed for targeted sequencing using the available SHGp heme panel of 393 genes.

      Gene: ITGB3

      Variant: NM_000212.2:c.727G>C (p.Asp243His)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA400023600

      gnomAD: N/A

    3. GT-72c

      Case53: (GT-72) Gender, age, or ethnicity not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Bleeding severity: Information not given (See Supplementary Table 3)

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry performed and CD41 and CD61 were observed (See Supplementary Table 3)

      PlateletAggregation: Minimal information (See Supplementary Table 3)

      CasePreviousTesting: DNA was extracted from peripheral blood samples from patients and family members, and Sanger sequencing and PCR was performed. Samples were processed for targeted sequencing using the available SHGp heme panel of 393 genes.

      Gene: ITGB3

      Variant: NM_000212.2:c.662C>T (p.Thr221Met)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA8623017

      gnomAD: MAF in European Finnish population 0.0001386 http://gnomad.broadinstitute.org/variant/17-45363673-C-T

    4. GT-56

      Case45: (GT-56) Female, age or ethnicity not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Bleeding severity: Moderate (See Supplementary Table 3)

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry performed and CD41 and CD61 were observed (See Supplementary Table 3)

      PlateletAggregation: Minimal information (See Supplementary Table 3)

      CasePreviousTesting: DNA was extracted from peripheral blood samples from patients and family members, and Sanger sequencing and PCR was performed. Samples were processed for targeted sequencing using the available SHGp heme panel of 393 genes.

      Gene: ITGA2B

      Variant: NM_000419.3:c.985G>T (p.Val329Phe)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA399804719

      gnomAD: N/A

    5. GT-16

      Case14: (GT-16) Male, age or ethnicity not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Probands GT15-GT20 are related to GT-16 see Table 1

      ParentalGenotype: Parents may be included in Table 1; however, not specified so no information

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Bleeding severity: Severe (See Supplementary Table 3)

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry performed and CD41 and CD61 were observed (See Supplementary Table 3)

      PlateletAggregation: Minimal information (See Supplementary Table 3)

      CasePreviousTesting: DNA was extracted from peripheral blood samples from patients and family members, and Sanger sequencing and PCR was performed. Samples were processed for targeted sequencing using the available SHGp heme panel of 393 genes.

      Gene: ITGB3

      Variant: NM_000212.2:c.727G>C (p.Asp243His)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA400023600

      gnomAD: N/A

    6. GT-46b

      Case36: (GT-46) Female, age or ethnicity not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Proband GT45-GT48 are related

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Bleeding severity: Information not available (See Supplementary Table 3)

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry performed and CD41 and CD61 were observed (See Supplementary Table 3)

      PlateletAggregation: Minimal information (See Supplementary Table 3)

      CasePreviousTesting: DNA was extracted from peripheral blood samples from patients and family members, and Sanger sequencing and PCR was performed. Samples were processed for targeted sequencing using the available SHGp heme panel of 393 genes.

      Gene: ITGA2B

      Variant: NM_000419.3:c.1879-2A>G

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA290949031

      gnomAD: N/A

    7. GT-52

      Case42: (GT-52) Male, age or ethnicity not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Proband GT49-GT52 are related

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Bleeding severity: Moderate (See Supplementary Table 3)

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry performed and CD41 and CD61 were observed (See Supplementary Table 3)

      PlateletAggregation: Minimal information (See Supplementary Table 3)

      CasePreviousTesting: DNA was extracted from peripheral blood samples from patients and family members, and Sanger sequencing and PCR was performed. Samples were processed for targeted sequencing using the available SHGp heme panel of 393 genes.

      Gene: ITGB3

      Variant: NM_000212.2:c.2113del (p.Leu705Cysfs*4)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA8623443

      gnomAD: MAF in East Asian population: 0.0001087 http://gnomad.broadinstitute.org/variant/17-45380183-TC-T

    8. GT-51

      Case41: (GT-51) Female, age or ethnicity not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Proband GT49-GT52 are related

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Bleeding severity: Information not available (See Supplementary Table 3)

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry performed and CD41 and CD61 were observed (See Supplementary Table 3)

      PlateletAggregation: Minimal information (See Supplementary Table 3)

      CasePreviousTesting: DNA was extracted from peripheral blood samples from patients and family members, and Sanger sequencing and PCR was performed. Samples were processed for targeted sequencing using the available SHGp heme panel of 393 genes.

      Gene: ITGB3

      Variant: NM_000212.2:c.2113del (p.Leu705Cysfs*4)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA8623443

      gnomAD: MAF in East Asian population: 0.0001087 http://gnomad.broadinstitute.org/variant/17-45380183-TC-T

    9. GT-13b

      Case11: (GT-13) Male, carrier, age or ethnicity not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Probands GT11 -GT14 are related to GT-13 see Table 1

      ParentalGenotype: Parents may be included in Table 1; however, not specified so no information

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Bleeding severity: Not available (See Supplementary Table 3)

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry performed and CD41 and CD61 were observed (See Supplementary Table 3)

      PlateletAggregation: Minimal information (See Supplementary Table 3)

      CasePreviousTesting: DNA was extracted from peripheral blood samples from patients and family members, and Sanger sequencing and PCR was performed. Samples were processed for targeted sequencing using the available SHGp heme panel of 393 genes.

      Gene: ITGB3

      Variant: NM_000212.2:c.727G>C (p.Asp243His)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA400023600

      gnomAD: N/A

    1. Supplementary Table S1:

      Case26: GT30, "USA"-what the supp table states, gender and age not specified

      DiseaseAssertion: Glanzmann thrombasthenia type I

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: All patients had a life-long history of mucocutaneous bleeding

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: All patients in this study met the clinical and platelet function requirements for GT-- this includes an absent or strongly reduced expression of alphaIIbBeta3 in platelets

      PlateletAggregation: All patients in this study met the clinical and platelet function requirements for GT-- this includes absent or severely reduced platelet aggregation with at least three physiological agonists

      CasePreviousTesting: Sanger sequencing was performed. Sanger sequencing ensured coverage of all exons and splice sties of the ITGA2B and ITGB3 genes and extended 300-500 bp into the introns as well as including the UTR. They sequenced 416 bp upstream of the ITGA2B promoter and 463 bp upstream of the ITGB3 promoter. In total they sequenced 51.2% of the ITGA2B gene and 19.4% of the larger ITGB3 gene

      Gene: ITGB3

      Variant: NM_000212.2:c.777+1G>A

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA8623036

      gnomAD: MAF in the Latino population is 0.0006774 https://gnomad.broadinstitute.org/variant/17-45363789-G-A

    2. Supplementary Table S1:

      Case59: GT69, French, age and gender are not specified here

      DiseaseAssertion: Glanzmann thrombasthenia type I

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: All patients had a life-long history of mucocutaneous bleeding

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: All patients in this study met the clinical and platelet function requirements for GT-- this includes an absent or strongly reduced expression of alphaIIbBeta3 in platelets

      PlateletAggregation: All patients in this study met the clinical and platelet function requirements for GT-- this includes absent or severely reduced platelet aggregation with at least three physiological agonists

      CasePreviousTesting: Sanger sequencing was performed. Sanger sequencing ensured coverage of all exons and splice sties of the ITGA2B and ITGB3 genes and extended 300-500 bp into the introns as well as including the UTR. They sequenced 416 bp upstream of the ITGA2B promoter and 463 bp upstream of the ITGB3 promoter. In total they sequenced 51.2% of the ITGA2B gene and 19.4% of the larger ITGB3 gene

      Gene: ITGA2B

      Variant: NM_000419.3:c.1878G>C (p.Gln626His/ p.Asp585_Gln626del)

      LegacyVariant: N/A

      ClinVar: 2903

      CAiD: CA115852

      gnomAD: N/A

    3. Supplementary Table S1:

      Case14: GT15, French, gender and age are not specified

      DiseaseAssertion: Glanzmann thrombasthenia type I

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: All patients had a life-long history of mucocutaneous bleeding

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: All patients in this study met the clinical and platelet function requirements for GT-- this includes an absent or strongly reduced expression of alphaIIbBeta3 in platelets

      PlateletAggregation: All patients in this study met the clinical and platelet function requirements for GT-- this includes absent or severely reduced platelet aggregation with at least three physiological agonists

      CasePreviousTesting: Sanger sequencing was performed. Sanger sequencing ensured coverage of all exons and splice sties of the ITGA2B and ITGB3 genes and extended 300-500 bp into the introns as well as including the UTR. They sequenced 416 bp upstream of the ITGA2B promoter and 463 bp upstream of the ITGB3 promoter. In total they sequenced 51.2% of the ITGA2B gene and 19.4% of the larger ITGB3 gene

      Gene: ITGA2B

      Variant: NM_000419.3:c.2095-19T>A and NM_000419.3:c.2770C>T

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA915940312 and CA399792054

      gnomAD: N/A

    4. Supplementary Table S1:

      Case37: GT43a, Morrocco, gender and age not specified

      DiseaseAssertion: Glanzmann thrombasthenia type I

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: All patients had a life-long history of mucocutaneous bleeding

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: All patients in this study met the clinical and platelet function requirements for GT-- this includes an absent or strongly reduced expression of alphaIIbBeta3 in platelets

      PlateletAggregation: All patients in this study met the clinical and platelet function requirements for GT-- this includes absent or severely reduced platelet aggregation with at least three physiological agonists

      CasePreviousTesting: Sanger sequencing was performed. Sanger sequencing ensured coverage of all exons and splice sties of the ITGA2B and ITGB3 genes and extended 300-500 bp into the introns as well as including the UTR. They sequenced 416 bp upstream of the ITGA2B promoter and 463 bp upstream of the ITGB3 promoter. In total they sequenced 51.2% of the ITGA2B gene and 19.4% of the larger ITGB3 gene

      Gene: ITGB3

      Variant: NM_000212.2:c.614+1G>T and NM_000212.2:c.683G>A (p.Arg228His)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA400023344 and CA8623025

      gnomAD: MAF in the African population is 0.00008012 https://gnomad.broadinstitute.org/variant/17-45363694-G-A

    5. Supplementary Table S1:

      Case35: GT41a, Canadian/Chinese, gender and age not specified here

      DiseaseAssertion: Glanzmann thrombasthenia type I

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: All patients had a life-long history of mucocutaneous bleeding

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: All patients in this study met the clinical and platelet function requirements for GT-- this includes an absent or strongly reduced expression of alphaIIbBeta3 in platelets

      PlateletAggregation: All patients in this study met the clinical and platelet function requirements for GT-- this includes absent or severely reduced platelet aggregation with at least three physiological agonists

      CasePreviousTesting: Sanger sequencing was performed. Sanger sequencing ensured coverage of all exons and splice sties of the ITGA2B and ITGB3 genes and extended 300-500 bp into the introns as well as including the UTR. They sequenced 416 bp upstream of the ITGA2B promoter and 463 bp upstream of the ITGB3 promoter. In total they sequenced 51.2% of the ITGA2B gene and 19.4% of the larger ITGB3 gene

      Gene: ITGA2B

      Variant: NM_000419.3:c.91del (p.Ala31ProfsTer2) and NM_000419.3:c.2915dup (p.Leu973AlafsTer63)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA913203486 and CA8602531

      gnomAD: MAF in the East Asian population is 0.0001088 https://gnomad.broadinstitute.org/variant/17-42452054-C-CG for the variant (p.Leu973Alafs*63)

    6. Supplementary Table S1:

      Case1: GT1, French/African, Gender or age not specified

      DiseaseAssertion: Glanzmann thrombasthenia type I

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: All patients had a life-long history of mucocutaneous bleeding

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: All patients in this study met the clinical and platelet function requirements for GT-- this includes an absent or strongly reduced expression of alphaIIbBeta3 in platelets

      PlateletAggregation: All patients in this study met the clinical and platelet function requirements for GT-- this includes absent or severely reduced platelet aggregation with at least three physiological agonists

      CasePreviousTesting: Sanger sequencing was performed. Sanger sequencing ensured coverage of all exons and splice sties of the ITGA2B and ITGB3 genes and extended 300-500 bp into the introns as well as including the UTR. They sequenced 416 bp upstream of the ITGA2B promoter and 463 bp upstream of the ITGB3 promoter. In total they sequenced 51.2% of the ITGA2B gene and 19.4% of the larger ITGB3 gene

      Gene: ITGB3

      Variant: NM_000212.2:c.1913+1G>A

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA400032825

      gnomAD: N/A

    7. Supplementary Table S1:

      Case11: GT12, French, age and gender not specified

      DiseaseAssertion: Glanzmann thrombasthenia type I

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: All patients had a life-long history of mucocutaneous bleeding

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: All patients in this study met the clinical and platelet function requirements for GT-- this includes an absent or strongly reduced expression of alphaIIbBeta3 in platelets

      PlateletAggregation: All patients in this study met the clinical and platelet function requirements for GT-- this includes absent or severely reduced platelet aggregation with at least three physiological agonists

      CasePreviousTesting: Sanger sequencing was performed. Sanger sequencing ensured coverage of all exons and splice sties of the ITGA2B and ITGB3 genes and extended 300-500 bp into the introns as well as including the UTR. They sequenced 416 bp upstream of the ITGA2B promoter and 463 bp upstream of the ITGB3 promoter. In total they sequenced 51.2% of the ITGA2B gene and 19.4% of the larger ITGB3 gene

      Gene: ITGB3

      Variant: NM_000212.2:c.565C>T (p.Pro189Ser)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA291224669

      gnomAD: MAF in the European (non-Finnish) population is 0.00002638 https://gnomad.broadinstitute.org/variant/17-45362012-C-T

    8. Supplementary Table S1:

      Case31: GT36a, Spain, gender and age not specified

      DiseaseAssertion: Glanzmann thrombasthenia type I

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: All patients had a life-long history of mucocutaneous bleeding

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: All patients in this study met the clinical and platelet function requirements for GT-- this includes an absent or strongly reduced expression of alphaIIbBeta3 in platelets

      PlateletAggregation: All patients in this study met the clinical and platelet function requirements for GT-- this includes absent or severely reduced platelet aggregation with at least three physiological agonists

      CasePreviousTesting: Sanger sequencing was performed. Sanger sequencing ensured coverage of all exons and splice sties of the ITGA2B and ITGB3 genes and extended 300-500 bp into the introns as well as including the UTR. They sequenced 416 bp upstream of the ITGA2B promoter and 463 bp upstream of the ITGB3 promoter. In total they sequenced 51.2% of the ITGA2B gene and 19.4% of the larger ITGB3 gene

      Gene: ITGA2B

      Variant: NM_000419.3:c.131G>T (p.Gly44Val) and NM_000419.3:c.1440-13_1440-1del

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA399806881 and CA913184940

      gnomAD: N/A

    9. Supplementary Table S1:

      Case17: GT20, French, gender and age not specified

      DiseaseAssertion: Glanzmann thrombasthenia type I

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: All patients had a life-long history of mucocutaneous bleeding

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: All patients in this study met the clinical and platelet function requirements for GT-- this includes an absent or strongly reduced expression of alphaIIbBeta3 in platelets

      PlateletAggregation: All patients in this study met the clinical and platelet function requirements for GT-- this includes absent or severely reduced platelet aggregation with at least three physiological agonists

      CasePreviousTesting: Sanger sequencing was performed. Sanger sequencing ensured coverage of all exons and splice sties of the ITGA2B and ITGB3 genes and extended 300-500 bp into the introns as well as including the UTR. They sequenced 416 bp upstream of the ITGA2B promoter and 463 bp upstream of the ITGB3 promoter. In total they sequenced 51.2% of the ITGA2B gene and 19.4% of the larger ITGB3 gene

      Gene: ITGA2B

      Variant: M_000419.3:c.2800G>T (p.Val934Phe)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA290946484

      gnomAD: N/A

    10. Supplementary Table S1:

      Case39: GT45, French, age and gender not specified

      DiseaseAssertion: Glanzmann thrombasthenia type I

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: All patients had a life-long history of mucocutaneous bleeding

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: All patients in this study met the clinical and platelet function requirements for GT-- this includes an absent or strongly reduced expression of alphaIIbBeta3 in platelets

      PlateletAggregation: All patients in this study met the clinical and platelet function requirements for GT-- this includes absent or severely reduced platelet aggregation with at least three physiological agonists

      CasePreviousTesting: Sanger sequencing was performed. Sanger sequencing ensured coverage of all exons and splice sties of the ITGA2B and ITGB3 genes and extended 300-500 bp into the introns as well as including the UTR. They sequenced 416 bp upstream of the ITGA2B promoter and 463 bp upstream of the ITGB3 promoter. In total they sequenced 51.2% of the ITGA2B gene and 19.4% of the larger ITGB3 gene

      Gene: ITGA2B

      Variant: NM_000419.3:c.551_626del (p.Arg184_Gln208del) and the other variant is noted as "LR deletion" and that is all the information we are given so I will note it as an Unknown Variant

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA915940373

      gnomAD: N/A

    1. GT2

      Case#: GT2 male, 7 years old

      Disease: Glazmann's Thrombasthenia

      CasePresentingHPOs: (found in appendix) HP:0000967, HP:0000979, HP:0031364, HP:0000978, HP:0002239

      ExpressionEvidence: Flow Cytometry of platelet αIIbβ3: 0%CD41, 0% CD61

      FamilyInfo: Positive consanguinity

      GenotypingMethod: Sanger DNA sequencing to identify causative mutations in each case

      ClinVar: 1691476

      CAID: CA400030171

      Variant: NM_000212.3:c.1641C>G

      GnomAD: Not Found

    1. Case25: Patient CD, gender and age are not specified, all of these patients are Caucasian (either Italian or European)

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: All patients presented with a current or past history of bleeding and a bleeding time >15 min. Bleeding symptoms were evaluated by examining available hospital records. Mild bleeders were defined as those who bled only after trauma or surgery or had minor symptoms, such as epistaxis. Moderate/severe bleeders were defined as those with a history of spontaneous or life threatening hemorrhages, such as gastrointestinal bleeding, or who had repeated episodes requiring platelet transfusions

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: See Table 1

      PlateletAggregation: See Table 1

      CasePreviousTesting: To identify point mutations responsible for GT, we have sequenced all coding regions of Ib and 3 genes and intron/exon boundaries.

      Gene: ITGA2B

      Variant: NM_000212.2:c.1801T>C

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA8623361

      gnomAD: MAF in the European non Finnish population is 0.00001758 https://gnomad.broadinstitute.org/variant/17-45376784-T-C

    2. Case5: Patient DRP, gender and age are not specified, all of these patients are Caucasian (either Italian or European)

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: All patients presented with a current or past history of bleeding and a bleeding time >15 min. Bleeding symptoms were evaluated by examining available hospital records. Mild bleeders were defined as those who bled only after trauma or surgery or had minor symptoms, such as epistaxis. Moderate/severe bleeders were defined as those with a history of spontaneous or life threatening hemorrhages, such as gastrointestinal bleeding, or who had repeated episodes requiring platelet transfusions

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: See Table 1

      PlateletAggregation: See Table 1

      CasePreviousTesting: To identify point mutations responsible for GT, we have sequenced all coding regions of Ib and 3 genes and intron/exon boundaries.

      Gene: ITGA2B

      Variant: This variant has a typo in the paper the real variant is this: NM_000419.3:c.800 G>A and NM_000419.3:c.2930del

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA399805147 and CA915940386

      gnomAD: N/A

    3. Case20: Patient LPR, gender and age are not specified, all of these patients are Caucasian (either Italian or European)

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: All patients presented with a current or past history of bleeding and a bleeding time >15 min. Bleeding symptoms were evaluated by examining available hospital records. Mild bleeders were defined as those who bled only after trauma or surgery or had minor symptoms, such as epistaxis. Moderate/severe bleeders were defined as those with a history of spontaneous or life threatening hemorrhages, such as gastrointestinal bleeding, or who had repeated episodes requiring platelet transfusions

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: See Table 1

      PlateletAggregation: See Table 1

      CasePreviousTesting: To identify point mutations responsible for GT, we have sequenced all coding regions of Ib and 3 genes and intron/exon boundaries.

      Gene: ITGB3

      Variant: NM_000212.2:c.355C>T and NM_000212.2:c.355C>T

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA8622924 and CA8623361

      gnomAD: MAF in the South Asian population is 0.0001307 https://gnomad.broadinstitute.org/variant/17-45360909-C-T and MAF in the European non Finnish pop is 0.00001758 https://gnomad.broadinstitute.org/variant/17-45376784-T-C

    4. Case24: Patient CI, gender and age are not specified, all of these patients are Caucasian (either Italian or European)

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: All patients presented with a current or past history of bleeding and a bleeding time >15 min. Bleeding symptoms were evaluated by examining available hospital records. Mild bleeders were defined as those who bled only after trauma or surgery or had minor symptoms, such as epistaxis. Moderate/severe bleeders were defined as those with a history of spontaneous or life threatening hemorrhages, such as gastrointestinal bleeding, or who had repeated episodes requiring platelet transfusions

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: See Table 1

      PlateletAggregation: See Table 1

      CasePreviousTesting: To identify point mutations responsible for GT, we have sequenced all coding regions of Ib and 3 genes and intron/exon boundaries.

      Gene: ITGA2B

      Variant: NM_000212.2:c.1801T>C

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA8623361

      gnomAD: MAF in the European non Finnish population is 0.00001758 https://gnomad.broadinstitute.org/variant/17-45376784-T-C

    5. Case9: Patient MR, gender and age are not specified, all of these patients are Caucasian (either Italian or European)

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: All patients presented with a current or past history of bleeding and a bleeding time >15 min. Bleeding symptoms were evaluated by examining available hospital records. Mild bleeders were defined as those who bled only after trauma or surgery or had minor symptoms, such as epistaxis. Moderate/severe bleeders were defined as those with a history of spontaneous or life threatening hemorrhages, such as gastrointestinal bleeding, or who had repeated episodes requiring platelet transfusions

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: See Table 1

      PlateletAggregation: See Table 1

      CasePreviousTesting: To identify point mutations responsible for GT, we have sequenced all coding regions of Ib and 3 genes and intron/exon boundaries.

      Gene: ITGA2B

      Variant: NM_000419.3:c.1214T>C (p.Ile374Thr)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA290950815

      gnomAD: N/A

    1. 1.

      Case1: Male, now deceased

      DiseaseAssertion: Glanzmann thrombasthenia type I

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0002239

      (Gastrointestinal bleeding)

      CaseHPOFreeText: Severe bleeding when young

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: N/A

      PlateletAggregation: Minimal information, not specific at all

      CasePreviousTesting: Sanger sequencing identified disease-causing variants in 18 out of 20 patients (Probands 6 and 14 excluded) with istoantibodies to αIIbβ3. The mutations were evenly distributed between ITGB3 and ITGA2B.

      Gene: ITGA2B

      Variant: NM_000419.3:c.1413C>G (p.Tyr471Ter) Codon change confirmed from PMID: 20492470 and NM_000419.3:c.1882C>T (p.Arg628Ter)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA290950376 and CA399801310

      gnomAD: MAF in European non Finnish population 0.000008791 http://gnomad.broadinstitute.org/variant/17-42457994-G-C and MAF in Latino population 0.00003983 http://gnomad.broadinstitute.org/variant/17-42456075-G-A

    2. 22.

      Case22: Female, age not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: N/A

      PlateletAggregation: Minimal information, not specific enough

      CasePreviousTesting: Sanger sequencing identified disease-causing variants in 18 out of 20 patients (Probands 6 and 14 excluded) with istoantibodies to αIIbβ3. The mutations were evenly distributed between ITGB3 and ITGA2B.

      Gene: ITGB3

      Variant: NM_000212.2:c.166-2A>G (IVS2-2A>G)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA291224483

      gnomAD: N/A

    3. 21

      Case21: Male, age not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Mild bleeding tendency (See Table 1 for Clinical and Biological data for selected genotyped patients

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: N/A

      PlateletAggregation: Minimal information, not specific enough

      CasePreviousTesting: Sanger sequencing identified disease-causing variants in 18 out of 20 patients (Probands 6 and 14 excluded) with istoantibodies to αIIbβ3. The mutations were evenly distributed between ITGB3 and ITGA2B.

      Gene: ITGA2B

      Variant: NM_000419.3:c.2421G>A (p.Trp807Ter)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA399796017

      gnomAD: N/A

    4. 20.

      Case20: Female, age not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Moderate bleeding

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: N/A

      PlateletAggregation: Minimal information, not specific enough

      CasePreviousTesting: N/A

      Gene: ITGA2B

      Variant: NM_000419.3:c.889G>A (p.Gly296Arg) **authors say (Gly297Arg) but ensembl shows Gly296Arg

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA8603304

      gnomAD: MAF in the South Asian population is 0.0003267https://gnomad.broadinstitute.org/variant/17-42461681-C-T

    5. 13.

      Case13: Female, African, age not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: N/A

      PlateletAggregation: Minimal information, not specific enough

      CasePreviousTesting: Sanger sequencing identified disease-causing variants in 18 out of 20 patients (Probands 6 and 14 excluded) with istoantibodies to αIIbβ3. The mutations were evenly distributed between ITGB3 and ITGA2B.

      Gene: ITGA2B

      Variant: NM_000419.3:c.1357C>T (p.Arg453Ter)

      LegacyVariant: N/A

      ClinVar: 631773

      CAiD: CA399803529

      gnomAD: N/A

    1. MU

      Case3: Patient MU, gender age and ethnicity not specified

      DiseaseAssertion: Glanzmann thrombasthenia type I

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Bleeding symptoms were evaluated by examining available hospital records. Mild bleeders were defined as those who had minor symptoms, such as epistaxis or gum bleeds, and moderate bleeders suffered, in addition, from bleeding complications after surgery and trauma. Severe bleeders were defined as those with a history of spontaneous or life-threatening hemorrhages, such as gastrointestinal bleeding, or who had repeated episodes requiring platelet transfusion. See Table 1.

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: See Table 6

      PlateletAggregation: See Table 6

      CasePreviousTesting: To ascertain the mutations, we sequenced the coding regions of the αIIb and β3 subunits including the exon/intron boundaries

      Gene: ITGA2B

      Variant: NM_000419.3:c.641T>C (p.Leu214Pro)

      LegacyVariant: N/A

      ClinVar: 2901

      CAiD: CA115848

      gnomAD: N/A

    2. LH

      Case17: Patient LH, gender, age and ethnicity not specified

      DiseaseAssertion: Glanzmann thrombasthenia type I

      FamilyInfo: Child is patient LN, significant other is patient LB

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Bleeding symptoms were evaluated by examining available hospital records. Mild bleeders were defined as those who had minor symptoms, such as epistaxis or gum bleeds, and moderate bleeders suffered, in addition, from bleeding complications after surgery and trauma. Severe bleeders were defined as those with a history of spontaneous or life-threatening hemorrhages, such as gastrointestinal bleeding, or who had repeated episodes requiring platelet transfusion. See Table 1.

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: See Table 6

      PlateletAggregation: See Table 6

      CasePreviousTesting: To ascertain the mutations, we sequenced the coding regions of the αIIb and β3 subunits including the exon/intron boundaries

      Gene: ITGA2B

      Variant: NM_000419.3:c.3062T>C

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA399787956

      gnomAD: N/A

    1. A 3-year-old girl

      Case1: Female, 3 year old, ethnicity not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: An analysis of family members indicated that the Gln517Stop and Arg553Stop mutations were located on different alleles and inherited from the patient’s mother and father, respectively

      CasePresentingHPOs: HP:0004406, HP:0002248, HP:0000978, HP:0000225

      (Recurrent epistaxis, hematemesis, easy bruising, gingival bleeding)

      CaseHPOFreeText: Petechial hemorrhages

      CaseNotHPOs: HP:0001945, HP:0002014, HP:0005261

      Fever, diarreah, hemarthrosis

      CaseNotHPOsFreeText: N/A

      ProteinExpression: A flow cytometry evaluation revealed marked reduction in glycoprotein IIb/IIIa (See Table 1 for Patient's Lab results)

      PlateletAggregation: Patients platelets did not aggregate in response to ADP, epinephrine, arachidonic acid, or collagen but platelets had normal ristocetin induced aggregation

      CasePreviousTesting: Molecular genetic analysis of ITGA2B was performed which revealed mutations

      Gene: ITGA2B

      Variant: NM_000419.3:c.1642C>T (p.Gln548Ter) and NM_000419.3:c.1750C>T (Arg584Ter)

      LegacyVariant: Gln517Ter and Arg553Ter

      ClinVar: 2892

      CAiD: CA399802364 and CA115834

      gnomAD: MAF in the East Asian population is 0.0002176

    1. 11

      Case9: No assertion made on age, gender or ethnicity

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Table 1 mentions family history available for this proband.

      ParentalGenotype: The identified variants were heterozygote in parents.

      CasePresentingHPOs: HP:0030402, HP:0005542

      (Abnormal platelet aggregation, prolonged clotting time)

      CaseHPOFreeText: Bleeding time greater than 20 minutes and hematocrit of 38.1%.

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: N/A

      CasePreviousTesting: Genetic study of patient was conducted using direct sequencing of entire coding and exon-intron boundaries of the ITGA2B and ITGB3 genes.

      Gene: ITGA2B

      Variant: NM_000419.3:c.286T>A (p.Cys96Ser)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA8603504

      gnomAD: N/A

    2. 5

      Case5: No assertion made on age, gender or ethnicity

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: The identified variants were heterozygote in parents.

      CasePresentingHPOs: N/A

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: N/A

      CasePreviousTesting: Genetic study of patient was conducted using direct sequencing of entire coding and exon-intron boundaries of the ITGA2B and ITGB3 genes.

      Gene: ITGB3

      Variant: NM_000212.2:c.538G>A (p.Gly180Arg) and NM_000212.2:c.155G>T (p.Cys52Phe)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA8622972 (p.Gly180Arg) CA8622859 (p.Cys52Phe)

      gnomAD: "Other" population (p.Gly180Arg) MAF is 0.0001630 https://gnomad.broadinstitute.org/variant/17-45361985-G-A and South Asian population p.Cys52Phe) MAF is 0.00003266.

    1. M9

      Case17: (M9) Female, 69 years old, French Gypsy

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Mucocutaneous bleeding

      CaseNotHPOs: N/A

      ProteinExpression: Failed to express alphaIIbbeta3 on the surface of their platelets

      Platelet Aggregation: Absent platelet aggregation to all agonists (no mention for which agonists or response to ristocetin)

      CasePreviousTesting: All the information we are given is "mutation screening of the ITGA2B and ITGB3 genes" the method for sequencing etc. was not stated

      Gene: ITGA2B

      Variant: NM_000419.3:c.1544+1G>A

      LegacyVariant: N/A

      ClinVar: 2895

      CAiD: CA10575473

      gnomAD N/A

    2. GT2

      Case2: (GT2) Male, 76 years old, French

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Mucocutaneous bleeding

      CaseNotHPOs: N/A

      ProteinExpression: <5% surface expression levels of αIIbβ3

      Platelet Aggregation: Absent platelet aggregation to all agonists (no mention for which agonists or response to ristocetin)

      CasePreviousTesting: All the information we are given is "mutation screening of the ITGA2B and ITGB3 genes" the method for sequencing etc. was not stated

      Gene: ITGB3

      Variant: NM_000212.2:c.1260G>A

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA8623200

      gnomAD MAF in the African population is 0.00004005 https://gnomad.broadinstitute.org/variant/17-45368454-G-A

    3. M16

      Case24: (M16) Male, 52 years old, French Gypsy

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Mucocutaneous bleeding

      CaseNotHPOs: N/A

      ProteinExpression: Failed to express alphaIIbbeta3 on the surface of their platelets

      Platelet Aggregation: Absent platelet aggregation to all agonists (no mention for which agonists or response to ristocetin)

      CasePreviousTesting: All the information we are given is "mutation screening of the ITGA2B and ITGB3 genes" the method for sequencing etc. was not stated

      Gene: ITGA2B

      Variant: NM_000419.3:c.1544+1G>A

      LegacyVariant: N/A

      ClinVar: 2895

      CAiD: CA10575473

      gnomAD N/A

    4. GT6

      Case6: (GT6), Male, 82 years old, French

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Mucocutaneous bleeding

      CaseNotHPOs: N/A

      ProteinExpression: 40-55% surface expression levels of αIIbβ3

      Platelet Aggregation: Absent platelet aggregation to all agonists (no mention for which agonists or response to ristocetin)

      CasePreviousTesting: All the information we are given is "mutation screening of the ITGA2B and ITGB3 genes" the method for sequencing etc. was not stated

      Gene: ITGB3

      Variant: NM_000212.2:c.665T>C (p.Leu222Pro) and NM_000212.2:c.1871G>A (p.Cys592Tyr)

      LegacyVariant: (p.Leu196Pro) and (p.Cys624Tyr) (The paper gives legacy and current nomenclature)

      ClinVar: N/A

      CAiD: CA291224887 and CA400032726

      gnomAD MAF in the European (non-Finnish) population is 0.00006482 https://gnomad.broadinstitute.org/variant/17-45363676-T-C

    5. M1

      Case9: (M1) Male, 9 years old, French Gypsy

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Mucocutaneous bleeding

      CaseNotHPOs: N/A

      ProteinExpression: Failed to express alphaIIbbeta3 on the surface of their platelets

      Platelet Aggregation: Absent platelet aggregation to all agonists (no mention for which agonists or response to ristocetin)

      CasePreviousTesting: All the information we are given is "mutation screening of the ITGA2B and ITGB3 genes" the method for sequencing etc. was not stated

      Gene: ITGA2B

      Variant: NM_000419.3:c.1544+1G>A

      LegacyVariant: N/A

      ClinVar: 2895

      CAiD: CA10575473

      gnomAD N/A

    1. proband‐III2

      Case3: Male, Israeli-Arab, (age is either 10 or 14)

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: See Fig 1C for pedigree

      ParentalGenotype: See Fig 1C for pedigree

      CasePresentingHPOs: HP:0000421, HP:0031364, HP:0000967

      (Severe epistaxis, ecchymosis, petechiae)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      ProteinExpression: No surface expression of αIIbβ3 was found in patients’ platelets (See Fig 3)

      PlateletAggregation: Absent platelet aggregation in response to ADP, epinephrine, collagen and normal ristocetin-induced platelet agglutination

      CasePreviousTesting: DNA fragments containing exons and flanking intronic regions of the aIIb and B3 genes were amplified by PCR using primers

      Gene: ITGA2B

      Variant: NM_000419.3:c.97A>G (p.Asn2Asp)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA399806951

      gnomAD: N/A

    1. CC

      Case9: Patient CC

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs:

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: αIIbβ3 expression

      PlateletAggregation: N/A

      CasePreviousTesting: The amplification of DNA fragments using PCR and their electrophoretic migration through a denaturing gradient was used to scan the entire coding region, splice site junctions and promoter regions of the GPIIb and GPIIIa genes for all 20 patients in this study

      Gene: ITGA2B

      Variant: NM_000419.3:c.666C>A (p.Phe222Leu)

      LegacyVariant: (p.Phe191Leu)

      ClinVar: N/A

      CAiD: CA399805465

      gnomAD: N/A

    2. FO

      Case7: Patient FO

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs:

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: N/A

      PlateletAggregation: N/A

      CasePreviousTesting: The amplification of DNA fragments using PCR and their electrophoretic migration through a denaturing gradient was used to scan the entire coding region, splice site junctions and promoter regions of the GPIIb and GPIIIa genes for all 20 patients in this study

      Gene: ITGA2B

      Variant: NM_000419.3:c.2153dup and NM_000419.3:c.1234G>A (p.Gly412Arg)

      LegacyVariant: (p.Gly381Arg)

      ClinVar: 381748

      CAiD: CA913189170 and CA8603182

      gnomAD MAF in the Latino population is 0.0001453 https://gnomad.broadinstitute.org/variant/17-42458406-C-T

    3. DC

      Case5: Patient DC

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs:

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: N/A

      PlateletAggregation: N/A

      CasePreviousTesting: The amplification of DNA fragments using PCR and their electrophoretic migration through a denaturing gradient was used to scan the entire coding region, splice site junctions and promoter regions of the GPIIb and GPIIIa genes for all 20 patients in this study

      Gene: ITGA2B

      Variant: NM_000419.3:c.1544+1G>A

      LegacyVariant: N/A

      ClinVar: 2895

      CAiD: CA10575473

      gnomAD N/A

    4. StopMB

      Case14: Patient MB

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: N/A

      PlateletAggregation: N/A

      CasePreviousTesting: The amplification of DNA fragments using PCR and their electrophoretic migration through a denaturing gradient was used to scan the entire coding region, splice site junctions and promoter regions of the GPIIb and GPIIIa genes for all 20 patients in this study

      Gene: ITGA2B

      Variant: NM_000419.3:c.1211-78A>G

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA915940720

      gnomAD: N/A

    1. I

      Case9: Patient ID I, Female, 3 years old, ethnicity not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Related to Patient's J and K (See Table 1)

      ParentalGenotype: N/A (Parents are consangenous)

      CasePresentingHPOs: HP:0000967, HP:0000979, HP:0000978, HP:0004406

      (Petechiae, purpura, easy bruising, recurrent epistaxis)

      CaseHPOFreeText: N/A

      CaseNotHPOs: HP:0000225, HP:0002239, HP:0002239, HP:0000790, HP:0005261, HP:0002248

      (Gingival bleeding, GI bleeding, intracranial hemorrhage, hematuria, hemarthrosis, hematemesis)

      CaseNotHPOsFreeText: Hemorrhage after dnetal, hemorrhage after trauma, ear bleeding, hematoma

      ProteinExpression: N/A

      PlateletAggregation: Defective response to ADP, adrenaline, collagen, arachidonic acid, and normal response to ristocetin

      CasePreviousTesting: Exon PCR was used to amplify coding regions of the ITGA2B and ITGB3 genes. PCR products were purified and Sanger sequenced. Segregation using parental samples was undertaken when available.

      Gene: ITGA2B

      Variant: NM_000419.3:c.1652G>A

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA8602986

      gnomAD: MAF in South Asian population is 0.00006536 http://gnomad.broadinstitute.org/variant/17-42457470-C-T

      PreviouslyPublished: PMID: 19172520

    1. GT 04

      Case15: GT04, Female, India, age of onset is 11 years old

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: Menorrhagia HP:0000132

      CaseHPOFreeText: Patients were recruited as they presented consecutively from 1996 to 1998 for evaluation of a mucocutaneous bleeding disorder

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: N/A

      PlateletAggregation: All patients examined had defective ADP, epinephrine, and collagen induced aggregation and normal ristocetin induced aggregation

      CasePreviousTesting: Mutations were detected by the method of single strand conformation polymorphism (SSCP) analysis, followed by nucleotide sequencing and confirmation by restriction fragment length polymorphism (RFLP) assays. The sequences of the primers employed and the reaction conditions for PCR amplification of the exons, adjacent intronic regions, and 50 and 30 untranslated regions of the aIIb and b3 gene

      Gene: ITGB3

      Variant: NM_000212.2:c.262C>T (p.Arg88Ter) and NM_000212.2:c.356G>A (p.Arg119Gln)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA400020703 and CA8622925

      gnomAD: MAF in the Other population is 0.0001385 https://gnomad.broadinstitute.org/variant/17-45360816-C-T and MAF in the African population is 0.0002470 https://gnomad.broadinstitute.org/variant/17-45360910-G-A

    2. GT 07

      Case16: GT07, Male, India, age of onset is 3 years old

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Patients were recruited as they presented consecutively from 1996 to 1998 for evaluation of a mucocutaneous bleeding disorder

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: N/A

      PlateletAggregation: All patients examined had defective ADP, epinephrine, and collagen induced aggregation and normal ristocetin induced aggregation

      CasePreviousTesting: Mutations were detected by the method of single strand conformation polymorphism (SSCP) analysis, followed by nucleotide sequencing and confirmation by restriction fragment length polymorphism (RFLP) assays. The sequences of the primers employed and the reaction conditions for PCR amplification of the exons, adjacent intronic regions, and 50 and 30 untranslated regions of the aIIb and b3 gene

      Gene: ITGB3

      Variant: NM_000212.2:c.153del (p.Trp51CysfsTer5)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA915940728

      gnomAD: N/A

    3. GT 55

      Case34: GT55, Male, India, age of onset is 21 years old

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Patients were recruited as they presented consecutively from 1996 to 1998 for evaluation of a mucocutaneous bleeding disorder

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: N/A

      PlateletAggregation: All patients examined had defective ADP, epinephrine, and collagen induced aggregation and normal ristocetin induced aggregation

      CasePreviousTesting: Mutations were detected by the method of single strand conformation polymorphism (SSCP) analysis, followed by nucleotide sequencing and confirmation by restriction fragment length polymorphism (RFLP) assays. The sequences of the primers employed and the reaction conditions for PCR amplification of the exons, adjacent intronic regions, and 50 and 30 untranslated regions of the aIIb and b3 gene

      Gene: ITGB3

      Variant: NM_000212.2:c.921C>A (p.Tyr307Ter)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA400025209

      gnomAD: N/A

    4. GT 24

      Case6: GT24, Male, India, age of onset is 10 years old

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Patients were recruited as they presented consecutively from 1996 to 1998 for evaluation of a mucocutaneous bleeding disorder

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: N/A

      PlateletAggregation: All patients examined had defective ADP, epinephrine, and collagen induced aggregation and normal ristocetin induced aggregation

      CasePreviousTesting: Mutations were detected by the method of single strand conformation polymorphism (SSCP) analysis, followed by nucleotide sequencing and confirmation by restriction fragment length polymorphism (RFLP) assays. The sequences of the primers employed and the reaction conditions for PCR amplification of the exons, adjacent intronic regions, and 50 and 30 untranslated regions of the aIIb and b3 gene

      Gene: ITGA2B

      Variant: NM_000419.3:c.2898_2902dup

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA915940725

      gnomAD: N/A

    5. GT 40

      Case29: GT40, Female, India, age of onset is 6 years old

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Patients were recruited as they presented consecutively from 1996 to 1998 for evaluation of a mucocutaneous bleeding disorder

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: N/A

      PlateletAggregation: All patients examined had defective ADP, epinephrine, and collagen induced aggregation and normal ristocetin induced aggregation

      CasePreviousTesting: Mutations were detected by the method of single strand conformation polymorphism (SSCP) analysis, followed by nucleotide sequencing and confirmation by restriction fragment length polymorphism (RFLP) assays. The sequences of the primers employed and the reaction conditions for PCR amplification of the exons, adjacent intronic regions, and 50 and 30 untranslated regions of the aIIb and b3 gene

      Gene: ITGB3

      Variant: NM_000212.2:c.428T>G (p.Leu143Trp)

      LegacyVariant: N/A

      ClinVar: 13567

      CAiD: CA123252

      gnomAD: MAF in the Other population is 0.0001629 https://gnomad.broadinstitute.org/variant/17-45361875-T-G)

    6. GT 09

      Case18: GT09, Female, India, age of onset is 21 years old

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Patients were recruited as they presented consecutively from 1996 to 1998 for evaluation of a mucocutaneous bleeding disorder

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: N/A

      PlateletAggregation: All patients examined had defective ADP, epinephrine, and collagen induced aggregation and normal ristocetin induced aggregation

      CasePreviousTesting: Mutations were detected by the method of single strand conformation polymorphism (SSCP) analysis, followed by nucleotide sequencing and confirmation by restriction fragment length polymorphism (RFLP) assays. The sequences of the primers employed and the reaction conditions for PCR amplification of the exons, adjacent intronic regions, and 50 and 30 untranslated regions of the aIIb and b3 gene

      Gene: ITGB3

      Variant: NM_000212.2:c.428T>G (p.Leu143Trp) and NM_000212.2:c.1261G>A (p.Val422Met)

      LegacyVariant: N/A

      ClinVar: 13567

      CAiD: CA123252 and CA400028437

      gnomAD: MAF in the Other population is 0.0001629 https://gnomad.broadinstitute.org/variant/17-45361875-T-G

    1. The probands are two brothers, 18

      Case1: Male, 18 years old, ethnicity not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: See Figure 4 for family pedigree of patients carrying the 288delC mutation in GPIIb

      ParentalGenotype: Heterozygous for variant

      CasePresentingHPOs: HP:0000978 (Bruising)

      CaseHPOFreeText: Mucocutaneous bleeding

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry analysis shown in Fig 1

      PlateletAggregation: Platelets failed to aggregate either spontaneously or in response to ADP, adrenaline, collagen or arachidonic acid, but they showed agglutination in the presence of ristocetin

      CasePreviousTesting: ITGA2B and ITGB3 both were sequenced

      Gene: ITGA2B

      Variant: NM_000419.3:c.291del

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA915940464

      gnomAD: N/A

    1. 56-year-old Algerian woman

      Case1: Female, 56 years old, Algerian

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0004406, HP:0000132

      (Recurrent epistaxis, menorrhagia)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: No platelet αIIbβ3 expression (mentioned briefly in abstract)

      PlateletAggregation: The patient shows all the typical signs of GT with no platelet aggregation in response to physiologic agonists and an absence of clot retraction. No mention of ristocetin

      CasePreviousTesting: N/A

      Gene: ITGA2B

      Variant: NM_000419.3:c.1063G>A (p.Glu355Lys)

      LegacyVariant: p.Glu324Lys

      ClinVar: 2899

      CAiD: CA115844

      gnomAD: MAF in European (non-Finnish population 0.00001978 http://gnomad.broadinstitute.org/variant/17-42461008-C-T

      PreviouslyPublished: Proband 9 in PMID: 2180491

    1. 6CabGT-6

      Case6: (Proband, CabGT-6), Male, age not specified, Caucasian

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      ProteinExpression: Flow cytometry showed <5% surface expression of GPIIIa and GPIIb

      Platelet Aggregation: N/A

      CasePreviousTesting: Promoter and exon sequences of aIIb and b3 genes were amplified and directly sequence

      Gene: ITGA2B

      Variant: NM_000419.3:c.1413C>G (p.Tyr471Ter) and NM_000419.3:c.2800G>T (p.Val934Phe)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA290950376 (p.Tyr471Ter) and CA290946484 (p.Val934Phe)

      gnomAD MAF in the European (non-Finnish) population is 0.000008791 https://gnomad.broadinstitute.org/variant/17-42457994-G-C

    2. 15CabGT-15

      Case15: (Proband CabGT-15)

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      ProteinExpression: N/A

      Platelet Aggregation: N/A

      CasePreviousTesting: Promoter and exon sequences of aIIb and b3 genes were amplified and directly sequence

      Gene: ITGA2B

      Variant: NM_000419.3:c.2800G>T (p.Val934Phe)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA290946484

      gnomAD N/A

    3. 21CabGT-21

      Case21: (ProbandGT-21) Male, age not specified, Caucasian

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      ProteinExpression: Flow cytometry showed <5% GPIIIa and GPIIIb surface expression

      Platelet Aggregation: N/A

      CasePreviousTesting: Promoter and exon sequences of aIIb and b3 genes were amplified and directly sequence

      Gene: ITGB3

      Variant: NM_000212.2:c.191G>A (p.Cys64Tyr) the second mutation was not identified

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA291224490

      gnomAD N/A

    4. 12

      Case12: (Proband CabGT-12), Female, age not specified, Caucasian

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      ProteinExpression: Flow cytometry showed 19% GPIIb and 40% GPIIIa surface expression

      Platelet Aggregation: N/A

      CasePreviousTesting: Promoter and exon sequences of aIIb and b3 genes were amplified and directly sequence

      Gene: ITGA2B

      Variant: NM_000419.3:c.2113T>C (p.Cys705Arg) and NM_000419.3:c.3060+2T>C (p.Val982_Lys1020del)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA8602816 and CA290944108

      gnomAD MAF in the European (non-Finnish) population is 0.000008792 https://gnomad.broadinstitute.org/variant/17-42455140-A-G and MAF in the European non Finnish population for (p.Val982_Lys1020del) is 0.00003876 https://gnomad.broadinstitute.org/variant/17-42451720-A-G

    1. 2

      Case2: Female, 67 years old, Japanese

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A per Table 1

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Prolonged ivy bleeding times, bleeding diathesis since early childhood

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      ProteinExpression: Surface expression of αIIbβ3 was analyzed by flow cytometry which was < 5% of normal

      PlateletAggregation: Aggregation in response to ADP, epinephrine and collagen was absent but normal in response to ristocetin

      CasePreviousTesting: Nucleotide sequences of the αIIb and β3 coding regions were determined by direct sequencing of RT-PCR products from platelet RNA.

      Gene: ITGA2B

      Variant: NM_000419.3:c.1063G>A (p.Glu355Lys)

      LegacyVariant: (p.Glu324Lys)

      ClinVar: 2899

      CAiD: CA115844

      gnomAD: MAF in the European (non-Finnish) population is 0.00001978 https://gnomad.broadinstitute.org/variant/17-42461008-C-T

    2. cases 1

      Case1: Female, 25 years old, Japanese

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A per Table 1

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Prolonged ivy bleeding times, bleeding diathesis since early childhood

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      ProteinExpression: Surface expression of αIIbβ3 was analyzed by flow cytometry which was < 5% of normal

      PlateletAggregation: Aggregation in response to ADP, epinephrine and collagen was absent but normal in response to ristocetin

      CasePreviousTesting: Nucleotide sequences of the αIIb and β3 coding regions were determined by direct sequencing of RT-PCR products from platelet RNA.

      Gene: ITGA2B

      Variant: NM_000419.3:c.959T>C (p.Phe320Ser)

      LegacyVariant: (p.Phe289Ser)

      ClinVar: N/A

      CAiD: CA399804774

      gnomAD: N/A

    1. Click here for additional data file

      Case Info Found in supplementary data:

      Case#: Patient GT, Female 43 years old. Greek family.

      FamilyInfo: Two sisters, one affected.

      Disease: Glazmann's Thrombasthenia

      CasePresentingHPOs: HP:0003540, HP:0000967, HP:0031364, HP:0000421, HP:0000225, HP:0000978, HP:0000132

      Impaired platelet aggregation, Petechiae, Ecchymosis, Epistaxis, Gingival bleeding, bruising susceptibility, Menorrhagia,

      PlateletAgreggation: Light transmission aggregometry studies demonstrated no aggregation in response to ADP, epinephrine, collagen, and arachidonic acid, but a normal response to ristocetin.

      GenotypingMethod: Reverse transcription PCR of platelet RNA confirmed the presence of a homozygous β3 C575R mutation.

      ClinVar: NA

      PAID: PA2573320341 (almost certainly CA400032399 but no c. reported)

      Variant: NA

      GnomAD: NA

      ExpressionEvidence: Flow cytometry demonstrated normal platelet binding of an antibody to GPIb, but virtually no binding of mAb 7E3. Immunoblot analysis demonstrated the presence of <20% of normal β3, with a faint band corresponding to pro-αIIb

    1. Supplemental Table S1:

      Case12: Male, Italy, age not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: Moderate bleeding

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: <5% αIIbβ3 expression

      PlateletAggregation: Absent platelet aggregation (all the information that is provided in Supp. Table S1)

      CasePreviousTesting: Sanger sequencing of exons, splice sites and untranslated regions of the ITGA2B and ITGB3 genes was performed

      Gene: ITGA2B

      Variant: NM_000419.3:c.1742C>A (p.Ala581Asp)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA399802112

      gnomAD: N/A

      PreviouslyPublished: PMID: 12083483

    1. Mother L

      Case1: Mother L

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Assessment of surface PTL expression of GPIIIa-IIb was performed

      PlateletAggregation: N/A

      CasePreviousTesting: DNA sequence analysis was performed -- direct sequence analysis of the PCR products corresponding to exon 10 was performed here

      Gene: ITGA2B

      Variant: NM_000212.2:c.1447T>C

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA400029321

      gnomAD: N/A

    1. GT1

      Case1: GT-1, Turkish, gender or age not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: Mother: c.2374delG heterozygous and Father: c.2374delG heterozygous

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Bleeding symptoms are severe and bleeding time is pathogenic (See Table 1) Abstract mentions patients' bleeding signs include epistaxis, mucocutaneous bleeding, haematomas, petechiae, GI bleeding and menorrhagia; however, not specified per proband.

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry was performed and expression is stated as pathogenic in Table 1

      PlateletAggregation: Platelet aggregation was performed and is stated as pathogenic in Table 1; however, no specific agonists mentioned

      CasePreviousTesting: All exons of ITGA2B and ITGB3 genes as well as surrounding intron regions were amplified by PCR using intronic primers as pre-viously described (12). The purified DNA fragments were then di-rectly sequenced.

      Gene: ITGA2B

      Variant: NM_000419.3:c.2374del

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA915940267

      gnomAD: N/A

    2. GT12

      Case12: GT-12, Caucasian, gender or age not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: Mother: c.2326_2331dupGAGGCC and Father: deceased

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Bleeding symptoms are severe and bleeding time is pathogenic (See Table 1) Abstract mentions patients' bleeding signs include epistaxis, mucocutaneous bleeding, haematomas, petechiae, GI bleeding and menorrhagia; however, not specified per proband.

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry was performed and expression is stated as pathogenic in Table 1

      PlateletAggregation: Platelet aggregation was performed and is stated as pathogenic in Table 1; however, no specific agonists mentioned

      CasePreviousTesting: All exons of ITGA2B and ITGB3 genes as well as surrounding intron regions were amplified by PCR using intronic primers as pre-viously described (12). The purified DNA fragments were then di-rectly sequenced.

      Gene: ITGA2B

      Variant: NM_000419.3:c.957T>A and NM_000419.3:c.2326_2331dupGAGGCC

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA399804780 and CA915940324

      gnomAD: N/A

    3. GT5

      Case5: GT-5, Caucasian, gender or age not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Bleeding symptoms are severe and bleeding time is pathogenic (See Table 1) Abstract mentions patients' bleeding signs include epistaxis, mucocutaneous bleeding, haematomas, petechiae, GI bleeding and menorrhagia; however, not specified per proband.

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry was performed and expression is stated as pathogenic in Table 1

      PlateletAggregation: Platelet aggregation was performed and is stated as pathogenic in Table 1; however, no specific agonists mentioned

      CasePreviousTesting: All exons of ITGA2B and ITGB3 genes as well as surrounding intron regions were amplified by PCR using intronic primers as pre-viously described (12). The purified DNA fragments were then di-rectly sequenced.

      Gene: ITGA2B

      Variant: NM_000419.3:c.408G>C and NM_000419.3:c.1787T>C

      LegacyVariant: N/A

      ClinVar: 2900

      CAiD: CA500624244 and CA115846

      gnomAD: MAF in the European (non-Finnish) population 0.00006484 http://gnomad.broadinstitute.org/variant/17-42463192-C-G and MAF in European (non-Finnish) population is 0.0001325 http://gnomad.broadinstitute.org/variant/17-42457148-A-G

    4. GT6 

      Case6: GT-6, Croats, gender or age not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Bleeding symptoms are severe and bleeding time is pathogenic (See Table 1) Abstract mentions patients' bleeding signs include epistaxis, mucocutaneous bleeding, haematomas, petechiae, GI bleeding and menorrhagia; however, not specified per proband.

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry was performed and expression is stated as pathogenic in Table 1

      PlateletAggregation: Platelet aggregation was performed and is stated as pathogenic in Table 1; however, no specific agonists mentioned

      CasePreviousTesting: All exons of ITGA2B and ITGB3 genes as well as surrounding intron regions were amplified by PCR using intronic primers as pre-viously described (12). The purified DNA fragments were then di-rectly sequenced.

      Gene: ITGB3

      Variant: NM_000212.2:c.166–2A>G

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: Unregistered Variant

      gnomAD: N/A

    1. GT5

      Disease: Glazmann's Thrombasthenia

      Case: 48 year old female French Gypsy

      CasePresentingHPOs: HP:0001975

      (Decreased platelet glycoprotein IIb-IIIa)

      GenotypingMethod:Genotyping analysis of the HPA-1 system by high resolution melting analysis (methods not provided, cited article I don't have access too)

      ClinVar: 2895

      CAID: CA10575473

      Variant: NM_000419.5:c.1544+1G>A

      GnomAD: Not found

      ExpressionEvidence: Failed to express αIIbβ3 integrin on their platelet surface (methods not provided cited article no access too)

    1. M10

      Case10: Patient M10, Male, French Gypsy, age is not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: See Figure 2 for pedigree

      ParentalGenotype: Unaffected parents see pedigree Fig 2

      CasePresentingHPOs: N/A

      CaseHPOFreeText: France, GT is particularly frequent in the Gypsy population, mainly represented by the Manouche tribe. Their clinical phenotype is the same as for classic type I disease, with a moderate and occasional severe bleeding syndrome

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry analysis has shown that these patients' surface expresses <5% of normal GPIIIa and GPIIb levels (we are not given an exact value for each proband)

      PlateletAggregation: "Absent platelet aggregation" this is all the information we are given for platelet aggregation

      CasePreviousTesting: N/A

      Gene: ITGA2B

      Variant: NM_000419.3:c.1544+1G>A

      LegacyVariant: N/A

      ClinVar: 2895

      CAiD: CA10575473

      gnomAD: N/A

    2. M1

      Case1: Patient M1, Female, French Gypsy, age is not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: See Figure 2 for pedigree

      ParentalGenotype: Unaffected parents see pedigree Fig 2

      CasePresentingHPOs: N/A

      CaseHPOFreeText: France, GT is particularly frequent in the Gypsy population, mainly represented by the Manouche tribe. Their clinical phenotype is the same as for classic type I disease, with a moderate and occasional severe bleeding syndrome

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry analysis has shown that these patients' surface expresses <5% of normal GPIIIa and GPIIb levels (we are not given an exact value for each proband)

      PlateletAggregation: "Absent platelet aggregation" this is all the information we are given for platelet aggregation

      CasePreviousTesting: N/A

      Gene: ITGA2B

      Variant: NM_000419.3:c.1544+1G>A

      LegacyVariant: N/A

      ClinVar: 2895

      CAiD: CA10575473

      gnomAD: N/A

    1. 13

      Case2: Female, 41 years old, ethnicity not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: "This mutation was confirmed in the proband and parents."

      CasePresentingHPOs: HP:0000225 (Gingival bleeding)

      CaseHPOFreeText: Site of bleeding: Skin

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      ProteinExpression: See Table 1 (information provided)

      PlateletAggregation: See Table 1 (information provided)

      CasePreviousTesting: Screened mutations in ITGA2B and ITGB3 by multiplex polymerase chain reaction (PCR) amplification (MPCR) and conformation-sensitive gel electrophoresis

      Gene: ITGA2B

      Variant: NM_000419.3:c.1750C>T (p.Arg584Ter)

      LegacyVariant: N/A

      ClinVar: 2892

      CAiD: CA115834

      gnomAD: MAF in the East Asian population is 0.0002176 https://gnomad.broadinstitute.org/variant/17-42457372-G-A

    1. F8.I.2

      Case#: Female, 75 (age when studied in 1975)

      Disease: Glazmann's Thrombasthenia Like Syndrome

      CasePresentingHPOs: HP:0001873, HP:0006298

      Thrombocytopenia, Prolonged bleeding after dental extraction

      CaseNotHPOs: NA

      FamilyInfo: Pedigree figure 1. Several affected family members.

      PlateletAgreggation:Daughter studied: Decreased PLT aggregation and diminished ATP release with the agonists ADP, collagen, and AA, with normal ristocetin agglutination

      GenotypingMethod: Genetic analysis of ITGA2B and ITGB3 genes was performed by next-generation sequencing (NGS). Sanger sequencing used to confirm variants.

      From Daughter

      ClinVar: Not Found

      CAID: CA400034393

      Variant: NM_000212.3:c.2278C>T (ITGB3)

      GnomAD: Not Found

      ExpressionEvidence: Level of expression on PLT surface determined by FCM: CD41a (GPIIb/IIIa) 52%, CD61 (GPIIIa) 77%, and CD42b (GPIb) 129%. Healthy control value range: CD41a (GPIIb/IIIa) (85-115%); CD61 (GPIIIa) (80-120%); CD42b (GPIb) (70-130%).

    2. Patient F4.II.1

      Case#: Male, 48

      Disease: Glazmann's Thrombasthenia Like Syndrome

      CasePresentingHPOs: HP:0001873, HP:0000421, HP:0031364, HP:0000225

      Thrombocytopenia, Epistaxis, Ecchymosis, Gingival bleeding

      CaseNotHPOs: NA

      FamilyInfo: Pedigree figure 1. Family history of thrombocytopenia.

      PlateletAgreggation: Decreased PLT aggregation and diminished ATP release with the agonists ADP, collagen, and AA, with normal ristocetin agglutination

      GenotypingMethod: Genetic analysis of ITGA2B and ITGB3 genes was performed by next-generation sequencing (NGS). Sanger sequencing used to confirm variants.

      ClinVar: 50232

      CAID: CA10575572

      Variant: NM_000419.5:c.3077G>A

      GnomAD: European non-Finnish 0.000008801 (1/113618)

      ExpressionEvidence: Level of expression on PLT surface determined by FCM: CD41a (GPIIb/IIIa) 49%, CD61 (GPIIIa) 44%, and CD42b (GPIb) 105%. Healthy control value range: CD41a (GPIIb/IIIa) (85-115%); CD61 (GPIIIa) (80-120%); CD42b (GPIb) (70-130%).

    1. 23

      Case23: Female, Arab, age not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Table 1 mentions family history available for the proband, however no specific details about family provided in paper

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0000421, HP:0000132)

      (Epistaxis, menorrhagia)

      CaseHPOFreeText: Haematuria

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: N/A

      PlateletAggregation: N/A

      CasePreviousTesting: N/A

      Gene: ITGA2B

      Variant: NM_000419.3:c.409-2_419del

      LegacyVariant: N/A

      ClinVar: 2889

      CAiD: CA10575471

      gnomAD: N/A

    1.  Case 1

      Case1: Female, 9 years old, Japanese

      DiseaseAssertion: Macrothrombocytopenia

      FamilyInfo: Information given in Table 1 and Fig 2

      ParentalGenotype: Mother: ITGA2B (p.Arg422Ter heterozygous) and Father: ITGA2B (p.Gly991Cys heterozygous) See Table 1 for this information

      Sequencing of parental DNA indicated parental mutations. CasePresentingHPOs: HP:0000979, HP:0000421, HP:0000978

      (Purpura, epistaxis, bruising)

      CaseHPOFreeText: Hemorrhage after dental

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometric analysis showed that surface αIIbβ3 expression in platelets (was markedly impaired 3-11%)

      PlateletAggregation: N/A

      CasePreviousTesting: Sequence analysis of entire coding regions of exons and exon-intron boundaries of ITGA2B and ITGB3 gene of the patient revealed two novel mutations in ITGA2B.

      Gene: ITGA2B

      Variant: NM_000419.3:c.3064G>T (p.Gly1022Cys) and NM_000419.3:c.1357C>T (p.Arg453Ter)

      LegacyVariant: (p.Gly991Cys legacy nomenclature for p.Gly1022Cys) and (p.Arg422Ter legacy nomenclature for p.Arg453Ter)

      ClinVar: 631773

      CAiD: CA399787943 and CA399803529

      gnomAD: N/A

    1. Case1: Male, 61 years old, Iraqi-Jewish origin

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: His sister is the other proband in this article

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0000225, HP:0000225, HP:0031364, HP:0002249

      (Gingival bleeding, epistaxis, ecchymosis, melena)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      ProteinExpression: Surface expression GPIIb/IIIa was 9% of normal

      PlateletAggregation: Platelet aggregation in response to thrombin, collagen, ADP and epinephrine was absent, whereas ristocetin induced aggregation was normal

      CasePreviousTesting: DNA fragments containing exons and flanking intronic regions of the GPIIb gene were amplified by PCR

      Gene: ITGA2B

      Variant: NM_000419.3:c.1947-2A>G

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA399801096

      gnomAD: N/A

    1. GTP1

      Case1: GTP1, gender, age, or ethnicity not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: Sequencing of both parental genomic DNA confirmed patient was homozygous for IVS4+1G>A mutation

      CasePresentingHPOs: N/A

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry showed <5% αIIbβ3 expression, which was confirmed by western blot analysis

      PlateletAggregation: N/A

      CasePreviousTesting: Sequencing of patient genomic DNA was done on ITGA2B (no mention of ITGB3)

      Gene: ITGA2B

      Variant: NM_000419.3:c.574+1G>A (IVS4+1G>A)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA399805691

      gnomAD: MAF in the European non-Finnish population 0.00001235 http://gnomad.broadinstitute.org/variant/17-42462918-C-T

  2. www.researchgate.net www.researchgate.net
    1. Patient 4

      Case4: Patient 4, Female, 12 years old

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Affected sister is Patient 3

      ParentalGenotype: N/A (Not consanguineous Caucasians, showed no increased bleeding tendency)

      CasePresentingHPOs: HP:0000967

      (Petechiae)

      CaseHPOFreeText: Hematomas, prolonged in vitro bleeding time

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry analysis revealed that there was no surface expression of GPIIb/IIIa for Patient 4 and there was approx. 1520 of GPIIb/IIIa expression for Patient 4.

      PlateletAggregation: All patients' platelets showed severely reduced platelet aggregation after stimulation with collagen and ADP in contrast to the normal range (See Table 1). Stimulation with epinephrine and arachidonic acid also demonstrated decreased platelet aggregation. In contrast, ristocetin-induced platelet aggregation was within a normal range.

      CasePreviousTesting: Sequenced ITGA2B and ITGB3 genes from one patient of each family (Patient 2 and 3) and Patient 1 and 4 were screened for the identified mutation in the corresponding family.

      Gene: ITGA2B

      Variant: NM_000419.3:c.1787T>C (p.Ile596Thr)

      LegacyVariant: N/A

      ClinVar: 2900

      CAiD: CA115846

      gnomAD: MAF in the European (non-Finnish) population is 0.0001325 http://gnomad.broadinstitute.org/variant/17-42457148-A-G

    1. A female patient

      Case1: Female, 20 years old, Chinese

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0000978, HP:0000421,

      (Easy bruising, epistaxis)

      CaseHPOFreeText: Prolonged bleeding time (more than 20 minutes, absent clot retraction

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Decreased of surface expression of αIIb and β3 in patient's platelets

      PlateletAggregation: Absent in vitro platelet aggregation in response to ADP, epinephrine, and collagen, but relatively normal ristocetin induced platelet aggregation

      CasePreviousTesting: DNA fragments containing exons and flanking intronic regions of ITGA2B and ITGB3 genes were produced by PCR using primers. Amplified fragments were subjected to analysis by direct DNA sequencing

      Gene: ITGA2B

      Variant: NM_000419.3:c.527C>A (p.Pro157His)

      LegacyVariant: (p.Pro126His)

      ClinVar: N/A

      CAiD: CA8603447

      gnomAD: MAF in the African population is 0.00006689 http://gnomad.broadinstitute.org/variant/17-42462966-G-T

    1. patient 3

      Case3: Patient 3, Female, 27 years old

      DiseaseAssertion: Glanzmann thrombasthenia type I (Diagnosed at 10 years old)

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Bleeding phenotypes are not specified per patient in this article, rather, it states: "Petechia, epistaxis, and prolonged bleeding after trauma were the most common symptoms among studied patients"

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: This patient has type 1 Glanzmann thrombasthenia; therefore, according to this article, this proband had between 0-5% of normal levels of surface GPIIb/IIIa expression.

      PlateletAggregation: Prolonged bleeding time, abnormal clot retraction, impaired platelet aggregation induced by most physiological agonists (ADP, epinephrine, and collagen) except ristocetin, mucosal bleeding, easy bruising, epistaxis, as well as normal prothrombin/activated partial thromboplastin time, and normal platelet count. (This is among inclusion criteria for this study)

      CasePreviousTesting: To identify the underlying molecular mechanism of GPIIb/IIIa complex abnormalities among probands in this study, all the 30 exons of ITGA2B and the 15 exons of ITGB3 were analyzed using PCR–CSGE and DNA sequencing.

      Gene: ITGA2B

      Variant: NM_000419.3:c.113del

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA915940264

      gnomAD: N/A

    1. The patient

      Case1: Male, 7 years old, ethnicity not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: See pedigree Fig 5

      ParentalGenotype: Parents heterozygous for the mutation proband has

      CasePresentingHPOs:

      (Petechia, bruising

      CaseHPOFreeText: Mucocutaneous hemorrhages

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: There was a lack of platelet surface expression of the GPIIb-IIIa complex as shown by Western blotting

      PlateletAggregation: Platelets fail to aggregate spontaneously or in response to agonists, although they agglutinate in response to ristocetin

      CasePreviousTesting: Screening of mutations in both ITGA2B and ITGB3 was carried out by single stranded conformational polymorphism (SSCP) analysis

      Gene: ITGA2B

      Variant: NM_000419.3:c.1882C>T (p.Arg628Ter)

      LegacyVariant: (p.Arg597Ter)

      ClinVar: N/A

      CAiD: CA399801310

      gnomAD: MAF in the Latino population is 0.00003983 http://gnomad.broadinstitute.org/variant/17-42456075-G-A

    1. Table 3 Molecular Diagnosis of Patients with Glanzmann Thrombasthenia:

      Case3: GT-3, age, gender, ethnicity not specified

      DiseaseAssertion: Glanzmann thrombasthenia type II

      FamilyInfo: Segregation analysis confirmed in presence of heterozygous mutations in this proband.

      ParentalGenotype: Although segregation analysis confirmed, we do not know which variant in particular came from mom or dad.

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Patients presented with a variable bleeding diathesis; most patients had epistaxis (54%), cutaneous bleeding (58%), and menorrhagia (100% of women) while other common symptoms (oral cavity, GI, following dental extraction of mild injuries, postpartum, or hematomas) were in general milder. There is no specific phenotypes attached to probands in this paper.

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry showed that αIIbβ3 expression was between 5% and 20%.

      PlateletAggregation: There was severely impaired aggregation in response to all physiological agonists, and ristocetin induced platelet agglutination was normal or reduced to some extent.

      CasePreviousTesting: Total RNA from peripheral blood was used for cDNA synthesis for RT-PCR. Then, using specific oligonucleotides and conditions, they amplified and sequenced ITGA2B and ITGB3 by Sanger sequencing. Every mutation found in cDNA was confirmed in DNA samples.

      Gene: ITGA2B

      Variant: NM_000419.3:c.2113T>C (p.Arg705Cys)

      LegacyVariant: (p.Cys674Arg)

      ClinVar: N/A

      CAiD: CA8602816

      gnomAD: MAF in European non-Finnish population is 0.000008792

    1. Case1: Female, 48 years old, ethnicity not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: HP:0000421, HP:0000225, HP:0000978, HP:0000132, HP:0006298, HP:0005261

      (Epistaxis, gingival bleeding, easy bruising, menorrhagia, bleeding after tooth extraction, hemarthrosis

      CaseHPOFreeText: Hemorrhage after surgery

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Platelet surface glycoprotein analysis by flow cytometry revealed a severe αIIbβ3 deficiency (Table 3 shows specific values)

      PlateletAggregation: There was a failure of ADP, collagen and adrenalin to induce platelet aggregation, but ristocetin-induced platelet aggregation (RIPA) was normal

      CasePreviousTesting: Integrin alphaIIb subunit gene (ITGA2B) sequencing showed that this proband was a compound heterozygote

      Gene: ITGA2B

      Variant: NM_000419.3:c.1214T>C (p.Ile405Thr) and NM_000419.3:c.1234G>A (p.Gly412Arg)

      LegacyVariant: (p.Ile374Thr) (p.Gly381Arg)

      ClinVar: 381748

      CAiD: CA290950815 (p.Ile403Thr) and CA8603182 (p.Gly412Arg)

      gnomAD: MAF in Latino population 0.0001453 http://gnomad.broadinstitute.org/variant/17-42458406-C-T

    1. P4

      Case4: P4, gender, age, ethnicity not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: N/A

      CasePresentingHPOs: N/A

      CaseHPOFreeText: Article mentions all patients have a severe bleeding phenotype

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: αIIbβ3 expression levels were (0.6% in patient 4)

      PlateletAggregation: N/A

      CasePreviousTesting: Acknowledgements section mentions acknowledging the Genoscope team for sequencing both ITGA2B and ITGB3 genes of the GT patients in this article

      Gene: ITGA2B

      Variant: NM_000419.3:c.857T>A (p.Val268Asp)

      LegacyVariant: N/A

      ClinVar: N/A

      CAiD: CA399805011

      gnomAD: N/A

    1. A 56-year-old Japanese female

      Case1: Female, 56 years old, Japanese

      DiseaseAssertion: Glanzmann thrombasthenia (Diagnosed at 21 years of age)

      FamilyInfo:

      ParentalGenotype:

      CasePresentingHPOs: HP:0004406, HP:0000225

      (Recurrent epistaxis, gingival bleeding)

      CaseHPOFreeText: N/A

      CaseNotHPOs: N/A

      CaseNotHPOsFreeText: N/A

      ProteinExpression: Flow cytometry demonstrated significantly decreased expression of CD41 and CD61 to less than 20% of normal levels (See Figure 2)

      PlateletAggregation: An in vitro assay revealed no platlet aggregation in response to agonists except ristocetin.

      CasePreviousTesting: DNA sequencing analysis revealed compound heterozygous mutations confirming a diagnosis of Glanzmann thrombasthenia

      Gene: ITGA2B

      Variant: NM_000419.3:c.2602-3C>G and NM_000419.3:c.641T>C (p.Leu214Pro)

      LegacyVariant: N/A

      ClinVar: 2893 and 2901

      CAiD: CA10575472 and CA115848

      gnomAD: MAF in East Asian population 0.00006523 http://gnomad.broadinstitute.org/variant/17-42453087-G-C

    1. Case1: Female, 29 years old, ethnicity not specified

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: N/A

      ParentalGenotype: Parents were heterozygous for mutation (parents are first cousins)

      CasePresentingHPOs: HP:0001892, HP:0000421, HP:0000225, HP:0000132

      (Severe hemorrhagic diathesis, epistaxis, gingival bleeding, menorrhagia)

      CaseHPOFreeText: Patients severe hemorrhagic diathesis manifested as epistaxis

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      ProteinExpression: N/A

      PlateletAggregation: N/A

      CasePreviousTesting: Amplification of reversely transcribed platelet GP IIIa mRNA by the polymerase chain reaction and subsequent sequence analysis showed a 86-bp deletion, which corresponds to exon i of the GP IIIa gene.

      Gene: ITGB3

      Variant: NM_000212.2:c.165+1G>T (No other assertion was made about the 2 other variants in this article, just this variant that is mentioned in this annotation)

      LegacyVariant: N/A

      ClinVar: 13560

      CAiD: CA400031853

      gnomAD: N/A

    1. The propositus (A.C.S.; II.1) in family 1 is a 22-yearold Portuguese girl

      Case1: Female, 22 years old, Portugese

      DiseaseAssertion: Glanzmann thrombasthenia

      FamilyInfo: Also studied were the patient’s mother (I.2),her father (1.1), and her sister (II.2). Of these family members, only her sister has reported excessive bleeding although platelet aggregation tests were normal for all of them. Consanguinity was present as her parents were cousins.

      ParentalGenotype: Parents heterozygous for mutation

      CasePresentingHPOs: HP:0000967

      (Petechia)

      CaseHPOFreeText: Mucocutaneous bleeding

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      ProteinExpression: <5% surface expression of aIIbb3

      PlateletAggregation: Absent with physiologic agonists but agglutination with ristocetin was normal

      CasePreviousTesting: We examined each of the 30 exons of the b3 gene and each of the 15 exons of the aIIb gene for migration changes in PCR-SSCP analysis

      Gene: ITGB3

      Variant:

      LegacyVariant:

      ClinVar:

      CAiD:

      gnomAD: N/A

    1. II.1

      CaseCII-1: N/A

      CasePresentingHPOs: N/A

      HPOsFreeText: Pretreatment phenylalanine level at 1515 umol/L

      CaseNotHPOs: N/A

      NotHPOsFreeText: N/A

      CaseAddInfo: N/A

      Variant1: NM_000277.3(PAH):c.194T>C (p.Ile65Thr)

      ClinVar: 636 https://www.ncbi.nlm.nih.gov/clinvar/variation/636/

      gnomAD: 0.0005574, https://gnomad.broadinstitute.org/variant/12-102894893-A-G?dataset=gnomad_r3

      Variant2: NM_000277.3(PAH):c.1065+1G>A

      ClinVar: 102501 https://www.ncbi.nlm.nih.gov/clinvar/variation/102501/

      gnomAD: 0.00004622, http://gnomad.broadinstitute.org/variant/12-103238113-C-T

    2. 11.2

      CaseAII-2: N/A

      CasePresentingHPOs: N/A

      HPOsFreeText: Pretreatment phenylalanine level at 375 umol/L

      CaseNotHPOs: N/A

      NotHPOsFreeText: N/A

      CaseAddInfo: N/A

      Variant1: NM_000277.3(PAH):c.165del (p.Phe55fs)

      ClinVar: 611 https://www.ncbi.nlm.nih.gov/clinvar/variation/611/

      gnomAD: 0.00002639, https://gnomad.broadinstitute.org/variant/12-103306571-CA-C?dataset=gnomad_r3

      Variant2: NM_000277.3(PAH):c.898G>T (p.Ala300Ser)

      ClinVar: 92751 https://www.ncbi.nlm.nih.gov/clinvar/variation/92751/

      gnomAD: 0.006318, https://gnomad.broadinstitute.org/variant/12-102851701-C-A?dataset=gnomad_r3

    1. Heterozygous c621G>A in genomic DNA (W207X, precursor protein)Detected on NBS, asymptomaticNone0.25 (0.33)No symptomsHomozygous for this mutation in cDNA

      Case3:

      CasePresentingHPOs:

      HPOFreeText: Identified by NBS with elevated C5-carnitine levels. Asymptomatic up to 3 year follow up. Levels of C5-carnitine decreased with time.

      CaseNotHPOs:

      CasePreviousTesting: Followup C5 carnitine 0.25 nM/ml (ref 0.33). Additional testing was performed on patients identified by NBS: all either had elevation of 2-methylbutyrlglycine in urine (with no intermediates consistent with isovaleric acidemia), or increase in 2-methylbutyrylcarnitine in culture from fibroblasts.

      CaseGenotypingMethod: Bidirectional sequence analysis of genomic DNA.

      Variant: 1. NM_001609.3(ACADSB):c.621G>A (p.Trp207Ter) 2. unknown

      ClinVar: 299075

      gnomAD:

      VariantEvidence: Genomic DNA showed heterozygosity for this variant, but cDNA indicated homozygosity. The variant on the second allele must result in loss of transcription, abnormal splicing, unstable RNA, or deletion containing exon 5.

      CaseAddInfo:

      CasePMIDs:

    1. Proband

      CaseF1P: Female, 8 yrs report, India

      CasePresentingHPOs: N/A

      HPOsFreeText: N/A

      CaseNotHPOs: N/A

      NotHPOsFreeText: N/A

      CaseAddInfo: Proband for Family 1, Variant is demonstrated to activate a cryptic splice site and abolish the canon splice site leading to a premature termination and nonsense-mediated decay

      CasePreviousTesting: Blood phenylalanine before treatment was 1174 μmol/l, Blood tyrosine before treatment was 33 μmol/l

      CaseGenotypingMethod: N/A

      Variant: NM_000277.3(PAH):c.169-2A>G

      ClinVar: 555212 https://www.ncbi.nlm.nih.gov/clinvar/variation/555212/

      gnomAD: 0.00003267, http://gnomad.broadinstitute.org/variant/12-103288698-T-C

    1. Table 1

      Case# P4, 4yr onset, Pakistani

      CasePresentingHPOs HP:0002151, HP:0001946, HP:0001942, HP:0001987

      CasePreviousTesting negative for NAGS and CPS1 genes.

      CaseGenotypingMethod sequence analysis of coding exons, including flanking intronic regions of CA5A and CA5B, was performed.

      Variant NM_001739.1:c.555+4_555+183del180bp

      CAID CA658820661

      VariantEvidence intronic splice site

      CaseAddInfo consanguineous

    1. Table 1

      Case3b: Female, 9 d at initiation of follow up, East Indian ancestry, sibling of Case 3a (Family 1)

      HPOsFreeText: NBS C4-acylcarnitine 2.1 umol/L, Plasma C4-acylcarnitine 2.47 umol/L, urine C4-acylcarnitine 21.66 mmol/mol creatinine, Urine C4/C3 ratio 42

      NotHPOsFreeText: normal urine isobutyrylgycine ug/mg creatinine

      CaseAddInfo: unremarkable clinical condition

      Case3b (Level 2)


      CasePreviousTesting: same as group

      CaseMethod1: same as group

      CaseMethod2: same as group

      CaseGenotypingMethod: same as group


      Variant: NM_014384.2(ACAD8):c.867C>A (p.His289Gln)

      ClinVar: 5358

      CAID: CA117441

      gnomAD: not in gnomAD


      CaseAddInfo: homozygous mutations, no data for SCAD gene variants

    2. Patient 8

      Case8: Male, 6 wks at initiation of follow up, European ancestry

      HPOsFreeText: NBS C4-acylcarnitine 1.8 umol/L, plasma C4 acylcarnitine 1.52 umol/L, in vitro probe isoC4-acylcarnitine 0.187 umol/ g protein, in vitro probe C4-acylcarnitine 0.573 umol/g protein, elevated urine C4-acylcarnitine 25.09 mmol/mol creatinine, Urine C4/C3 ratio 88

      NotHPOsFreeText: normal urine isobutyryglycine

      CaseAddInfo: unremarkable clinical condition

      Case8 (Level 2)


      CasePreviousTesting: same as group

      CaseMethod1: same as group

      CaseMethod2: same as group

      CaseGenotypingMethod: same as group


      Variant1: NM_014384.2(ACAD8):c.512C>G (p.Ser171Cys)

      ClinVar: 95589

      CAID: CA223125

      gnomAD: 0.02252 (European non-Finnish)


      Variant2: NM_014384.2(ACAD8):c.455T>C (p.Met152Thr)

      ClinVar: 5355

      CAID: CA117433

      gnomAD: 0.0001395 (European Non-Finnish)


      CaseAddInfo: compound heterozygote specified allele 1 and 2, but not maternal and paternal. Potential splice-site alteration at exon 3(+3A>G). ACADS (SCAD-deficient) gene variants 625G>A/625G>A.

    1. Case report

      Monoallelic, AD

      Case#: Muriello case

      CaseHPOs: HP:0003235 (hypermethioninemia)

      CaseHPOsFreeText: Elevated methionine on newborn screen. Intermottent elevations of ALT (66 and 88 U/L) with normal AST, alkaline phosphatase and total bilirubin.

      CaseNotHPOsFreeText: Normal plasma homocysteine

      CasePreviousTesting: Plasma methionine 0.81 mg/dL (54 μmol/L) at 1 day, 1.08 mg/dL (73 μmol/L) at 16 days (normal < 0.8 mg/dL). Methionine concentration was 175, 185, 192, 136, 75 μmol/L (reference range 9–43 μmol/L) at ages 3.5 weeks, 2 months, 3 months, 5 months, and 12 months, respectively. Normal plasma homocysteine, normal tyrosine. Normal S-adenosylmethionine, and S-adenosylhomocysteine.

      CaseGenotypingMethod: WES

      Variant: NM_000429.2:c.776C>T (p.Ala259Val) (heterozygous)

      ClinVar: 279845

      gnomAD: The highest population minor allele frequency in gnomAD is 0.00006437 (African)

      VariantEvidence: In the dimerization domain, like p.R264H. 80% reduction of the MAT activity

      CaseAddInfo: The variant is maternally inherited. The mother had a mild elevation of methionine of 50 μmol/L (normal range 10–42) at 27 years of age; this was normal on repeat at 28 years old (33 umol/L) Transaminases were normal on both occasions, but she had a history of elevated liver enzymes as a child including a hepatitis-like illness, which lasted months.

      CasePMIDs:

      Points: 0.5 This patient and her mother are heterozygous for a missense variant in MAT1A. The highest population minor allele frequency in gnomAD is 0.00006437 (African). The Ala259 residue is located in the dimerization interface of the protein and is predicted to act in a dominant negative fashion by interfering with the dimerization (MAT III) or tetramerization (MAT I) of the enzyme.

    1. ID no. 765

      Case765: Female, 9 years report, Spain

      CasePresentingHPOs: HP:0003153, HP:0001256, HP:0007359, HP:0012000 (Cystathioninuria, Mild mental retardation, Partial seizures, EEG with generally recognized spikes)

      HPOsFreeText: Elevated urine cystathionine (750 umol/g creatine; reference <46) and Elevated tHcys in urine (61 umol/g creatine; reference <20), Elevated plasma tHcys (19 umol/l; reference <7.5), Elevated plasma cystathionine (10 umol/l; reference =0), Post treatment normal urine cystathionine (34 umol/g creatine)

      CaseNotHPOs: HP:0003345 (Glutathione synthetase deficiency)

      NotHPOsFreeText: N/A

      CaseAddInfo: Patient is homozygous for this variant

      CasePreviousTesting: Karyotype, magnetic resonance imaging, specific genetic tests for neurogenetic diseases and screening for inborn errors of metabolism (lactate, pyruvate, ammonium, uric acid, amino acids, organic acids, glycosaminoglycanes, creatine and guanidinoacetate, purines and pyrimidines, and isoelectric focusing pattern of transferrin), as well as folate, pyridoxine and cobalamine deficiencies, neural tumors and genetically determined homocystinurias, were all ruled out.

      CaseGenotypingMethod: All twelve exons of the CTH gene and the intronic flanking sequences of the subjects and their parents was PCR amplified and directly sequenced.

      Variant: NM_001902.5:c.200C>T (p.Thr67Ile)

      ClinVar: 2939 https://www.ncbi.nlm.nih.gov/clinvar/variation/2939/

      gnomAD: Ashkenazi Jewish 9.934e-3, Overall 6.308e-3 https://gnomad.broadinstitute.org/variant/1-70881670-C-T

    1. P2

      Case# P2, M, 1mo onset, Indian

      CasePresentingHPOs HP:0001263, HP:0001250, HP:0001298, HP:0008344

      CasePreviousTesting Biochemical testing (Leu + Ile- 1235 Val- 591) on Tandem Mass Spectrometry (TMS) and/or abnormal metabolites (elevated BCKAs, 2-keto isocaproate, 3-hydroxy butyrate, 2-hydroxy isovalerate, 2-hydroxy caproate, 2-keto 3-methyl valerate) on a urinary organic acid profile using Gas Chromatography Mass Spectrometry (GC–MS) was performed to make the diagnosis.

      CaseMethod1 PCR

      CaseMethod2 Direct

      CaseGenotypingMethod Coding regions as well as flanking exon–intron boundaries of genes (BCKDHA- 9 exons, BCKDHB- 10 exons, and DBT- 11 exons) were amplified by PCR. Bidirectional Sequencing on products

      Variant NM_000709.3(BCKDHA):c.844G>C (p.Asp282His)

      ClinVar 204377

      VariantEvidence none

      CaseAddInfo consanguineous

    1. 10

      Case10 age/gender unknown, Caucasian, Germany

      CasePresentingHPOs HP:0001250

      (Seizures)

      HPOsFreeText seizure onset in neonatal period from minutes after birth until 3 weeks of age. Probable PDE: either pyridoxine-responsive seizures and an affected sibling or neonatal seizures responsive to a single dose of pyridoxine with later recurrence of seizures again responsive to pyridoxine.

      CaseNotHPOs n/a

      CasePreviousTesting post treatment testing: Pipecolic acid in plasma 7.5(nv 0.4-4.9µmol/liter), AASA in plasma 5.5(nv<0.2µmol/liter), urine AASA 26(nv<1mmol/molcreatinine). Normal urine PA after pyridoxine treatment.

      Variant NM_001182.4(ALDH7A1):c.1279G>C (p.Glu427Gln), homozygous

      ClinVar 17994

      gnomAD not in gnomAD

      CaseAddInfo n/a

      CasePMIDs n/a

    2. 9

      Case9 age/gender unknown, Caucasian, Germany

      CasePresentingHPOs HP:0001250

      (Seizures)

      HPOsFreeText seizure onset in neonatal period from minutes after birth until 3 weeks of age. Definite PDE: formal pyridoxine withdrawal had resulted in reoccurrence of seizures that again responded to pyridoxine.

      CaseNotHPOs n/a

      CasePreviousTesting post treatment testing: Pipecolic acid in plasma 5.5(nv 0.7-2.6µmol/liter), AASA in plasma 5.8(nv<0.2µmol/liter). Normal urine PA after pyridoxine treatment.

      Variant 1. NM_001182.4:c.696-2A>G (p.=), 2. NM_001182.4(ALDH7A1):c.1279G>C (p.Glu427Gln), compound heterozygous

      ClinVar 1. n/a 2. 17994

      CAID 1. CA360730346

      gnomAD neither in gnomAD

      CaseAddInfo n/a

      CasePMIDs n/a

    3. 6

      Case6 age/gender unknown, Caucasian, Germany

      CasePresentingHPOs HP:0001250

      (Seizures)

      HPOsFreeText seizure onset in neonatal period from minutes after birth until 3 weeks of age. Definite PDE: formal pyridoxine withdrawal had resulted in reoccurrence of seizures that again responded to pyridoxine.

      CaseNotHPOs n/a

      CasePreviousTesting post treatment testing: Pipecolic acid in plasma 23(nv 0.8-5.5µmol/liter), AASA in plasma 4.6(nv<0.2µmol/liter). Normal urine PA after pyridoxine treatment.

      Variant 1. NM_001182.4(ALDH7A1):c.328C>T (p.Arg110Ter), 2. NM_001182.4(ALDH7A1):c.1279G>C (p.Glu427Gln), compound heterozygous

      ClinVar 1. 17995 2. 17994

      gnomAD 1. MAF=0.0001385(Other), no homozygotes 2. not in gnomAD

      CaseAddInfo n/a

      CasePMIDs n/a

    1. We evaluated 16 patients with IVA, including 3 pairs of siblings

      Patient8: Male, 2yo, sibling to patient 9

      CasePresentingHPOs:

      HPOsFreeText: Asymptomatic, C5 (DBS) = 6.4 μmol l−1, Ammonium (μmol l−1) = 30, pH = 7.36, Protein intake (g kg−1 per day) = 1.5, PDI/IQ in follow-up = 108

      CaseNotHPOs: HP:0011968, HP:0002013, HP:0001944, HP:0001254, HP:0001259

      (poor feeding, vomiting, dehydration, lethargy, coma)

      NotHPOsFreeText: sweaty feet odor

      CaseAddInfo: Diagnosed with NBS at 11 days old, homozygous

      CasePMIDs:

      CasePreviousTesting: same as group

      CaseGenotypingMethod: same as group

      Variant: NM_002225.3:c.941C>G

      CAID: CA391721562, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA391721562

      gnomAD: n/a

    2. We evaluated 16 patients with IVA, including 3 pairs of siblings

      Patient15: Female, 15yo

      CasePresentingHPOs: HP:0011968, HP:0002013, HP:0001944, HP:0001941

      (poor feeding, vomiting, dehydration, acidosis)

      HPOsFreeText: intermittent isovaleric acidemia, C5 (DBS) = 7.8 μmol l−1, IVA incorp (%) = 4.9, IVG in urine mmol permol creatinine = 4653, Ammonium (μmol l−1) = 28, pH = 7.18, Protein intake (g kg−1 per day) = 0.8, treated with carnitine and glycine supplements, PDI/IQ in follow-up = 92

      CaseNotHPOs: HP:0001254, HP:0001259 (lethargy, coma)

      NotHPOsFreeText: sweaty feet odor

      CaseAddInfo: diagnosed via clinical findings at 6yo, hospitalized outside of detection period

      CasePMIDs:

      CasePreviousTesting: same as group

      CaseGenotypingMethod: same as group, nucleotide changes detected in homozygosity in mRNA

      Variant1: NM_002225.3:c.1099T>C

      CAID: CA391723803, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA391723803

      gnomAD: n/a

      Variant2: c.1-?_c.295+? (Delexons 1–3) no ClinVar or CAID

    1. U3

      CaseREU3: Male, 6 yrs report, United Kingdom

      CasePresentingHPOs: HP:0001337, HP:0001263, HP:0000717, HP:0001382, HP:0012120 (Tremor, Global developmental delay, Autism, Joint hypermobility, Methylmalonic aciduria)

      HPOsFreeText: Malonic aciduria

      CaseNotHPOs: N/A

      NotHPOsFreeText: N/A

      CaseAddInfo: Proband is homozygous for this variant

      CasePreviousTesting: All participants had undergone multiple standard and specialized biochemical tests, invasive procedures (e.g. muscle and/or skin biopsy, lumbar puncture) and targeted gene testing; MRI head not performed

      CaseGenotypingMethod: 16 broad classes of IEM was target enriched and sequenced. Any suspected pathogenic variants were confirmed with Sanger sequencing.

      Variant: NM_001243279.3:c.1453A>C (p.Ser485Arg)

      CAID: CA397148172, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA397148172

      gnomAD: Not in gnomAD

    1. Patient PA007

      CasePA007 4do onset, Taiwan

      CasePresentingHPOs HP:0003571, HP:0011968, HP:0002098, HP:0001290, HP:0002240, HP:0002789, HP:0004372, HP:0001987, HP:0003811

      (propionicacidemia, poor feeding, respiratory distress, hypotonia, hepatomegaly, tachypnea, disturbed consciousness, hyperammonemia, neonatal death)

      HPOsFreeText poor activity and other phenotypes presented at 4 days old. Died at 6 days old

      CaseNotHPOs n/a

      CasePreviousTesting coding regions and flanking areas of PCCA also analyzed with PCR and Sanger

      Variant 1. NM_000532.4(PCCB):c.1301C>T (p.Ala434Val),2. NM_000532.4(PCCB):c.838dup (p.Leu280Profs)

      ClinVar 1. 554490, 2. 552435

      gnomAD 1. MAF= 0.0003510(East Asian), no homozygotes, 2. not in gnomAD

      CaseAddInfo n/a

      CasePMIDs n/a

    2. Patient PA006

      CasePA006 2yo report, Taiwan

      CasePresentingHPOs HP:0011343, HP:0003571

      (moderate global developmental delay, propionicacidemia)

      HPOsFreeText did not experience other classical PA phenotype after liver transplant(10mo) during 12-month follow up. Urine methylcitrate levels and serum propionylcarnitine levels have not markedly decreased

      CaseNotHPOs n/a

      CasePreviousTesting coding regions and flanking areas of PCCA also analyzed with PCR and Sanger

      Variant 1. NM_000532.4(PCCB):c.1301C>T (p.Ala434Val), 2. NM_000532.4(PCCB):c.1534C>T (p.Arg512Cys)

      ClinVar 1. 554490, 2. 38879

      gnomAD 1. MAF=0.0003510(East Asian), no homozygotes, 2. MAF=0.00005440(East Asian), no homozygotes

      CaseAddInfo n/a

      CasePMIDs n/a

    3. patient PA005-2,

      CasePA005-2 8yo report, Taiwan

      CasePresentingHPOs HP:0003571, HP:0011968, HP:0002013, HP:0001987, HP:0011343

      (propionicacidemia, poor feeding, vomiting, hyperammonemia, moderate developmental delay)

      CaseNotHPOs n/a

      CasePreviousTesting coding regions and flanking areas of PCCA also analyzed with PCR and Sanger

      Variant 1. NM_000532.4(PCCB):c.1301C>T (p.Ala434Val), 2. NM_000532.4:c.-4156_183+3713del

      ClinVar 1. 554490, 2. n/a

      CAID 2. n/a

      gnomAD 1. MAF=0.0003510(East Asian), no homozygotes, 2. n/a

      CaseAddInfo Older sister presented at two weeks old with poor feeding, vomiting, hyperammonemia, metabolic acidosis, recurrent infection, and elevated urine 3-hydroxypropionic and 2-methyl-3-hydroxybutyric acids suggestive of PA. Died of severe infection at 1yr 6mo without genetic testing

      CasePMIDs n/a

    4. PA004

      CasePA004 40do onset, Taiwan

      CasePresentingHPOs HP:0003571, HP:0001987, HP:0011968, HP:0001263, HP:0000952, HP:0001942, HP:0001522

      (propionicacidemia, hyperammonemia, poor feeding, developmental delay, jaundice, metabolic acidosis, death in infancy)

      HPOsFreeText severe jaundice and other symptoms at 40days old. Death at 1yr 6mo

      CaseNotHPOs n/a

      CasePreviousTesting coding regions and flanking areas of PCCA also analyzed with PCR and Sanger

      Variant NM_000532.4(PCCB):c.1301C>T (p.Ala434Val), homozygous

      ClinVar 554490

      gnomAD MAF= 0.0003510(East Asian), no homozygotes

      CaseAddInfo n/a

      CasePMIDs n/a

    5. PA003

      CasePA003 3do onset, Taiwan

      CasePresentingHPOs HP:0003571, HP:0000952, HP:0011968, HP:0001290, HP:0001942, HP:0002154, HP:0001987, HP:0001522

      (propionicacidemia, jaundice, poor feeding, hypotonia, metabolic acidosis, hyperglycinemia, hyperammonemia, death in infancy)

      HPOsFreeText died at 5m 15days (also check 2178070 first)

      CaseNotHPOs "

      NotHPOsFreeText "

      CasePreviousTesting coding regions and flanking areas of PCCA also analyzed with PCR and Sanger + "

      Variant 1. NM_000532.4(PCCB):c.1301C>T (p.Ala434Val), 2. NM_000532.4:c.580T>C (p.Ser194Pro)

      ClinVar 1. 554490, 2. n/a

      CAID 2. CA354641839

      gnomAD 1. MAF=0.0003510(East Asian), no homozygotes, 2. not in gnomAD

      CaseAddInfo "

      CasePMIDs 2178070

    1. 3

      CaseGM01566: Female, 16 years report, Caucasian, Europe

      CasePresentingHPOs: HP:0003153 (Cystathioninuria)

      HPOsFreeText: N/A

      CaseNotHPOs: N/A

      NotHPOsFreeText: N/A

      CaseAddInfo: Proband is a compound heterozygote for this variant, Variants were confirmed in trans by parental testing

      CasePreviousTesting: N/A

      CaseGenotypingMethod: Primers were developed and the CTH exons 1-12 and exon-intron boundaries were PCR amplified and sequenced. All sequence variations were verified by restriction enzyme analysis and/or repeat sequencing.

      Variant1: NM_001902.5:c.200C>T (p.Thr67Ile)

      ClinVar: 2939 https://www.ncbi.nlm.nih.gov/clinvar/variation/2939/

      gnomAD: Ashkenazi Jewish 9.934e-3, Overall 6.308e-3 https://gnomad.broadinstitute.org/variant/1-70881670-C-T

      Variant2: CTH, 1-BP DEL, 1220C AKA: NM_001902.5:c.1064del (p.Thr355Ilefs*19)

      ClinVar: 2938 https://www.ncbi.nlm.nih.gov/clinvar/variation/2938/

      gnomAD: European (Non-Finnish) 1.551e-4, Overall 8.845e-5 https://gnomad.broadinstitute.org/variant/1-70904381-AC-A

    1. 27

      Case27 Male, 3do onset, Ethnicity: Turkish

      CasePresentingHPOs HP:0003571, HP:0008872, HP:0008947, HP:0002789, HP:0002789

      (propionicacidemia, feeding difficulties in infancy, infantile hypotonia, tachypnea)

      HPOsFreeText feeding difficulties, hypotonia, somnolence, tachypnea (3do)

      CaseNotHPOs n/a

      CasePreviousTesting Diagnosis by selective metabolic screen.

      Variant NM_000532.4:c.1309G>A (p.Gly437Ser), homozygous

      ClinVar n/a

      CAID CA354649286

      gnomAD MAF= 0.00008674(Latino), no homozygotes

      CaseAddInfo parental consanguinity

      CasePMIDs n/a

    2. 22

      Case22 Male, 13.5yo report, Ethnicity: German

      CasePresentingHPOs HP:0003571, HP:0008872, HP:0001531, HP:0002240

      (propionicacidemia, feeding difficulties in infancy, failure to thrive in infancy, hepatomegaly)

      HPOsFreeText feeding difficulties, failure to thrive, hepatomegaly(4do), 55 IQ on Snijders-Omen Test

      CaseNotHPOs n/a

      CasePreviousTesting Diagnosed by selective metabolic screening. PCC activity was 0.81 in patient fibroblasts vs control.

      Variant NM_000532.4:c.1218_1231delins12 (p.Gly406fs), homozygous

      ClinVar n/a

      CAID link to register the deletion, but the insertion is not described

      gnomAD not in gnomAD

      CaseAddInfo no parental consanguinity

      CasePMIDs n/a

    1. m

      CaseBI2K: N/A

      CasePresentingHPOs: HP:0001875, HP:0001644, HP:0003756 (Neutropenia, Dilated cardiomyopathy, Skeletal myopathy)

      HPOsFreeText: N/A

      CaseNotHPOs: N/A

      NotHPOsFreeText: N/A

      CaseGenotypingMethod: Five genes noted to have high heart and skeletal muscle expression were sequenced and ORFs created. After PCR amplification and direct sequencing of the TAZ gene (G4.5.), a unique missense variant was found in this proband.

      CasePreviousTesting: N/A

      CaseAddInfo: N/A

      Variant: NM_000116.5(TAZ):c.239-1G>C

      ClinVar: 11102, https://www.ncbi.nlm.nih.gov/clinvar/variation/11102/

      gnomAD: Not in gnomAD

    1. Case 2

      Case2: female, Turkish, neonatal screening

      CasePresentingHPOs: HP:0000403

      HPOFreeText: Neonatal screening suggestive of MBD deficiency. Normal free carnitine. No treatment, but normal at 6 years. Adenotomy and bilateral paracentesis at 5.5 years.

      CaseNotHPOs:

      CasePreviousTesting: Neonatal screening: elevated C5 acylcarnitine (0.75 umol/l, ref <0.31). Urinary organic acids showed increased N-methylbutyrylglycine.

      CaseGenotypingMethod: Genomic DNA extracted from DBS or peripheral blood. All exons and intron-exon boundaries of ACADSB sequenced.

      Variant: NM_001609.3(ACADSB):c.443C>T (p.Thr148Ile) (homozygous)

      ClinVar: 9202

      gnomAD: South Asian 0.002678; Overall 0.0008097, no homozygotes

      VariantEvidence: Decreases ACADSB enzymatic activity to 2.8% of wild type in vitro (PMID: 20547083).

      CaseAddInfo: Consanguinity. 7 year old brother also found to have enzyme deficiency. No symptoms.

      CasePMIDs:

    2. Case 4

      Case4: female, Turkish, neonatal screening

      CasePresentingHPOs:

      HPOFreeText: Neonatal screening suggestive of MBD deficiency. Treatment of 100 mg L-carnitine/kg body weight and has shown normal development until 3 years.

      CaseNotHPOs:

      CasePreviousTesting: Neonatal screening: elevated C5 acylcarnitine (0.68 umol/l and 2.08 umol/l , ref <0.31). Urinary organic acids showed increased N-methylbutyrylglycine.

      CaseGenotypingMethod: Genomic DNA extracted from DBS or peripheral blood. All exons and intron-exon boundaries of ACADSB sequenced.

      Variant: NM_001609.3(ACADSB):c.1159G>A (p.Glu387Lys) (homozygous)

      ClinVar: 9203

      gnomAD: Latino 0.0004797, Overall 0.0002404, no homozygotes

      VariantEvidence: In vitro expression in E. coli shows no protein on Western blot, reduced enzymatic activity to 2% and defects in protein folding and stability (PMID: 20547083).

      CaseAddInfo:

      CasePMIDs:

    1. 3

      Case3: Female, 1y 5m, Chinese

      HPOsFreeText: (at 21 days) 1.96 C4, 0.17 C4/C2, 2.09 C4/C3

      NotHPOsFreeText: normal urine isobutyrylglycine

      Case3 (Level 2):


      CasePreviousTesting: same as group

      CaseMethod1: same as group

      CaseMethod2: same as group

      CaseGenotypingMethod: same as group


      Variant: NM_014384.2:c.286G>A (p.Gly96Ser)

      ClinVar: n/a

      CAID: CA6372895

      gnomAD: 0.001453 (East Asian)


      CaseAddInfo:

    1. 41

      Case41 sex unknown, Spain

      CasePresentingHPOs HP:0006846, HP:0002540, HP:0001344, HP:0001332

      (Acute encephalopathy, Non-ambulatory, Nonverbal, Dystonia)

      HPOsFreeText Phenotype was classified as "severe," with passive or static dystonia and an inability to stand up, walk, or speak. Patient may have gone undetected by routine screens as glutarate excretion was normal and 3-hydroxyglutarate was only slightly increased.

      CaseNotHPOs n/a

      NotHPOsFreeText n/a

      CasePreviousTesting GC-MS measured glutarate of 48(nv 2–10 mmol/mol creatinine) and 3-OH-glutarate 101(nv 2–14 mm/mol creatinine). In patient fibroblasts, %GCD activity was 0.8. Patient tested negative in glutarylcarnitine blood spot test, even under carnitine supplementation.

      CaseMethod1 SSCP

      CaseMethod2 Sanger

      CaseGenotypingMethod PCR amplified and SSCP screened 11 exons and intron boundaries of GCDH gene. Confirmed variants with Sanger sequencing and restriction digest. The F71S variant creates an MnlI restriction site. Thus, while the patient's DNA fragments would cleave, control fragments would not be cleaved.

      Variant 1. NM_000159.3:c.212T>C(p.Phe71Ser), 2. NM_000159.3(GCDH):c.1173delG (p.Asn392Metfs), compound heterozygous

      ClinVar 1. n/a, 2. 370106

      CAID 1. CA404315187

      gnomAD 1. not in gnomAD, 2. MAF= 0.00005646(Latino), no homozygotes

      CaseAddInfo n/a

      CasePMIDs n/a

    2. 37

      Case37 sex unknown, Spain

      CasePresentingHPOs HP:0001332

      (Dystonia)

      HPOsFreeText Clinical onset was "insidious," involving slowly progressive psychomotor delay, dystonic postures, lethargy, or macrocephaly. Phenotypes were "mild," owing to static or improving dystonia, with maintained ability to walk without assistance. Patient may have gone undetected by routine screens as glutarate excretion was normal and 3-hydroxyglutarate was only slightly increased.

      CaseNotHPOs HP:0002540

      (Non-ambulatory)

      NotHPOsFreeText n/a

      CasePreviousTesting GC-MS measured glutarate of 6(nv 2–10 mmol/mol creatinine) and 3-OH-glutarate 23(nv 2–14 mm/mol creatinine). In patient fibroblasts, %GCD activity was 7. Patient tested negative in glutarylcarnitine blood spot test, even under carnitine supplementation.

      CaseMethod1 SSCP

      CaseMethod2 Sanger

      CaseGenotypingMethod PCR amplified and SSCP screened 11 exons and intron boundaries of GCDH gene. Confirmed variants with Sanger sequencing and restriction digest. The A293T variant, with the addition of a mismatch primer, destroys an HgaI restriction site. Thus, while the patient's DNA fragments would not cleave, control fragments would be cleaved. The R227P variant creates a NlaIV site. This would lead to cleaved patient DNA fragments and uncleaved control fragments.

      Variant 1. NM_000159.3(GCDH):c.877G>A (p.Ala293Thr), 2. NM_000159.3(GCDH):c.680G>C (p.Arg227Pro), compound heterozygous

      ClinVar 1. 2083, 2. 2089

      gnomAD 1. MAF= 0.0004013(African), no homozygotes, 2. MAF= 0.0003566(European(non-Finnish)), no homozygotes

      CaseAddInfo n/a

      CasePMIDs n/a

    3. 15

      Case15 sex unknown, Spain

      CasePresentingHPOs HP:0006846, HP:0002540, HP:0001344, HP:0001332

      (Acute encephalopathy, Non-ambulatory, Nonverbal, Dystonia)

      HPOsFreeText Phenotype was classified as "severe," with passive or static dystonia and an inability to stand up, walk, or speak. Diagnosed by routine GC-MS organic acid analysis in urine. There was high excretion of glutarate and 3-hydroxyglutarate with glutarate excretion being higher than that of 3-hydroxyglutarate.

      CaseNotHPOs n/a

      NotHPOsFreeText n/a

      CasePreviousTesting n/a

      CaseMethod1 SSCP

      CaseMethod2 Sanger

      CaseGenotypingMethod PCR amplified and SSCP screened 11 exons and intron boundaries of GCDH gene. Confirmed variants with Sanger sequencing and restriction digest. The R402W variant destroys a MspI site. This would lead to uncleaved patient DNA fragments and cleaved control fragments.

      Variant NM_000159.3(GCDH):c.1204C>T (p.Arg402Trp), homozygous

      ClinVar 2085

      gnomAD MAF= 0.0007566(European(Finnish)), no homozygotes

      CaseAddInfo Patient died and had no metabolic testing, diangosis based on clinical features and heterozygosity of parents.

      CasePMIDs n/a

    4. 9

      Case9 sex unknown, Spain

      CasePresentingHPOs HP:0000707

      (Neurological abnormality)

      HPOsFreeText Clinical onset was "insidious," involving slowly progressive psychomotor delay, dystonic postures, lethargy, or macrocephaly. Phenotypes defined as "slight," entailing minimal neurological signs and an otherwise normal life. Diagnosed by routine GC-MS organic acid analysis in urine. There was high excretion of glutarate and 3-hydroxyglutarate with glutarate excretion being higher than that of 3-hydroxyglutarate.

      CaseNotHPOs n/a

      NotHPOsFreeText n/a

      CasePreviousTesting GC-MS measured glutarate of 2982(nv 2–10 mmol/mol creatinine) and 3-OH-glutarate 415(nv 2–14 mm/mol creatinine). In patient fibroblasts, %GCD activity was <0.5.

      CaseMethod1 SSCP

      CaseMethod2 Sanger

      CaseGenotypingMethod PCR amplified and SSCP screened 11 exons and intron boundaries of GCDH gene. Confirmed variants with Sanger sequencing and restriction digest. The A293T variant, with the addition of a mismatch primer, destroys an HgaI restriction site. Thus, while the patient's DNA fragments would not cleave, control fragments would be cleaved. Likewise, the R402W variant destroys a MspI site. This would lead to uncleaved patient fragments and cleaved control fragments.

      Variant 1. NM_000159.3(GCDH):c.877G>A (p.Ala293Thr), 2. NM_000159.3(GCDH):c.1204C>T (p.Arg402Trp), compound heterozygous

      ClinVar 1. 2083, 2. 2085

      gnomAD 1. MAF=0.0004013(African), no homozygotes, 2. MAF= 0.0007566(European(Finnish)), no homozygotes

      CaseAddInfo n/a

      CasePMIDs n/a

    1. 10334M19961 month1080<0.5SevereGoodW90X

      Case# Patient 10, Turkish, Male, 1mo diagnosis

      CasePresentingHPOs HP:0004923

      CasePreviousTesting screened for BH4 deficiency using dried blood and urine spots, Final di-agnosis was made by measurements of neurotransmitter and pterinmetabolites in cerebrospinal fluid (CSF) and urine, in addition toDHPR enzyme activity, which was assessed in whole red bloodcells

      CaseMethod1 PCR

      CaseMethod2 DGGE

      Variant NM_000320.2:c.350T>A(p.W90Ter)

      CAID CA356448578

      VariantEvidence null

    1. The patient

      Case1: Male, 5 years onset, African

      CasePresentingHPOs: HP:0410020, HP:0003750, HP:0030234 (Fish odor, Muscle fatigue, Highly elevated creatine phosphokinase)

      HPOsFreeText: Increased fish odor under stress or effort, Elevated plasma creatine kinase (1066 U/L; reference 30–270), Riboflavin (10 mg/day) had no effect, High N,N-dimethylglycine in urine (449 mmol DMG/mol; over 20x normal)

      CaseNotHPOs: HP:0001249, HP:0040126, HP:0003138, HP:0040087, HP:0010919, HP:0010901, HP:0003614, HP:0001871, HP:0001410 (Intellectual disability, Abnormal serum cobalamin level, Increased blood urea nitrogen, Abnormal serum folate, Abnormality of homocysteine metabolism, Abnormality of methionine metabolism, Trimethylaminuria, Hematological abnormality, Liver dysfunction)

      NotHPOsFreeText: Normal serum cobalamin (222 pmol/L; reference 150–400) and urea (5 mmol/L; reference 2.5–7.5), Normal plasma folate (9.7 nmol/L; reference 4–15) and homocysteine (12 μmol/L; reference 8–18)

      CasePMIDs: 10767172, 10102904

      CaseAddInfo: Consanguinity of the parents is unknown, Brothers, sisters, and the two sons of the patient were without signs or symptoms, Patient is homozygous for this mutation

      CasePreviousTesting: Nuclear magnetic resonance (NMR) spectroscopy, Conventional metabolic screening techniques, Gas chromatography (GC) analysis, Analysis of the very-long-chain fatty acids and a carnitine ester profile in serum, Amino acid and organic acid analyses of blood and urine

      CaseGenotypingMethod: cDNA was prepared from the patient and control fibroblast cultures. PCR amplification was performed and the DMGDH gene was sequenced. After the mutation was confirmed, the area around it was again amplified and sequenced.

      Variant: NM_013391.3:c.326A>G (p.His109Arg)

      ClinVar: 4742 https://www.ncbi.nlm.nih.gov/clinvar/variation/4742/

      gnomAD: African 4.737e-3, Overall 5.205e-4 https://gnomad.broadinstitute.org/variant/5-78351682-T-C

    1. Supplementary Table 2

      CaseEPI4Kn2: Female, 1 month onset

      CasePresentingHPOs: HP:0002521, HP:0011167, HP:0032794, HP:0000618, HP:0003089, HP:0000473, HP:0003487, HP:0032988, HP:0008936, HP:0001276, HP:0010864 (Hypsarrhythmia, Focal tonic seizure, Myoclonic seizure, Blindness, Hamstring contractures, Torticollis, Babinski sign, Persistent head lag, Muscular hypotonia of the trunk, Hypertonia, Severe intellectual disability)

      HPOsFreeText: N/A

      CaseNotHPOs: HP:0001263 (Global developmental delay)

      NotHPOsFreeText: N/A

      CaseAddInfo: N/A

      CasePreviousTesting: Currently on vigabatrin, topiramate, and oxcarbazepine; Previously on phenobarbitone and levetriacetam; Bifrontal central frequent discharges on EEG; Normal brain imaging; No confirmed genetic or metabolic diagnosis, and no history of congenital TORCH infection, premature birth (before 32 weeks gestation), neonatal hypoxic-ischemic encephalopathy or neonatal seizures, meningitis/encephalitis, stroke, intra-cranial hemorrhage, significant head trauma, or evidence of acquired epilepsy

      CaseGenotypingMethod: Exome sequencing was performed from primary DNA in parental leukocytes. Coding regions of the genome were sequenced in a trio in order to determine which loci bearing de novo mutations were present according to specifications. All candidate de novo variants were confirmed with Sanger sequencing of the proband and parents.

      Variant: NM_004171.4(SLC1A2):c.244G>C (p.Gly82Arg)

      ClinVar: 254265, https://www.ncbi.nlm.nih.gov/clinvar/variation/254265/

      gnomAD: Not in gnomAD

    1. Family 2

      CaseFZ2: Male, Finland, 2.9 yrs deceased

      CasePresentingHPOs: HP:0001511, HP:0008897, HP:0001999, HP:0000973, HP:0100678, HP:0000963, HP:0010648, HP:0001388, HP:0100790, HP:0001374, HP:0001181, HP:0001762, HP:0002650, HP:0000938, HP:0000270, HP:0002645, HP:0012443, HP:0025356, HP:0008872, HP:0001252, HP:0001348, HP:0000518, HP:0002677, HP:0000325, HP:0011220, HP:0000337, HP:0000411, HP:0000369 (Intrauterine growth retardation, Postnatal growth retardation, Abnormal facial shape, Cutis laxa, Premature skin wrinkling, Thin skin, Dermal translucency, Joint laxity, Hernia, Congenital hip dislocation, Adducted thumb, Talipes equinovarus, Scoliosis, Osteopenia, Delayed cranial suture closure, Wormian bones, Abnormality of brain morphology, Psychomotor retardation, Feeding difficulties in infancy, Muscular hypotonia, Brisk reflexes, Cataract, Small foramen magnum, Triangular face, Prominent forehead, Broad forehead, Protruding ear, Low-set ears)

      HPOsFreeText: Typical facial gestalt, Reduced collagen type 1 and 3 production

      CaseNotHPOs: HP:0000252, HP:0005116, HP:0000486 (Microcephaly, Arterial tortuosity, Strabismus)

      NotHPOsFreeText: N/A

      CaseAddInfo: Variant is confirmed de novo in this and two other cases with the same variant and similar presentation, No family history,

      CasePreviousTesting: N/A

      CaseGenotypingMethod: ALDH18A1 and PYRC1 were investigated by Sanger sequencing, with the latter revealing no abnormalities and the former showing a heterozygous change at the Arg138 residue. qPCR was used to exclude the presence of a exonic deletion and investigation revealed no further variants in the coding regions. Familial sequencing revealed the inheritance was de novo with no variants in the parents.

      Variant: NM_002860.4(ALDH18A1):c.412C>T (p.Arg138Trp)

      ClinVar: 217259 https://www.ncbi.nlm.nih.gov/clinvar/variation/217259/

      gnomAD: Not in gnomAD

    2. Family 5

      CaseFZ5: Male, Mexico, 4 yrs report

      CasePresentingHPOs: HP:0001511, HP:0008897, HP:0001999, HP:0000973, HP:0100678, HP:0000963, HP:0010648, HP:0001388, HP:0001374, HP:0001181, HP:0001762, HP:0002650, HP:0000938, HP:0000270, HP:0025356, HP:0001252, HP:0001348, HP:0000518, HP:0000325, HP:0011220, HP:0000337, HP:0000411, HP:0000369, HP:0000252 (Intrauterine growth retardation, Postnatal growth retardation, Abnormal facial shape, Cutis laxa, Premature skin wrinkling, Thin skin, Dermal translucency, Joint laxity, Congenital hip dislocation, Adducted thumb, Talipes equinovarus, Scoliosis, Osteopenia, Delayed cranial suture closure, Psychomotor retardation, Muscular hypotonia, Brisk reflexes, Cataract, Triangular face, Prominent forehead, Broad forehead, Protruding ear, Low-set ears, Microcephaly)

      HPOsFreeText: Typical facial gestalt

      CaseNotHPOs: HP:0005116, HP:0000486, HP:0100790, HP:0002645, HP:0012443 (Arterial tortuosity, Strabismus, Hernias, Wormian bones, Abnormality of brain morphology)

      NotHPOsFreeText: N/A

      CaseAddInfo: Variant is confirmed de novo in this case with one other maternally-confirmed case with the same variant and similar presentation, No family history

      CasePreviousTesting: N/A

      CaseGenotypingMethod: ALDH18A1 and PYRC1 were investigated by Sanger sequencing, with the latter revealing no abnormalities and the former showing a heterozygous change at the Arg138 residue. qPCR was used to exclude the presence of a exonic deletion and investigation revealed no further variants in the coding regions. Familial sequencing revealed the inheritance was de novo with no variants in the parents.

      Variant: NM_002860.4(ALDH18A1):c.413G>T (p.Arg138Leu)

      ClinVar: 217261 https://www.ncbi.nlm.nih.gov/clinvar/variation/217261/

      gnomAD: Not in gnomAD

    1. CaseLE25: Male, 7 yrs report

      CasePresentingHPOs: HP:0000639 (Nystagmus)

      HPOsFreeText: N/A

      CaseNotHPOs: N/A

      NotHPOsFreeText: N/A

      CaseAddInfo: Variants confirmed in-trans via parental testing

      CasePreviousTesting: Specific plasma MMA levels, urine MMA levels, urine MA levels, and MMA/MA ratio available in Table 2

      CaseGenotypingMethod: See Group

      Variant1: NM_001243279.3:c.634G>A (p.Val212Met)

      CAID: CA397135749, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA397135749

      gnomAD: 0.00004778, https://gnomad.broadinstitute.org/variant/16-89167723-G-A

      Variant2: NM_001243279.3(ACSF3):c.1470G>C (p.Glu490Asp)

      ClinVar: 377432, https://www.ncbi.nlm.nih.gov/clinvar/variation/377432/

      gnomAD: 0.001502, https://gnomad.broadinstitute.org/variant/16-89211778-G-C

    2. CaseLE17: Male, 7 yrs report

      CasePresentingHPOs: N/A

      HPOsFreeText: N/A

      CaseNotHPOs: N/A

      NotHPOsFreeText: N/A

      CaseAddInfo: Variants not confirmed in-trans due to lack of parental testing

      CasePreviousTesting: Specific plasma MMA levels, urine MMA levels, urine MA levels, and MMA/MA ratio available in Table 2

      CaseGenotypingMethod: See Group

      Variant1: NM_001243279.3:c.774_775del (p.Trp259Glyfs*10)

      CAID: CA1139532418, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA1139532418

      gnomAD: Not in gnomAD

      Variant2: NM_001243279.3(ACSF3):c.1672C>T (p.Arg558Trp)

      ClinVar: 31134, https://www.ncbi.nlm.nih.gov/clinvar/variation/31134/

      gnomAD: 0.004790, https://gnomad.broadinstitute.org/variant/16-89220556-C-T

    1. E

      CaseE: Male, French, Germany

      CasePresentingHPOs: HP:0010896, HP:0010897 (Hypersarcosinemia, Hypersarcosinuria)

      HPOsFreeText: Elevated blood Sarcosine (192 μmol/l; reference 0-9), Elevated urine Sarcosine (645 μmol/mmol; reference 0-36)

      CaseNotHPOs: N/A

      NotHPOsFreeText: N/A

      CaseAddInfo: Phase of the variants are unknown

      CasePreviousTesting: N/A

      CaseGenotypingMethod: DNA was extracted from the probands and immediate family. The whole coding region and the exon-intron boundaries of the SARDH gene was then amplified and sequenced.

      Variant1: NM_007101.3:c.1540C>T (p.Arg514Ter)

      ClinVar: 39451 https://www.ncbi.nlm.nih.gov/clinvar/variation/39451/

      gnomAD: Latino 2.154e-4, Overall 1.120e-4 https://gnomad.broadinstitute.org/variant/9-136570084-G-A

      Variant2: NM_007101.3:c.2167C>T (p.Arg723Ter)

      ClinVar: 39450 https://www.ncbi.nlm.nih.gov/clinvar/variation/39450/

      gnomAD: African 9.899e-5, Overall 5.729e-6 http://gnomad.broadinstitute.org/variant/9-136536816-G-A

    1. F-3

      CaseF-3 Male, 5do onset, Ethnicity: North Indian, Hindu

      CasePresentingHPOs HP:0006846, HP:0001254, HP:0011968, HP:0001250, HP:0002098, HP:0001942, HP:0001987, HP:0003571, HP:0002154, HP:0010910, HP:0012026

      (Acute encephalopathy, Lethargy, Poor feeding, Seizures, Respiratory distress, Metabolic acidosis, Hyperammonemia, Propionicacidemia, Elevated blood glycine, Elevated blood valine, Elevated blood ornithine)

      HPOsFreeText Serum ammonia 143micromolar, acycarnitines 31.7(normal <3.6nmol/mL)

      CaseNotHPOs n/a

      CasePreviousTesting Also screened for variants in PCCA

      Variant NM_000532.4(PCCB):c.183+5G>A

      ClinVar 217896

      gnomAD MAF= 0.00003328(South Asian), no homozygotes

      CaseAddInfo nonconsanguineous, abnormality in family history noted

      CasePMIDs n/a

    1. patients

      CaseDO2: Male, Italy, 1 day onset

      CasePresentingHPOs: HP:0001252, HP:0002045, HP:0002033, HP:0001958, HP:0001987, HP:0002151, HP:0001942, HP:0003648, HP:0001640, HP:0001644, HP:0001667, HP:0003324, HP:0001270, HP:0001510, HP:0001875, HP:0002098, HP:0001649, HP:0000969, HP:0001712, HP:0012666, HP:0003535, HP:0001397, HP:0001706 (Muscular hypotonia, Hypothermia, Poor suck, Nonketotic hypoglycemia, Hyperammonemia, Increased serum lactate, Metabolic acidosis, Lacticaciduria, Cardiomegaly, Dilated cardiomyopathy, Right ventricular hypertrophy, Generalized muscle weakness, Motor delay, Growth delay, Neutropenia, Respiratory distress, Tachycardia, Edema, Left ventricular hypertrophy, Severely reduced ejection fraction, 3-Methylglutaconic aciduria, Hepatic steatosis, Endocardial fibroelastosis)

      HPOsFreeText: N/A

      CaseNotHPOs: HP:0001875 (Neutropenia)

      NotHPOsFreeText: N/A

      CaseAddInfo: N/A

      CasePreviousTesting: Birth weight of 2830 g; Unremarkable family history; See "Results" for exact metabolic values

      CaseGenotypingMethod: Genomic DNA was isolated from whole blood and the TAZ gene was amplified and directly sequenced.

      Variant: NM_000116.4:c.541+1G>A

      CAID: CA415183775, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA415183775

      gnomAD: Not in gnomAD

    2. two

      CaseDO1: Male, Italy, 3 days onset

      CasePresentingHPOs: HP:0011968, HP:0001254, HP:0001252, HP:0002045, HP:0001640, HP:0012664, HP:0002119, HP:0001943, HP:0002910, HP:0003236, HP:0001942, HP:0002151, HP:0003542, HP:0100493, HP:0008315, HP:0011936, HP:0003648, HP:0003344, HP:0003535, HP:0001508, HP:0001270, HP:0001649, HP:0001875, HP:0001644, HP:0002375, HP:0001706, HP:0001397 (Poor feeding, Lethargy, Muscular hypotonia, Hypothermia, Cardiomegaly, Reduced ejection fraction, Ventriculomegaly, Hypoglycemia, Elevated hepatic transaminase, Elevated serum creatine kinase, Metabolic acidosis, Increased serum lactate, Increased serum pyruvate, Hypoammonemia, Decreased plasma free carnitine, Decreased plasma total carnitine, Lacticaciduria, 3-Methylglutaric aciduria, 3-Methylglutaconic aciduria, Failure to thrive, Motor delay, Tachycardia, Neutropenia, Dilated cardiomyopathy, Hypokinesia, Endocardial fibroelastosis, Hepatic steatosis)

      HPOsFreeText: N/A

      CaseNotHPOs: HP:0002240, HP:0002919 (Hepatomegaly, Ketonuria)

      NotHPOsFreeText: N/A

      CaseAddInfo: N/A

      CasePreviousTesting: Birth weight of 2780 g; Three maternal great-uncles and two maternal second cousins died in the first years of life; See "Results" for exact metabolic values;

      CaseGenotypingMethod: Genomic DNA was isolated from whole blood and the TAZ gene was amplified and directly sequenced.

      Variant: NM_000116.5(TAZ):c.589G>A (p.Gly197Arg)

      ClinVar: 11105, https://www.ncbi.nlm.nih.gov/clinvar/variation/11105/

      gnomAD: Not in gnomAD

    1. Patient 2

      Case2: Female, Iran, 18 mo (age at diagnosis)

      CasePresentingHPOs: HP:0003324, HP:0001254, HP:0004789, HP:0002039, HP:0002015, HP:0002098, HP:0001508, HP:0002360, HP:0001298 (generalized muscle weakness, lethargy, milk intolerance, anorexia, swallowing difficulty, breathing difficulties, failure to thrive, sleep disturbance, encephalopathy)

      HPOsFreeText: unspecified abnormalities in sitting and speech

      Case (Level 2)


      CasePreviousTesting: elevated propionylcarnitines (4.24 umol/L), Urine MMA (BT) 2200 umol/mmol creatinine, Urine MMA (AT) 40.0 umol/mmol creatinine

      CaseMethod1: same as group

      CaseGenotypingMethod: same as group


      Variant: NM_000255.3:c.2125-3C>G

      ClinVar: n/a

      CAID: CA913187295

      gnomAD: n/a


      CaseAddInfo: consanguineous parents. Treated for MMA with L-carnitine, biotin, and vitamin B12. Died at the age of 3.5 y. homozygous mutation.

    2. Patient 3

      Case3: Female, Iran, 3 d (age at diagnosis)

      CasePresentingHPOs: HP:0002883, HP:0001254, HP:0004789, HP:0002039, HP:0001290, HP:0001941, HP:0001508, HP:0001298, HP:0002019 (rapid breathing, lethargy, milk intolerance, anorexia, hypotonia, acidosis, failure to thrive, encephalopathy, constipation)

      Case (Level 2)


      CasePreviousTesting: elevated propionylcarnitine (61 umol/L), Urine MMA (BT) 1950 umol/mmol creatinine, Urine MMA (AT) 35.0 umol/mmol creatinine.

      CaseMethod1: same as group

      CaseGenotypingMethod: same as group


      Variant: NM_000255.3:c.2125-3C>G

      ClinVar: n/a

      CAID: CA913187295

      gnomAD: n/a


      CaseAddInfo: Consanguineous parents. Treated for MMA with L-carnitine, sodium benzoate, and vitamin B12. Currently 6 y, with moderately delayed development. Deceased infant sibling with similar symptoms, not genotyped. homozygous mutation.

    3. Patient 1

      Case1: Female, Iran, 22 mo (age at diagnosis)

      CasePresentingHPOs: HP:0001250, HP:0001290, HP:0001941, HP:0002019, HP:0002355, HP:0001344 (seizures, generalized hypotonia, acidosis, constipation, difficulty walking, absent speech)

      HPOsFreeText: congenital malformations

      Case (Level 2)


      CasePreviousTesting: elevation of propionylcarnitine (9.8 umol/L0, Urine MMA (BT) 2800 umol/mmol creatinine, Urine MMA (AT) 47.0 umol/mmol creatinine

      CaseMethod1: same as group

      CaseGenotypingMethod: same as group


      Variant: NM_000255.3:c.2125-3C>G

      ClinVar: n/a

      CAID: CA913187295

      gnomAD: n/a


      CaseAddInfo: consanguineous parents, treated for MMA with phenobarbital, L-carnitine, and vitamin B12. Died at 3 y of age. homozygous mutation.

    1. Case report

      Case1: Male, 3 months onset, China, Asian

      CasePresentingHPOs: HP:0011968, HP:0001290, HP:0001263, HP:0001508, HP:0000023, HP:0002793, HP:0004691, HP:0001999, HP:0000369, HP:0000218, HP:0000954, HP:0006802, HP:0100952, HP:0002079, HP:0002151, HP:0012736, HP:0002421 (Poor feeding, Generalized hypotonia, Psychomotor delay, Poor weight gain, Inguinal hernia, Abnormal pattern of respiration, 2-3 toe syndactyly, Dysmorphic facies, Low-set ears, High-arched palate, Transverse palmar crease, Abnormality of the anterior horn cells, Enlarged lateral sulcus, Thinning of the corpus callosum, Increased serum lactate, Profound global developmental delay, Poor head control)

      HPOsFreeText: 3 kg birth weight, Breath-holding spells, The parameters at 5 months were as follows: weight, 4 kg (<0.4th percentile); length, 58 cm (<0.4th percentile), head circumference, 36.5 cm (<0.4th percentile), Enlarged anterior portion of bilateral ventricles and thinning surrounding whiter, Abnormal infant EEG

      CaseNotHPOs: HP:0001946, HP:0003542, HP:0000364, HP:0003457 (Ketosis, Increased serum pyruvate, Hearing abnormality, EMG abnormality)

      NotHPOsFreeText: N/A

      CaseAddInfo: Parents are non-consanguineous, parental heterozygosity is confirmed, Both variants are predicted to destroy normal splicing sites and cause a null protein with Variant 1 skipping exon 4 and Variant 2 skipping exon 12

      CasePreviousTesting: Mild elevation of hydroxyl-C4-carnitine (0.79; reference: 0.03–0.70), Normal venous blood lactate at 3 months (1.1 mmol/L; reference 0.44–1.78 mmol/L) and elevated at 5 months (3.2 mmol/L; reference: 1.42–1.90 mmol/L), Ketone and pyruvate levels at 5 months were normal, Karyotype analysis was performed to confirm normality. Low-coverage massively parallel CNV sequencing was used to confirm any copy number variation, which showed normal results.

      CaseGenotypingMethod: Genomic DNA was extracted from lymphocytes and whole exome sequencing was performed. The identified variants were filtered for pathogenicity and confirmed via Sanger sequencing. cDNA sequence analysis was also performed to determine the effect of these variants on the protein.

      Variant1: NM_014362.3:c.304+3A>G (p.=)

      CAID: CA913203579 http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA913203579

      gnomAD: Not in gnomAD

      Variant2: NM_014362.3:c.1010_1011+3delTGGTA

      CAID: CA2027408 http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvsOrDescriptor=NM_014362.3%3Ac.1010_1011%2B3delTGGTA

      gnomAD: Not in gnomAD

    1. Table 2

      Case2: Male, Belgium

      CasePresentingHPOs: HP:0001290, HP:0003324, HP:0002093, HP:0011968, HP:0001283, HP:0002804, HP:0003798, HP:0001558, HP:0001623, HP:0000602 (Generalized hypotonia, Generalized muscle weakness, Respiratory insufficiency, Feeding difficulties, Bulbar weakness, Arthrogryposis, Decreased fetal movement, Breech presentation, Ophthalmoplegia)

      HPOsFreeText: N/A

      CaseNotHPOs: HP:0001627 (Cardiac abnormality)

      NotHPOsFreeText: N/A

      CaseAddInfo: Severe congenital myopathy, Deceased 10 months

      CasePreviousTesting: N/A

      CaseGenotypingMethod: After LMOD3 was identified as a potential causal gene, bidirectional Sanger sequencing was performed on DNA in genetically unresolved patients using PCR amplification covering 3 exons.

      Variant: NM_198271.4(LMOD3):c.138dup (p.Ser47Glnfs)

      ClinVar: 162215 https://www.ncbi.nlm.nih.gov/clinvar/variation/162215/

      gnomAD: European (Non-Finnish) 8.879e-6, Overall 8.049e-6 https://gnomad.broadinstitute.org/variant/3-69171399-T-TG

    2. Table 2

      Case4: Male, Japan, Asian

      CasePresentingHPOs: HP:0001290, HP:0003324, HP:0002093, HP:0011968, HP:0001283, HP:0003798 (Generalized hypotonia, Generalized muscle weakness, Respiratory insufficiency, Feeding difficulties, Bulbar weakness, Nemaline bodies)

      HPOsFreeText: Atrophic myofibers

      CaseNotHPOs: HP:0001627 (Cardiac abnormality)

      NotHPOsFreeText: N/A

      CaseAddInfo: Severe congenital myopathy, Alive at 4 months

      CasePreviousTesting: N/A

      CaseGenotypingMethod: After LMOD3 was identified as a potential causal gene, bidirectional Sanger sequencing was performed on DNA in genetically unresolved patients using PCR amplification covering 3 exons.

      Variant: NM_198271.4:c.231G>A (p.Trp77*)

      CAID: CA353478954 http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NM_198271.4%3Ac.231G%3EA

      gnomAD: Not in gnomAD

    1. 30

      Case30 Female, 24yo diagnosis (Family 25)

      CasePresentingHPOs HP:0001083, HP:0001256, HP:0001263, HP:0002625, HP:0002204

      (Lens dislocation, Mild intellectual disability, Developmental delay, Deep vein thrombosis, Pulmonary embolism)

      HPOsFreeText Presented with a pulmonary embolus at 23yo after birth of son, presumably secondary to deep vein thrombosis. Patient's plasma free homocystine was reduced from >80μmol to <10μmol (nv <60μmol) in response to treatment with folate and pyridoxine.

      CaseNotHPOs HP:0001249

      (Intellectual disability)

      NotHPOsFreeText n/a

      CasePreviousTesting Diagnosed by family screen and deep vein thrombosis.

      Variant 1. NM_000071.2(CBS):c.536_553del18 (p.Asp179_Leu184del), 2. NM_000071.2(CBS):c.1105C>T (p.Arg369Cys), comp het

      ClinVar 1. 198388, 2. 212860

      gnomAD 1. MAF=0.00002683(European(non-Finnish), no homozygotes, 2. MAF= 0.006796(Ashkenazi Jewish), 5 homozygotes

      CaseAddInfo mother of patient 29

      CasePMIDs n/a

    2. E1

      Case12 4yo diagnosis, Anglo-Celtic

      CasePresentingHPOs n/a

      HPOsFreeText Plasma free homocystine was reduced from >80μmol to <10μmol (nv <60μmol) in response to treatment with folate and pyridoxine. Treatment began with 100-200mg/day for two weeks followed by an addition of 5mg/day folic acid.

      CaseNotHPOs HP:0001249, HP:0001083

      (Intellectual disability, Lens dislocation)

      NotHPOsFreeText no other sequelae

      CasePreviousTesting Diagnosis was based on family screen. Free homocystine, methionine, cystine, and cysteine-homo-cysteine mixed disulfide levels were measured by amino acid analyzers and total (free plus bound)homocysteine (tHcys) was measured. Exact values were not provided.

      CaseMethod1 PCR

      CaseMethod2 Sanger

      CaseGenotypingMethod PCR amplified then direct sequenced the entire coding region of CBS.

      Variant 1. NM_000071.2(CBS):c.430G>A (p.Glu144Lys), 2. NM_000071.2(CBS):c.146C>T (p.Pro49Leu), compound heterozygous

      ClinVar 1. 122, 2. 212872

      gnomAD 1. MAF=0.00009799(South Asian), no homozygotes, 2. MAF=0.0003116(European(non-Finnish)), no homozygotes

      CaseAddInfo n/a

      CasePMIDs n/a

    3. h A

      Case33 41yo diagnosis, South African

      CasePresentingHPOs HP:0001083

      (Lens dislocation)

      HPOsFreeText Diagnosis was based on dislocated lens and skeletal deformities. Treatment began with 100-200mg/day for two weeks followed by an addition of 5mg/day folic acid. Treatment began with 100-200mg/day for two weeks followed by an addition of 5mg/day folic acid. Patient was not responsive to the treatment, plasma homocysteine levels went unchanged. Patient was given additional oral betaine(3g twice per day) with a low protein diet

      CaseNotHPOs HP:0001249

      (Intellectual disability)

      NotHPOsFreeText n/a

      CasePreviousTesting Free homocystine, methionine, cystine, and cysteine-homo-cysteine mixed disulfide levels were measured by amino acid analyzers and total (free plus bound)homocysteine (tHcys) was measured. Exact values were not provided.

      CaseMethod1 PCR

      CaseMethod2 Sanger

      CaseGenotypingMethod PCR amplified then direct sequenced the entire coding region of CBS.

      Variant 1. NM_000071.2(CBS):c.494G>A (p.Cys165Tyr), 2. NM_000071.2:c.1622dup (p.Asn541LysfsTer?), comp het

      ClinVar 1. 495531

      CAID 2. register

      gnomAD 1. MAF=0.00001308(European(non-Finnish)), no homozygotes, 2. not in gnomAD

      CaseAddInfo n/a

      CasePMIDs n/a

    4. lo-C

      Case26 2yo diagnosis, Australia, Anglo-Celtic

      CasePresentingHPOs HP:0001083, HP:0010864, HP:0000939, HP:0001263

      (Lens dislocation, Severe intellectual disability, Osteoporosis, Developmental delay)

      HPOsFreeText Patient had severe osteoporosis and was diagnosed on the basis of developmental delay and osteogenesis impefecta type IV. Treatment began with 100-200mg/day for two weeks followed by an addition of 5mg/day folic acid. Patient was not responsive to the treatment, plasma homocysteine levels went unchanged. Patient was given additional oral betaine(3g twice per day) with a low protein diet

      CaseNotHPOs n/a

      NotHPOsFreeText n/a

      CasePreviousTesting Free homocystine, methionine, cystine, and cysteine-homo-cysteine mixed disulfide levels were measured by amino acid analyzers and total (free plus bound)homocysteine (tHcys) was measured. Exact values were not provided. (PMID:9156316): Urinary homocysteine was 42μmol/l before and 14μmol/l after treatment with betaine, folic acid, and aspirin.

      CaseMethod1 PCR

      CaseMethod2 Sanger

      CaseGenotypingMethod PCR amplified then direct sequenced the entire coding region of CBS. (PMID:9156316): c.992C>A variant was also confirmed with HinfI restriction digest. A G mismatch was introduced to the 3' end of the antisense primer used to amplify the region in order to create the Hinfl restriction site as c.992C>A does not do so on its own. While the father and control sample had only an uncleaved 105bp band, both a 73bp and 32bp fragment were detected on HinfI restriction digestion analysis of the mother and proband.

      Variant 1. NM_000071.2(CBS):c.992C>A (p.Ala331Glu), 2. NM_000071.2:c.444dup, comp het

      ClinVar 1. 212857

      CAID 2. register

      gnomAD 1. MAF=0.000008824(European(non-Finnish), no homozygotes, 2. not in gnomAD

      CaseAddInfo n/a

      CasePMIDs 9156316

    5. eltic

      Case20 7yo diagnosis, Anglo-Celtic

      CasePresentingHPOs HP:0001083, HP:0002650

      (Lens dislocation, Scoliosis)

      HPOsFreeText Diagnosis based on lens dislocation. Treatment began with 100-200mg/day for two weeks followed by an addition of 5mg/day folic acid. Patient was not responsive to the treatment, plasma homocysteine levels went unchanged. Patient was given additional oral betaine(3g twice per day) with a low protein diet

      CaseNotHPOs HP:0001249

      (Intellectual disability)

      NotHPOsFreeText n/a

      CasePreviousTesting Free homocystine, methionine, cystine, and cysteine-homo-cysteine mixed disulfide levels were measured by amino acid analyzers and total (free plus bound)homocysteine (tHcys) was measured. Exact values were not provided.

      CaseMethod1 PCR

      CaseMethod2 Sanger

      CaseGenotypingMethod PCR amplified then direct sequenced the entire coding region of CBS.

      Variant 1. NM_000071.2(CBS):c.919G>A (p.Gly307Ser), 2. NM_000071.2(CBS):c.494G>A (p.Cys165Tyr), comp het

      ClinVar 1. 117, 2. 495531

      gnomAD 1. MAF=0.00041539(Other), no homozygotes, 2. MAF= 0.00001308(European(non-Finnish)), no homozygotes

      CaseAddInfo n/a

      CasePMIDs n/a

    1. Case presentation

      Case: 4 years (Dx), male, Somali

      CasePresentingHPOs: HP:0001250, HP:0000750, HP:0000817, HP:0008762

      HPOFreeText: 5 months: seizure-like movements, stopped at 8 months with antieplieptic drug. Delayed speech. Protein restricted diet for 5 months with no improvement.

      CaseNotHPOs: Normal growth and motor development. 5 years: no dysmorphic features. Normal muscle tone, strength, coordination and deep tendon reflexes. Eye exam, hearing test, EEG, EKG, and MRI normal.

      CasePreviousTesting: Blood glucose, urea, creatinine, and liver transaminases normal. Normal chromosome analysis. Southern blot for Angelman syndrome negative. Urine analysis showed large amounts of 2-methylbutyryl glycine. Increased plasma level of C5-acylcarnitine (1.43 micromoles/L, reference range 0.05–0.38) and an increased C5/C3-acylcarnitines ratio of 2.83 (reference range 0.16–0.73).

      CaseGenotypingMethod: PCR of all exons and flanking intron sequences of genomic DNA. Mother was also sequenced.

      Variant: NM_001609.3(ACADSB):c.303+3A>G

      ClinVar: 448980

      gnomAD:

      VariantEvidence: Functional studies demonstrate that the c.303+3A>G variant causes complete exon skipping of exon 3 (Madsen et al., 2006).

      CaseAddInfo:

      CasePMIDs:

    1. three

      CaseKLC: Male, 42 yrs death, Japan, Asian

      CasePresentingHPOs: HP:0001394, HP:0002078, HP:0000651, HP:0008353, HP:0003763, HP:0100785, HP:0001276, HP:0030904, HP:0030906, HP:0030903 (Cirrhosis, Truncal ataxia, Diplopia, Neutral hyperaminoaciduria, Bruxism, Insomnia, Hypertonia, Glabellar reflex, Suck reflex, Grasp reflex)

      HPOsFreeText: Monoamino-monocarboxylic aciduria, Transient stupor

      CaseNotHPOs: HP:0000992, HP:0011123, HP:0040129 (Cutaneous photosensitivity, Dermatitis, Abnormal nerve conduction velocity)

      NotHPOsFreeText: N/A

      CaseAddInfo: Parents are first-cousin consanguineous, Max LOD score is 2.1 for family

      CasePreviousTesting: Defects in the intestinal absorption of monoamino-monocarboxylic acids determined by oral loading; Urine analyses confirmed the absence of hyperaminoaciduria in the mother (III-4), father (III-5) and the younger brother (IV-3);

      CaseGenotypingMethod: DNA was isolated from peripheral blood samples and from liver samples collected at autopsy. A genome-wide screen with 343 different markers was carried out and linkage analysis performed using homozygosity mapping. Both SLC6A18 and SLC6A19 were investigated for possible pathogenicity, with SLC6A19's pattern of expression supporting it as a primary candidate. Intronic primers were used to bidirectionally sequence each exon and flanking intronic regions, locating a homozygous frameshift mutation that perfectly segregated with the phenotype.

      CasePMIDs: 2582682, 11394870

      Variant: NM_001003841.3(SLC6A19):c.882_883TG[1] (p.Val295fs)

      ClinVar: 2018 https://ww.ncbi.nlm.nih.gov/clinvar/variation/2018/

      gnomAD: 0.000008900, https://gnomad.broadinstitute.org/variant/5-1214174-CTG-C?dataset=gnomad_r2_1

    2. Japanese

      CaseKLD: Female, 6 yrs report, Japan, Asian

      CasePresentingHPOs: HP:0001047, HP:0002028, HP:0004325, HP:0004322, HP:0008353, HP:0001397, HP:0001249 (Atopic dermatitis, Chronic diarrhea, Decreased body weight, Short stature, Neutral hyperaminoaciduria, Hepatic steatosis, Intellectual disability)

      HPOsFreeText: Lowered concentrations of valine, methionine, isoleucine, tyrosine, phenylalanine, and tryptophan with generalized mild hypoaminoacidemia

      CaseNotHPOs: N/A

      NotHPOsFreeText: N/A

      CaseAddInfo: Parents are first-cousin consanguineous, Max LOD score is 1.45 for family, Pedigree in Figure 1aD

      CasePreviousTesting: Oral loading tests demonstrated impaired absorption of tryptophan from the gut, while the absorption of proline was intact; Absence of hyperaminoaciduria was confirmed by urine analyses of the pedigree members

      CaseGenotypingMethod: DNA was isolated from peripheral blood samples and from liver samples collected at autopsy. A genome-wide screen with 343 different markers was carried out and linkage analysis performed using homozygosity mapping. Both SLC6A18 and SLC6A19 were investigated for possible pathogenicity, with SLC6A19's pattern of expression supporting it as a primary candidate. Intronic primers were used to bidirectionally sequence each exon and flanking intronic regions, locating a homozygous missense mutation that perfectly segregated with the phenotype.

      CasePMIDs: 2582682, 11394870

      Variant: NM_001003841.3:c.169C>T (p.Arg57Cys)

      CAID: CA3182581 http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA3182581

      gnomAD: 0.0002181, https://gnomad.broadinstitute.org/variant/5-1201934-C-T

  3. www.nature.com www.nature.com
    1. KM05

      Case#: KM05, F, 2 years (Dx)

      CasePresentingHPOs: HP:0005974 (Episodic ketoacidosis)

      HPOsFreeText: At 11 years old she was eating a normal diet without restriction and plasma branched-chain amino acids were normal.

      CasePreviousTesting: Lymphoblastoid cells from the patient showed reduced decarboxylation activity (~9% of control) and expression of the protein was moderately reduced (PMID 3417306).

      CaseMethod1: PCR

      CaseMethod2: Sequencing

      CaseGenotypingMethod: Total RNA was prepared from lymphoblastoid cells or peripheral leukocytes. An additional set of primers were used to distinguish each cDNA fragment from 2 different alleles. Clones were amplified and sequenced then confirmed by amplifying genomic DNA and performing restriction enzyme digestion.

      Variant: 1. NM_001918.3(DBT):c.1150G>A (p.Gly384Ser); 2. NM_001918.3(DBT):c.294C>G (p.Ile98Met)

      ClinVar: 1. 11949; 2. 11948

      gnomAD: 1. East Asian 0.9705 (8883 homozygotes), Overall 0.9139; 2. Not in gnomAD

      VariantEvidence: Variant 1 is likely benign

      CaseAddInfo: Parents not available for testing.

      CasePMIDs: 3417306

    1. 7

      Patient7: Female, 1.9yo

      CasePresentingHPOs: HP:0001254, HP:0011968, HP:0001298, HP:0001259, HP:0007021 (lethargy, poor feeding, encephalopathy, coma, pain insensitivity)

      HPOsFreeText: acute neonatal IVA, convulsions, treated with IVA special formula along with L-carnitine and glycine supplements, elevated isovalerylglycine, C5-carnitine = 2.45 µmol/l, weight = 11kg, height = 90cm, currently meeting normal milestones and has normal neurological examination

      CaseNotHPOs:

      NotHPOsFreeText:

      CaseAddInfo: symptom onset at 3do, diagnosis at 10do via clinical presentation, consanguineous family

      CasePMIDs:

      CasePreviousTesting: same as group

      CaseGenotypingMethod: same as group

      Variant1: NM_002225.3:c.1136T>C

      CAID: CA391723904, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA391723904

      gnomAD: n/a

      Variant2: NC_000015.9:g.40699940T>C (NM_002225.4(IVD):c.234+14C=)

      CAID: CA147572, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NC_000015.9%3Ag.40699940T%3EC

      ClinVar: 94053, https://www.ncbi.nlm.nih.gov/clinvar/variation/94053/

      gnomAD: 0.6830, https://gnomad.broadinstitute.org/variant/15-40699940-T-C

    2. 5

      Patient5: Male, 7yo

      CasePresentingHPOs: HP:0002572, HP:0011968, HP:0011675, HP:0001254, HP:0011675, HP:0002616, HP:0001659 (episodic vomiting, poor feeding, lethargy, abnormal EKG, aortic root dilation, aortic regurgitation)

      HPOsFreeText: chronic intermittent IVA, recurring hospitalization (every 3mo), abnormal urine odor, treated with vegetarian diet with L-carnitine, elevated isovalerylglycine, C5-carnitine = 4.6 µmol/l, birth weight = 3.5kg, at 7yo had an abnormal EKG and had subsequent abnormal ECHO, sat at 6mo, walked at 1.2yo, spoke first word at 1yo, current height = 128cm, current weight = 18kg

      CaseNotHPOs:

      NotHPOsFreeText:

      CaseAddInfo: symptom onset at 12mo, diagnosis at 60mo via clinical presentation, consanguineous family, older sister had poor sucking at birth and died at 7 days old

      CasePMIDs:

      CasePreviousTesting: same as group

      CaseGenotypingMethod: same as group

      Variant1: NM_002225.3:c.749G>C

      CAID: CA391718929, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA391718929

      gnomAD: n/a

      Variant2: NC_000015.9:g.40699940T>C (NM_002225.4(IVD):c.234+14C=)

      CAID: CA147572, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvs=NC_000015.9%3Ag.40699940T%3EC

      ClinVar: 94053, https://www.ncbi.nlm.nih.gov/clinvar/variation/94053/

      gnomAD: 0.6830, https://gnomad.broadinstitute.org/variant/15-40699940-T-C

    1. 5

      CaseCA5: Male, 9 months death

      CasePresentingHPOs: HP:0001644, HP:0001875, HP:0001508, HP:0003535, HP:0002014, HP:0008872, HP:0003146 (Dilated cardiomyopathy, Neutropenia, Failure to thrive, 3-Methylglutaconic aciduria, Diarrhea, Feeding difficulties in infancy, Hypocholesterolemia)

      HPOsFreeText: N/A

      CaseNotHPOs: N/A

      NotHPOsFreeText: N/A

      CaseAddInfo: N/A

      CasePreviousTesting: N/A

      CaseGenotypingMethod: The TAZ gene was PCR amplified in three fragments and directly sequenced in the mother and proband.

      Variant: NM_000116.4:c.629T>G (p.Leu210Arg)

      CAID: CA415184340, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA415184340

      gnomAD: Not in gnomAD

    1. In family 2, a male child

      Case# F2-2:1, 38wk born, Russian

      CasePresentingHPOs HP:0001254, HP:0001824, HP:0001943, HP:0001942, HP:0000952, HP:0002789, HP:0002919

      CasePreviousTesting molecular analysis of CPS1 and NAGS did no reveal disease-causing mutations. Metabolic analysis (Table 1)

      CaseMethod1 Sanger

      CaseGenotypingMethod Sanger of all seven CA5A exons

      Variant NM_001739.1(CA5A):c.555G>A (p.Lys185=)

      ClinVar 127088

      gnomAD 0.0004648 (Other), 0.0001554 (Overall)

      VariantEvidence RT-PCR amplifying exons 2-7 of CA5A (in proband and WT) generated different sized products. Sanger of smaller band revealed a deletion in exon 4 (Fig. 3).

      CaseAddInfo nonconsanguineous, heterozygous parents

    1. CLINICAL REPORT

      CaseSK: Male, Pakistan, Birth onset

      CasePresentingHPOs: HP:0008846, HP:0001562, HP:0002987, HP:0012453, HP:0001623, HP:0001518, HP:0003561, HP:0002209, HP:0011359, HP:0000963, HP:0100678, HP:0000973, HP:0100679, HP:0000348, HP:0002007, HP:0005280, HP:0000463, HP:0003196, HP:0000430, HP:0000233, HP:0000490, HP:0007759, HP:0000218, HP:0000347, HP:0005328, HP:0002828, HP:0002098, HP:0009110, HP:0000883, HP:0011682, HP:0001655, HP:0100545, HP:0007727, HP:0002033, HP:0002015, HP:0001250, HP:0000023, HP:0001525 (Severe intrauterine growth retardation, Oligohydramnios, Elbow contracture, Bilateral wrist flexion contracture, Breech presentation, Small for gestational age, Birth length less than 3rd percentile, Sparse scalp hair, Dry hair, Thin skin, Wrinkled skin, Cutis laxa, Lack of skin elasticity, High forehead, Frontal bossing, Depressed nasal bridge, Anteverted nares, Short nose, Underdeveloped nasal alae, Thin vermilion border, Deeply set eye, Opacification of the corneal stroma, High-arched palate, Micrognathia, Progeroid facial appearance, Multiple joint contractures, Respiratory distress, Diaphragmatic eventration, Thin ribs, Perimembranous ventricular septal defect, Patent foramen ovale, Arterial stenosis, Opacification of the corneal epithelium, Poor suck, Dysphagia, Seizures, Inguinal hernia, Severe failure to thrive)

      HPOsFreeText: Clenched fists, Birth weight was 1.52 kg (<3rd centile), his length was 38 cm (<3rd centile) and his OFC was 29.5 cm (<3rd centile). His Apgar scores were six and nine at 1 and 5 min respectively, Parchment paper‐like textured skin, Prominent cheek jowls, Absent Bowman's membrane, Increased cellularity in the substantia propia, Decreased amount of elastin compared to controls, Less-deefined collagen fibers, Amounts of collagen type I and III were qualitatively decreased

      CaseNotHPOs: N/A

      NotHPOsFreeText: Normal lung parenchyma

      CaseAddInfo: Born to consanguineous first-cousin once removed parents

      CasePreviousTesting: Maternal TORCH analysis showed no signs of an acute infection; Amniocentesis showed a normal male karyotype (46,XY), and amniotic fluid virology studies showed no detectable virus; Fetal echocardiography was normal; Fibroblast analysis showed cell proliferation was severely diminished along with abnormally decreased collagen production; A heterozygous variant in PYCR1 was also found (c.329C > T) but is predicted benign and no functional expression alteration of PYCR1 was found.

      CaseGenotypingMethod: The exons and exon-intron boundaries of ALDH18A1 were subject to mutation screening via direct sequencing and PCR amplification. A homozygous canonical splice-site variant was found with both parents heterozygous for the same mutation. cDNA was applied to test for functional alteration of the transcript which yielded, rathert than the WT 706 bp protein, a shortened protein ranging from 492-583 bp. These two transcripts either lead to a large deletion of c.1757–1970 or a premature termination codon predicted to undergo NMD.

      Variant: NM_002860.4(ALDH18A1):c.1923+1G>A

      ClinVar: 29727 https://www.ncbi.nlm.nih.gov/clinvar/variation/29727/

      gnomAD: Not in gnomAD

    1. Patient 2

      Case2: Male, White, 18 yrs report

      CasePresentingHPOs: HP:0010864, HP:0000717, HP:0002019, HP:0002300, HP:0001250, HP:0012072 (Severe Intellectual disability, Autism, Constipation, Mutism, Seizures, Aciduria)

      HPOsFreeText: N/A

      CaseNotHPOs: HP:0001627, HP:0000175 (Abnormal heart morphology, Cleft palate)

      NotHPOsFreeText: N/A

      CaseAddInfo: Parents are non-consanguineous, Has 22q11.2 deletion so phenotypes other than urinary excretion may result from that

      CasePreviousTesting: Urine analysis at 25 years of age showed an increase of AAA (226 mmol/mol creatinine; ref <14) and KAA (68 mmol/mol creatinine; ref not detected)

      CaseGenotypingMethod: All 17 exons and flanking intronic sequences of DHTKD1 were Sanger sequenced. SSCP analysis confirmed the presence of the 22q11.2 deletion.

      Variant1: NM_018706.5(DHTKD1):c.2185G>A (p.Gly729Arg)

      ClinVar: 39564 https://www.ncbi.nlm.nih.gov/clinvar/variation/39564/

      gnomAD: 0.002748, https://gnomad.broadinstitute.org/variant/10-12154929-G-A

      Variant2: NM_018706.7(DHTKD1):c.2318C>T (p.Pro773Leu)

      ClinVar: 420289 https://www.ncbi.nlm.nih.gov/clinvar/variation/420289/

      gnomAD: 0.0001423, https://gnomad.broadinstitute.org/variant/10-12155062-C-T

    1. one new de novo dominant case

      CaseST: Female, 2 days onset

      CasePresentingHPOs: HP:0002521, HP:0010841, HP:0012000, HP:0032842, HP:0011468, HP:0007289, HP:0100704, HP:0000639, HP:0001601, HP:0012820, HP:0002835, HP:0001252, HP:0001257, HP:0001263, HP:0002079, HP:0011757, HP:0003429 (Hypsarrhythmia, Multifocal epileptiform discharges, EEG with generalized spikes, Generalized-onset epileptic spasm, Facial tics, Limb fasciculations, Cerebral visual impairment, Nystagmus, Laryngomalacia, Bilateral vocal cord paralysis, Aspiration, Muscular hypotonia, Spasticity, Global developmental delay, Hypoplasia of the corpus callosum, Posterior pituitary hypoplasia, CNS hypomyelination)

      HPOsFreeText: Lack of normal sleep or wake features on EEG

      CaseNotHPOs: HP:0002650 (Scoliosis)

      NotHPOsFreeText: N/A

      CaseAddInfo: Proband is confirmed de novo heterozygous

      CasePreviousTesting: Currently on vigabatrin, levetiracetam, Rufinamide and ketogenic diet, previously on phenobarbatol, ACTH, Cannabidiol oil and Prednisolone; MRS with small lactate peaks in the basal ganglia and supratentorial white matter

      CaseGenotypingMethod: Whole exome sequencing revealed a pathogenic heterozygous c.254T>C (p.Leu85Pro) variant in the SLC1A2 gene, which was classified as de novo using parental testing.

      Variant: NM_004171.4(SLC1A2):c.254T>C (p.Leu85Pro)

      ClinVar: 254266, https://www.ncbi.nlm.nih.gov/clinvar/variation/254266/

      gnomAD: Not in gnomAD

    1. AC007 II-1

      CaseAC007_II-1: Male, 5 yrs onset, Liberia, Black

      CasePresentingHPOs: HP:0001992, HP:0002373, HP:0010864, HP:0000729, HP:0000750, HP:0002539, HP:0002282 (Organic aciduria, Febrile seizure, Severe intellectual disability, Autistic behavior, Delayed speech and language development, Cortical dysplasia, Gray matter heterotopia)

      HPOsFreeText: N/A

      CaseNotHPOs: N/A

      NotHPOsFreeText: N/A

      CaseAddInfo: Parents are reportedly non-consanguineous, Proband is confirmed homozygous for this variant without parental confirmation via restriction fragment analysis

      CasePreviousTesting: Identified by the assessment of urinary organic acids by gas chromatography–mass spectrometry; Accumulation of N-acetylated amino acids was much less pronounced than in previously reported patients

      CaseGenotypingMethod: Genomic DNA was extracted either from peripheral blood or EBV-transformed lymphocytes. PCR-amplification and bidirectional sequencing of all exons and exon-intron boundaries of ACY1 was performed. Restriction digest analysis was performed to confirm homozygosity.

      Variant: NM_000666.3(ACY1):c.1156C>T (p.Arg386Cys)

      ClinVar: 712435, https://www.ncbi.nlm.nih.gov/clinvar/variation/712435/

      gnomAD: 0.01775 (3 homozygotes), https://gnomad.broadinstitute.org/variant/3-52023020-C-T

    1. GM-649

      Case# GM-649, M--1989 orginally

      CaseMethod1 Sanger

      CaseMethod2 PCR

      Variant NM_000709.3(BCKDHA):c.1312T>A (p.Tyr438Asn) , NM_000709.3:c.887_894del(p.Ile296ArgfsTer3)

      CAID 100009(miss), CA658820684(del)

      gnomAD miss=0.0001603(European (Non-Finnish)), 0.00007284(Overall)

      VariantEvidence total BCKDH activity in fibroblast extracts from the patient (GM649) is < 10% of normal (Table 1) in 2703538

      CaseAddInfo in trans

      CasePMIDs 2703538, 1943689, 12888983

    1. Patient II:1

      CasePAII-1: Female, 18 yrs onset

      CasePresentingHPOs: HP:0000147, HP:0040292, HP:0002083, HP:0003401, HP:0001251, HP:0000640, HP:0006855, HP:0006744 (Polycystic ovary disease, Left hemiplegia, Migraine without aura, Paresthesia, Ataxia, Gaze-evoked nystagmus, Cerebellar vermis atrophy, Adrenocortical carcinoma)

      HPOsFreeText: N/A

      CaseNotHPOs: HP:0000505 (Visual impairments)

      NotHPOsFreeText: N/A

      CaseAddInfo: Parents are consanguineous, Mother has similar symptoms but declined to be clinically examined

      CasePreviousTesting: Episodes triggered by menstruation but also by stress and preceded by a sensorimotor march; EEG and electroneurography were normal; Pathologic CAG expansions in CACNA1A and conventional mutations in CACNA1A, ATP1A2, and SCN1A were ruled out; Treatment with ACZ (250 mg twice daily) prevented hemiplegic spells and interictal GEN receded; MRS demonstrated low combined glutamate and glutamine peak that responded to ACZ treatment during an episode

      CaseGenotypingMethod: Targeted genotyping analysis was performed.

      Variant: NM_004172.5:c.379_383del (p.Tyr127Aspfs*60)

      CAID: CA1139532263, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA1139532263

      gnomAD: Not in gnomAD

    1. 25014 (F)

      Case25014: Female, 31 yrs onset, United States

      CasePresentingHPOs: HP:0002527, HP:0002064, HP:0002460, HP:0002395, HP:0007350, HP:0003487, HP:0000012, HP:0006938, HP:0100658, HP:0000518, HP:0002322, HP:0010784, HP:0012104, HP:0006913 (Falls, Spastic gait, Distal muscle weakness, Lower limb hyperreflexia, Hyperreflexia in upper limbs, Babinski sign, Urinary urgency, Impaired vibration sensation at ankles, Cellulitis, Cataract, Resting tremor, Uterine neoplasm, Parietal cortical atrophy, Frontal cortical atrophy)

      HPOsFreeText: 5/7 disability score, Chronic microvascular disease

      CaseNotHPOs: HP:0001317, HP:0002464, HP:0100543, HP:0000973 (Abnormal cerebellum morphology, Spastic dysarthria, Cognitive impairment, Cutis laxa)

      NotHPOsFreeText: N/A

      CaseGenotypingMethod: Exome sequencing data of 160 index patients with autosomal dominant spastic paraplegia and 275 index patients with autosomal recessive or sporadic spastic paraplegia was examined. 95 patients were screened through panel sequencing. Any determined ALDH18A1 mutations were confirmed by Sanger sequencing.

      CasePreviousTesting: N/A

      CaseAddInfo: Case is sporadic

      Variant: NM_002860.4(ALDH18A1):c.755G>A (p.Arg252Gln)

      ClinVar: 217117 https://www.ncbi.nlm.nih.gov/clinvar/variation/217117/

      gnomAD: Not in gnomAD

    1. 53

      Case53: 4 mo (at biopsy), Arab/Turkish, female

      CaseNotHPOs: metabolic acidosis, homocystinuria (HP:0001942, HP:0002156)

      NotHPOsFreeText: normal synthesis of adenosylcobalamin and methylcobalmin (suggests patient does not have cblX disease).

      Case 53 (Level 2)


      CasePreviousTesting: same as group. found 1.0 nmol/mg protein/18 h propionate incorporation, 0.8 nmol/mg/protein/18 h propionate incorporation with hydroxocobalamin supplementation

      CaseMethod1: same as group

      CaseMethod2: same as group

      CaseGenotypingMethod: same as group


      Variant1: NM_005334.2:c.4475C>T (p.Pro1492Leu)

      ClinVar: n/a

      CAID: CA415114585

      gnomAD: n/a


      CaseAddInfo: Originally identified as mut0 type patient through somatic cell complementation. But NGS instead identified a novel heterozygous mutation in HCFC1, which is detailed above. Based on clinical presentation it was determined unlikely that the identified variant is related to the patients MMA.

    2. 52

      Case52: 3 wks (at biopsy), Irish/Italian

      CasePresentingHPOs: methylmalonic acidemia (HP:0002912)

      HPOsFreeText: SIDS, elevation in C3 carnitine (post mortem blood spot)

      Case 52 (Level 2)


      CasePreviousTesting: same as group. found 2.0 nmol/mg protein/18 h propionate incorporation, 2.3 nmol/mg/protein/18 h propionate incorporation with hydroxocobalamin supplementation

      CaseMethod1: same as group

      CaseMethod2: same as group

      CaseGenotypingMethod: same as group


      Variant1: NM_001177599.1:c.273A>T (p.Arg91Ser)

      ClinVar: n/a

      CAID: CA353555085

      gnomAD: n/a


      CaseAddInfo: Originally identified as mut0 type patient through somatic cell complementation. But NGS instead identified a novel heterozygous mutation in SUCLG2. Unknown relevance of variant to patient's phenotype.

    3. 51

      Case51: 3 wks (at biopsy), Irish/Italian

      CasePresentingHPOs: metabolic acidosis-severe, methylmalonic acidemia-mild, lactic acidosis, sensorineural hearing loss (HP:0001942, HP:0002912, HP:0003128, HP:0000407)

      Case 51 (Level 2)


      CasePreviousTesting: same as group. found 1.0 nmol/mg protein/18 h propionate incorporation, 0.9 nmol/mg/protein/18 h propionate incorporation with hydroxocobalamin supplementation

      CaseMethod1: same as group

      CaseMethod2: same as group

      CaseGenotypingMethod: same as group


      Variant1: NM_003849.3:c.433G>A (p.Glu145Lys)

      ClinVar: n/a

      CAID: CA347515756

      gnomAD: 0.00001761 (European non-Finnish)


      Variant2: NM_003849.3:c.511A>C (p.Asn171His)

      ClinVar: n/a

      CAID: CA347515593

      gnomAD: n/a


      CaseAddInfo: Originally identified as mut0 type patient through somatic cell complementation. But NGS instead identified two novel heterozygous mutations in the SUCLG1 gene (detailed above). Mutations are likely causative of patient's phenotype.

    1. cases

      CaseSA4P: Female, 12 months onset, European

      CasePresentingHPOs: HP:0001988, HP:0000825, HP:0001987, HP:0002167 (Recurrent hypoglycemia, Hyperinsulinemic hypoglycemia, Hyperammonemia, Neurological speech impairment)

      HPOsFreeText: N/A

      CaseNotHPOs: N/A

      NotHPOsFreeText: N/A

      CaseAddInfo: Has mother with confirmed variant and similar phenotypes

      CasePreviousTesting: Leucine load test showed leucine sensitivity; Protein/leucine restriction was effective at reducing symptoms

      CaseGenotypingMethod: Genomic DNA was prepared from all patients via peripheral blood leukocytes. The GLUD1 gene exons 1-13 and the flanking intronic regions were PCR-amplified and directly sequenced. All variants were confirmed via restriction enzyme analysis. Additionally, paternity testing was performed by HLA typing and by southern blot analysis of DNA fragments as well as PCR analysis of STRs.

      Variant: NM_005271.5(GLUD1):c.965G>A (p.Arg322His)

      ClinVar: 16129, https://www.ncbi.nlm.nih.gov/clinvar/variation/16129/

      gnomAD: Not in gnomAD