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  1. Last 7 days
    1. The consequences of telomerase deficiency were studied in model organisms before telomerase mutations were discovered in the setting of human disease[18, 19]

      Animal Models telomerase deficiency was studied in mouse models prior to their discovery in association with human disease, with dyskeratosis congenita being the first to be associated with TBD

    2. The consequences of telomerase deficiency were studied in model organisms before telomerase mutations were discovered in the setting of human disease[18, 19]

      Animal Models telomerase deficiency was studied in mouse models prior to their discovery in association with human disease, with dyskeratosis congenita being the first to be associated with TBD

    1. RESULTS

      NonHumanModel: Murine

      GeneAlteration: murine Galns portions of intron 1 and exon 2 were deleted via homologous recombination of a cre-neomycin resistance-cre cassette and mated with a cre recombinase strain to remove the cassette and complete the deletion

      ModelPhenotype: No outward phenotypes but biochemically there was up to a 6 fold increase in GAG excretion in urine, chondroitin-6-sulfate specifically and not keratan sulfate, consistent with the human phenotype

      HumanPhenotype: in severe cases there are obvious skeletal deformations, increase of GAG's chondroitin-6-sulfate and keratan sulfate in urine and decreased or absent GALNS activity

      ModelEvidence: X-rays of mice and multiple life stages, GAG assays in urine, immunohistochemistry images of tissues with labeled chondoritin-6-sulfate and keratan sulfate to show distribution in multiple tissue types and

      ModelVariant: large deletion of portion of intron 1 and exon 2

      WhereInPaper:

    2. RESULTS

      NonHumanModel: Murine

      GeneAlteration: murine Galns portions of intron 1 and exon 2 were deleted via homologous recombination of a cre-neomycin resistance-cre cassette and mated with a cre recombinase strain to remove the cassette and complete the deletion

      ModelPhenotype: No outward phenotypes but biochemically there was up to a 6 fold increase in GAG excretion in urine, chondroitin-6-sulfate specifically and not keratan sulfate, consistent with the human phenotype

      HumanPhenotype: in severe cases there are obvious skeletal deformations, increase of GAG's chondroitin-6-sulfate and keratan sulfate in urine and decreased or absent GALNS activity

      ModelEvidence: X-rays of mice and multiple life stages, GAG assays in urine, immunohistochemistry images of tissues with labeled chondoritin-6-sulfate and keratan sulfate to show distribution in multiple tissue types and

      ModelVariant: large deletion of portion of intron 1 and exon 2

      WhereInPaper:

    1. This is substantiated by the observation that, similarly to some types of SGR that affect the RNA decay machinery (for example, DIS3 or MTREX; Fig. 4c) and likely increase the level of functional hTR, an inhibitor of the hTR poly(A) polymerase PAPD5 increases the level of mature hTR and improves the potential of haematopoietic stem and progenitor cells in the context of PARN or dyskerin deficiency59,237,238,239.

      potential gene therapy targets to increase TERC (hTR)

    2. This is substantiated by the observation that, similarly to some types of SGR that affect the RNA decay machinery (for example, DIS3 or MTREX; Fig. 4c) and likely increase the level of functional hTR, an inhibitor of the hTR poly(A) polymerase PAPD5 increases the level of mature hTR and improves the potential of haematopoietic stem and progenitor cells in the context of PARN or dyskerin deficiency59,237,238,239.

      potential gene therapy targets to increase TERC (hTR)

    1. Glycosaminoglycans: KS and C6S

      ExperimentName: Accumulation of glycosaminoglycans

      GOterm:

      FunctionalEvidence: Patient cells assayed with artificial substrates for the N-acetylgalactosamine-6-sulfate sulfatase encoded by GALNS, depending on the severity of the coding sequence alteration, are either unable to break down the substrate or are hindered. Further, in mucopolysaccharidosis IVA patients with known variants, elevated levels of keratan sulfate and chondroitin-6-sulfate can be found in their urine where levels in unaffected individuals are much lower.

      HGNC:

      GeneEvidence:

      SharedGeneImplication:

    2. Glycosaminoglycans: KS and C6S

      ExperimentName: Accumulation of glycosaminoglycans

      GOterm:

      FunctionalEvidence: Patient cells assayed with artificial substrates for the N-acetylgalactosamine-6-sulfate sulfatase encoded by GALNS, depending on the severity of the coding sequence alteration, are either unable to break down the substrate or are hindered. Further, in mucopolysaccharidosis IVA patients with known variants, elevated levels of keratan sulfate and chondroitin-6-sulfate can be found in their urine where levels in unaffected individuals are much lower.

      HGNC:

      GeneEvidence:

      SharedGeneImplication:

    1. A novel deletion (IVS11+3del4) identified in the human PAX6 gene in a patient with aniridia

      PMID:

      Gene: PAX6

      Variant NM_000280.5:c.333C>A(p.Val111=)

      Disease: Ocular dysgenesis

      InheritancePattern: AD

      Notes In Table 1. and Figure 3 there are nice illustrations of the consequences of this variant leading to a 27bp truncation in exon 6, in frame, which causes an AA deletion p.Cys112_Val120del version of PAX6. No patient phenotype data is available.

    2. A novel deletion (IVS11+3del4) identified in the human PAX6 gene in a patient with aniridia

      PMID:

      Gene: PAX6

      Variant NM_000280.5:c.333C>A(p.Val111=)

      Disease: Ocular dysgenesis

      InheritancePattern: AD

      Notes In Table 1. and Figure 3 there are nice illustrations of the consequences of this variant leading to a 27bp truncation in exon 6, in frame, which causes an AA deletion p.Cys112_Val120del version of PAX6. No patient phenotype data is available.

    1. Four patients (2 males, 2 females)

      Case#: Fateen_P4

      Demographics: Egyptian

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

      CaseNotHPOs:

      CasePreviousTesting:

      CaseMethod1:

      CaseMethod2:

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

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

      ClinVar: 1048369

      CAID: CA397100962

      gnomAD: n/a

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

      CaseAddInfo:

      CasePMIDs:

    2. Four patients (2 males, 2 females)

      Case#: Fateen_P4

      Demographics: Egyptian

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

      CaseNotHPOs:

      CasePreviousTesting:

      CaseMethod1:

      CaseMethod2:

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

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

      ClinVar: 1048369

      CAID: CA397100962

      gnomAD: n/a

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

      CaseAddInfo:

      CasePMIDs:

    1. phenotype of the Australian kindred is similar to the basal ganglia disorder (Waisman syndrome [MIM 311510]) reported for a Wisconsin kindred5 (Figure 1; Table S1). Members of the defining family included 13 affected males who presented with variable degrees of ID and early-onset parkinsonism. Multipoint linkage analysis of the Wisconsin family previously localized the disease-causing mutation to Xq27.3–qter with a maximum multipoint LOD of 6.75 at the genetic marker F8C (chrX:154,929,351–154,929,630; GRCh38/hg38).

      Wilson_Wisconsin kindred

      Family#PresentingHPOs: HP:0001263, HP:0000750, HP:0001249, HP:0002174, HP:0007351, HP:0002362, HP:0002067, HP:0002396, HP:0001260, HP:0000256, HP:0002007, HP:0000218, HP:0001355,

      Age at clinical evaluation <2y; early learning difficulty with ability to read and live independently (in some members), age at tremor onset 10-20y, age at Parkinson diagnosis 20s, absent response to L-Dopa, hypokinetic dysarthria, skin depigmented papules, normal cerebellar function and eye examination, normal karyotype, normal copper testing, normal blood count and chemistry, normal urine metabolic testing, normal hearing.

      FamilyNotHPOs:

      Fragile X syndrome,

      CountryOrigin: Germany

      Ethnicity:

      Race:

      Family#PreviousTesting: Multipoint linkage analysis was performed. X chromosome exome sequencing revealed no other variants in the linkage region. Direct sequencing of CLIC2 ruled out variants in the gene.

      Family#Method1: Sanger seq

      Family#Method2:

      Family#GenotypingMethod: RAB39B was directly sequenced

      Affected: 16

      Unaffected:

      Segregations:

      PublishedLOD: 6.75

      eLOD:

      AddSegregationInfo:

      ProbandLabel: Wilson_Wisconsin kindred proband

      Variant: NM_171998.4(RAB39B):c.503C>A (p.Thr168Lys)

      ClinVar: 156532

      CAID:

      gnomAD: NR

      FamilyAddInfo: Family is noted to be of German ancestry, and no consanguinity is noted.

      FamilyPMIDs: 1674730, 4025396

    2. We identified an Australian kindred with three brothers who presented in childhood with nonprogressive intellectual disability (ID), which included delayed developmental milestones, cognitive impairment, and macrocephaly

      Case#: Wilson_Australian kindred_Person II:2

      Demographics: Male, 44y at diagnosis, Australia

      CasePresentingHPOs: HP:0000750, HP:0001249, HP:0007351, HP:0002362, HP:0002067, HP:0100660, HP:0002396, HP:0000256

      Age at onset <2y, while age at tremor onset was 38y. Birth and early milestones were normal. Early learning difficulties were reported and the proband was able to read and write. Parkinsonism classification was akinetic-rigid. Proband showed L-Dopa response, hypokinetic dysarthria, and normal cerebellar function. Other normal features included normal eye examination, MRI, Fragile X testing, karyotype, Copper testing, blood count and chemistry, urine metabolic testing and hearing.

      CaseNotHPOs:

      CasePreviousTesting: Linkage analysis using homozygous recessive model identified no linkage to autosomes, but to two regions: Xp22.2 and Xq27.3–qter

      CaseMethod1: Copy number variation analysis

      CaseMethod2: PCR

      CaseGenotypingMethod: A ~45-kb deletion within the Xq haplotype was identified that encompassed the complete RAB39B gene and the last 3 coding exons of CLIC2.

      Variant: NC_000023.11:g.(155246216_?)_(?_155288781)del

      ClinVar: 157665

      CAID:

      gnomAD:

      VariantEvidence: The proband was hemizygous for the ~45-kb deletion encompassing the complete RAB39B and partial CLIC2 genes. Expression of both transcripts was absent from fibroblast cells of affected individuals. The proband is not scored any points as the variant involves deletion of part of an additional gene, CLIC2. Although the authors ruled out seizures and cardiac anomalies (phenotypes associated with CLIC2 missense variant) in patients from the family, it is not conclusive that CLIC2 deletion does not have any impact on the proband's phenotype.

      CaseAddInfo: The proband's siblings were also similarly affected. Elder brother of the proband died at 48y from positional asphyxia, and postmortem neuropathological studies on proband's brain showed pallor of the substantia nigra and locus coeruleus. H&E staining of substantia nigra revealed PD features, including loss of pigmented neurons and Lewy bodies in surviving neurons. Abundance of cortical Lewy bodies, were noted. Tau-immunoreactive NFTs were also observed in a small proportion of the surviving pigmented SN neurons

      CasePMIDs:

    3. phenotype of the Australian kindred is similar to the basal ganglia disorder (Waisman syndrome [MIM 311510]) reported for a Wisconsin kindred5 (Figure 1; Table S1). Members of the defining family included 13 affected males who presented with variable degrees of ID and early-onset parkinsonism. Multipoint linkage analysis of the Wisconsin family previously localized the disease-causing mutation to Xq27.3–qter with a maximum multipoint LOD of 6.75 at the genetic marker F8C (chrX:154,929,351–154,929,630; GRCh38/hg38).

      Wilson_Wisconsin kindred

      Family#PresentingHPOs: HP:0001263, HP:0000750, HP:0001249, HP:0002174, HP:0007351, HP:0002362, HP:0002067, HP:0002396, HP:0001260, HP:0000256, HP:0002007, HP:0000218, HP:0001355,

      Age at clinical evaluation <2y; early learning difficulty with ability to read and live independently (in some members), age at tremor onset 10-20y, age at Parkinson diagnosis 20s, absent response to L-Dopa, hypokinetic dysarthria, skin depigmented papules, normal cerebellar function and eye examination, normal karyotype, normal copper testing, normal blood count and chemistry, normal urine metabolic testing, normal hearing.

      FamilyNotHPOs:

      Fragile X syndrome,

      CountryOrigin: Germany

      Ethnicity:

      Race:

      Family#PreviousTesting: Multipoint linkage analysis was performed. X chromosome exome sequencing revealed no other variants in the linkage region. Direct sequencing of CLIC2 ruled out variants in the gene.

      Family#Method1: Sanger seq

      Family#Method2:

      Family#GenotypingMethod: RAB39B was directly sequenced

      Affected: 16

      Unaffected:

      Segregations:

      PublishedLOD: 6.75

      eLOD:

      AddSegregationInfo:

      ProbandLabel: Wilson_Wisconsin kindred proband

      Variant: NM_171998.4(RAB39B):c.503C>A (p.Thr168Lys)

      ClinVar: 156532

      CAID:

      gnomAD: NR

      FamilyAddInfo: Family is noted to be of German ancestry, and no consanguinity is noted.

      FamilyPMIDs: 1674730, 4025396

    1. Germline mutations and genotype–phenotype correlations in patients with apparently sporadic pheochromocytoma/paraganglioma in Korea J.H. Kim, J.H. Kim Department of Internal medicine, Seoul National University College of Medicine, Seoul, South KoreaBoth the authors contributed equally to this work.Search for more papers by this authorM.-W. Seong, M.-W. Seong Department of Laboratory medicine, Seoul National University College of Medicine, Seoul, South KoreaBoth the authors contributed equally to this work.Search for more papers by this authorK.E. Lee, K.E. Lee Department of Surgery, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorH.J. Choi, H.J. Choi Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, South KoreaSearch for more papers by this authorE.J. Ku, E.J. Ku Department of Internal medicine, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorJ.H. Bae, J.H. Bae Department of Internal medicine, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorS.S. Park, S.S. Park Department of Laboratory medicine, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorS.H. Choi, S.H. Choi Department of Internal medicine, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorS.W. Kim, S.W. Kim Department of Internal medicine, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorCS Shin, CS Shin Department of Internal medicine, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorS.Y. Kim, Corresponding Author S.Y. Kim Department of Internal medicine, Seoul National University College of Medicine, Seoul, South Korea Corresponding author: Prof Seong Yeon Kim, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 110-744, South Korea. Tel.: 082-02-2072-3216; fax: 082-02-762-9662; e-mail: seongyk@plaza.snu.ac.krSearch for more papers by this author

      PMID: 24134185

      Gene: VHL

      StandardizedReferenceSequence: NM_000551.3

    2. Germline mutations and genotype–phenotype correlations in patients with apparently sporadic pheochromocytoma/paraganglioma in Korea J.H. Kim, J.H. Kim Department of Internal medicine, Seoul National University College of Medicine, Seoul, South KoreaBoth the authors contributed equally to this work.Search for more papers by this authorM.-W. Seong, M.-W. Seong Department of Laboratory medicine, Seoul National University College of Medicine, Seoul, South KoreaBoth the authors contributed equally to this work.Search for more papers by this authorK.E. Lee, K.E. Lee Department of Surgery, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorH.J. Choi, H.J. Choi Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, South KoreaSearch for more papers by this authorE.J. Ku, E.J. Ku Department of Internal medicine, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorJ.H. Bae, J.H. Bae Department of Internal medicine, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorS.S. Park, S.S. Park Department of Laboratory medicine, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorS.H. Choi, S.H. Choi Department of Internal medicine, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorS.W. Kim, S.W. Kim Department of Internal medicine, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorCS Shin, CS Shin Department of Internal medicine, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorS.Y. Kim, Corresponding Author S.Y. Kim Department of Internal medicine, Seoul National University College of Medicine, Seoul, South Korea Corresponding author: Prof Seong Yeon Kim, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 110-744, South Korea. Tel.: 082-02-2072-3216; fax: 082-02-762-9662; e-mail: seongyk@plaza.snu.ac.krSearch for more papers by this author

      PMID: 24134185

      Gene: VHL

      StandardizedReferenceSequence: NM_000551.3

    1. Mucopolysaccharidosis type IVA. N-acetylgalactosamine-6-sulfate sulfatase exonic point mutations in classical Morquio and mild cases.

      PMID: 1522213

      Gene: GALNS

      Disease: Mucopolysaccharidosis IVA

      MonDO: MONDO:0009659

      InheritancePattern: AR

      ExperimentName: Expression of variant carrying cDNA in GALNS deficient fibroblasts

      FunctionalEvidence: cDNA encoding each of the 15 variants identified in the study were transfected into a GALNS deficient fibroblast cell line. 14 of the 15 altered cDNA's showed no increase in GALNS activity when the cells were assayed, confirming a lack of enzymatic activity.

      HGNC:

      GeneEvidence:

      SharedGeneImplication:

  2. Oct 2026
    1. The proband of thisfamily (Patient #4

      Case#: Male, Family #2, patient #4, onset at 48y.o

      DiseaseAssertion: STGD

      FamilyInfo: proband sister(#3) identical ABCA4 allele to proband, developed central vision issues. Proband son has complex allele w/ early onset cone-rod dystrophy. Proband daughter(#6) has complex allele mutation, central vision issues developed at 17. retinal exam showed atrophic macular lesions. Proband second daughter(patient #5, asymptomatic)

      CasePresentingHPOs: HP:0012508, HP:0030500

      CaseHPOFreeText:Proband presented with bull's eye macular lesions with no fundus flecks. Normal rod-mediated amplitudes, normal single-flash response, reduces 32-Hz flicker amplitude.

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: maintained foveal sparing in both eyes 20/25+2 R.E, 20/25+1 L.E.

      Genotyping Method: Genotyping performed at Columbia University, sequencing technology used is not disclosed.

      PreviouslyPublished: n/a

      Variant: c.4139C>T (p.P1380L), BoldM1: c.5603A>T(p.N18681)[NM_000350.3(ABCA4):c.5603A>T (p.Asn1868Ile) - Variation ID 99390], M2: c.[1622T>C; 3113C>T] (p.[L541P; A1308V])

      ClinVar: M1) 99390 M2) 99067

      CAID: n/a

      SupplementalData: Fig 1: Pedigree illustrating ABCA4 variants and the associated Stargardt phenotype for 5 families. Proband Labeled w/ white arrow for each family. Fig 2: retinal scan measuring melanin in 4 patients of family 2. Panel shows bull's-eye ring of RPE atropy. Fig 3: Macular SD-OCT line profile from b-scans. Reflectivity plotted against function of retinal depth. Table 1: table shows patients with p.N18681 variant, type of mutation, and pathogenicity class. Table 2: Patients, age on-set and first symptom

  3. Sep 2026
    1. The proband of Family #4

      Case#: Female, Family #4, patient #8

      DiseaseAssertion: STGD

      FamilyInfo: Proband's daughter shares ABCA4 variant and struggled with difficulty focusing at age 19. BVCA 20/200 R.E and 20/80 in L.E.

      CasePresentingHPOs: HP:0030500, HP:0007663, HP:0000608

      CaseHPOFreeText: Proband's first symptom was difficulty with night vision occurring at 45 y.o, BVCA at 50 y.o in both eyes was 20/20. atrophy in macula and Stage 2 fundus flecks identified.

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      Genotyping Method: Genotyping performed at Columbia University, sequencing technology used is not disclosed.

      PreviouslyPublished: n/a

      Variant: NM_000350.3(ABCA4):c.1622T>C (p.Leu541Pro), NM_000350.3(ABCA4):c.1957C>T (p.Arg653Cys)

      ClinVar: M2) 99067, M5) 99108

      CAID: n/a

      SupplementalData: Fig 1: Pedigree illustrating ABCA4 variants and the associated Stargardt phenotype for 5 families. Proband Labeled w/ white arrow for each family. Fig 2: retinal scan measuring melanin in 4 patients of family 2. Panel shows bull's-eye ring of RPE atropy. Fig 3: Macular SD-OCT line profile from b-scans. Reflectivity plotted against function of retinal depth. Table 1: table shows patients with p.N18681 variant, type of mutation, and pathogenicity class. Table 2: Patients, age on-set and first symptom

    2. son (the proband of Family #3, pedigree in Figure 1C)

      Case#: Male, Family#3, Proband M1, M2: II,1 on pedigree

      DiseaseAssertion: STGD

      FamilyInfo: mother of proband has p.N18681 and p.P1380L mutations and is asymptomatic with no changes to NIR-AF and SD-OCT. Treated with 400mg of hydroxychloroquine for lupus prior to imaging. Non-affected father.

      CasePresentingHPOs:HP:0007663, HP:0000493

      CaseHPOFreeText: Proband has reduced visual acuity and issues reading with BCVA 20/200 in R.E and 20/50-2 in L.E. Oval foveal lesions with stage 2 flecks. Visual acuity reducing starting at age 10.

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      Genotyping Method: Genotyping performed at Columbia University, sequencing technology used is not disclosed.

      PreviouslyPublished: n/a

      Variant: M1:p.P1380L, complex allele: M2: p.N18681 and IVS38:c.5461-10T>C. M3: c.4139C>T(p.P1380L)

      ClinVar: M1) 99390 M2) 99067 M3) Variation ID: 7904

      CAID: n/a

      SupplementalData: Fig 1: Pedigree illustrating ABCA4 variants and the associated Stargardt phenotype for 5 families. Proband Labeled w/ white arrow for each family. Fig 2: retinal scan measuring melanin in 4 patients of family 2. Panel shows bull's-eye ring of RPE atropy. Fig 3: Macular SD-OCT line profile from b-scans. Reflectivity plotted against function of retinal depth. Table 1: table shows patients with p.N18681 variant, type of mutation, and pathogenicity class. Table 2: Patients, age on-set and first symptom

    3. The proband (Patient #20

      Case#: Female, family #5, Patient #20

      DiseaseAssertion: STGD

      FamilyInfo: Proband's sister presented with same clinical prognosis. Sister diagnosed with pattern dystrophy and photoaversion at age 57, with difficulty seeing at night. Sister has nuclear sclerotic and cortical cataracts in both eyes.

      CasePresentingHPOs: HP:0000662, HP:0000603, HP:0000603, HP:0000493

      CaseHPOFreeText: Proband presented with localized blur at age 62, (late onset) in her left eye. BVCA 20/20-3 and 20/20-2 at age 70. Also has macular lesions with stage 2 fundus flecks.

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      Genotyping Method: Genotyping performed at Columbia University, sequencing technology used is not disclosed.

      PreviouslyPublished: n/a

      Variant: p.N18681, IVS36:c.5196+1G>A

      ClinVar: M2) 99067, M6) 99351

      CAID: N/A

      SupplementalData: Fig 1: Pedigree illustrating ABCA4 variants and the associated Stargardt phenotype for 5 families. Proband Labeled w/ white arrow for each family. Fig 2: retinal scan measuring melanin in 4 patients of family 2. Panel shows bull's-eye ring of RPE atropy. Fig 3: Macular SD-OCT line profile from b-scans. Reflectivity plotted against function of retinal depth. Table 1: table shows patients with p.N18681 variant, type of mutation, and pathogenicity class. Table 2: Patients, age on-set and first symptom

    1. proband

      Case#: Two affected sisters/Female siblings/Progressive onset initially presenting as Stargardt disease

      DiseaseAssertion: ABCA4

      FamilyInfo: Large American family pedigree with two affected sisters. Both sisters were compound heterozygous for two novel ABCA4 variants. Unaffected relatives carried one variant or neither variant, supporting autosomal recessive inheritance.

      CasePresentingHPOs: HP:0000556, HP:0000572, HP:0007754, HP:0000648, HP:0000510, HP:0001133, HP:0000610

      CaseHPOFreeText: Proband initially showed phenotype compatible with Stargardt disease with progressive central vision loss. Over several years disease advanced into severe cone-rod dystrophy with worsening retinal degeneration, abnormal visual fields, and reduced electroretinography responses.

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: Unaffected family members with only one mutation had no retinal disease phenotype.

      Genotyping Method: Genome-wide linkage analysis using 408 microsatellite markers followed by direct Sanger DNA sequencing of all ABCA4 exons and exon-intron boundaries. Segregation analysis performed in family members.

      PreviouslyPublished: No, both variants were novel at time of publication.

      Variant: ABCA4 (RefSeq: NM_000350.3): c.655A>T ; ABCA4 (RefSeq: NM_000350.3): c.5312+3A>T

      ClinVar: 632118

      CAID: n/a

      SupplementalData: Variants absent in 200 unrelated controls. Clinical testing included visual acuity, fundus examination, fluorescein angiography, visual field testing, and electroretinography. Compound heterozygous state associated with severe progressive phenotype.

    1. 54-year-old female patient

      Case#: Female, 54 yo

      FamilyInfo: No family members were available

      CasePresentingHPOs: HP:0007924, HP:0000519,HP:0001105, HP:0030825,

      CaseHPOFreeText: diagnosed with HIV 15 years ago. She was initially diagnosed with HIV following recurrent respiratory infections and an unintentional weight loss of 12 kg over six months. The diagnosis was confirmed via a positive HIV antibody test, followed by a Western blot confirmation and a CD4 count of 400 cells/mm³ at the time of diagnosis. Antiretroviral therapy (ART) was initiated shortly after confirmation of the diagnosis. Her condition has since progressed to AIDS, with a recent CD4 count of 80 cells/mm³. She was on ART, including tenofovir, emtricitabine, and efavirenz.

      CaseNotHPOs: n/a

      GenotypeMethod: NGS, Sanger Sequencing

      Variant: c.2588G>C in exon 13, c.5461-10T>C in intron 39

      ClinVar: Not reported in ClinVar

      **SupplementalData: ** indicative of significant loss of central retinal structure (Figure 4).

    1. Age of onset

      Case #: Eldest sister/Female/Onset at 3yo

      DiseaseAssertion: SLC26A2

      FamilyInfo: Family pedigree showing consanguinity of the proband's parents. The osteochondrodysplasia genotype, derived from a homozygous variant in the SLC26A2 gene and compound heterozygous variants in the ABCA4 gene, is responsible for the retinal phenotype

      CasePresentingHPOs: HP:0034345, HP:0000556, HP:0002098, HP:0001903, HP:0001385, HP:0007754, HP:0002650, HP:0000939, HP:0025388, HP:0007987, HP:0003124, HP:0007401

      CaseHPOFreeText: Visual acuity was 1/50 and 2/50 for both eyes, knee dysplasia, sticky platelet syndrome type II

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      GenotypyingMethod: genetic screening by next‐generation sequencing (NGS) was performed on a panel of genes involved in retinal dystrophy and macular degeneration

      PreviouslyPublished: n/a

      Variant: ABCA4 (RefSeq: NM_000350.3(ABCA4):c.203C>T (p.Pro68Leu))

      CAID: n/a

      SupplementalData: Comparison of phenotypes (table 1)

    1. 231

      Case#: Patient 231, Female, age of onset at 7 y.o, Poland

      DiseaseAssertion: STGD1

      FamilyInfo: Mother was a carrier, unaffected father.

      CasePresentingHPOs: HP:0007722, HP:0000608, HP:0025158

      CaseHPOFreeText: RPE atrophy, macular degeneration, central hyper-autofluorescence in fundus autofluorescence

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a, non-proband identified HPO's mentioned, but not assignable to individual proband.

      Genotyping Method: DNA isolated from peripheral blood from patients and relatives via MagNA Pure 24, samples screened with MIPs targeting 108 genes involved in pathogensis of IRD's. PCR completed on library, analysed with NGS fragment analysis kit.

      PreviouslyPublished: yes

      Variant: c.4234C>T , p.(Gln1412*)

      ClinVar: 99263

      gnomeAD 0.00001984 allelic frequency

      CAID: n/a

      SupplementalData: Fig1: List of families displaying pseudo-dominant inheritance. Fig2: Number of alleles for most common variants.

    2. c.634C>T

      Case#: Patient 225, Female, age of onset 7 y.o, Poland

      DiseaseAssertion: STGD-1

      FamilyInfo: no given family information.

      CasePresentingHPOs: HP:0007722, HP:0000608, HP:0025158

      CaseHPOFreeText: RPE atrophy, macular degeneration, central hyper-autofluorescence in fundus autofluorescence

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a, non-proband identified HPO's mentioned, but not assignable to individual proband.

      Genotyping Method: DNA isolated from peripheral blood from patients and relatives via MagNA Pure 24, samples screened with MIPs targeting 108 genes involved in pathogensis of IRD's. PCR completed on library, analysed with NGS fragment analysis kit.

      PreviouslyPublished: yes

      Variant: c.634C>T,p.(Arg212Cys)

      ClinVar: 7898

      CAID: n/a

      gnomeAD 0.0001177 allele frequency

      SupplementalData: Fig1: List of families displaying pseudo-dominant inheritance. Fig2: Number of alleles for most common variants.

    3. c.5882G>A

      Case#: Patient 231, Female, age of onset at 7 y.o, Poland

      DiseaseAssertion: STGD1

      FamilyInfo: Mother was a carrier, unaffected father.

      CasePresentingHPOs: HP:0007722, HP:0000608, HP:0025158

      CaseHPOFreeText: RPE atrophy, macular degeneration, central hyper-autofluorescence in fundus autofluorescence

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a, non-proband identified HPO's mentioned, but not assignable to individual proband.

      Genotyping Method: DNA isolated from peripheral blood from patients and relatives via MagNA Pure 24, samples screened with MIPs targeting 108 genes involved in pathogensis of IRD's. PCR completed on library, analysed with NGS fragment analysis kit.

      PreviouslyPublished: yes

      Variant: c.5882G>A

      ClinVar:7888

      gnomeAD: 0.00310 allelic freq.

      CAID: n/a

      SupplementalData: Fig1: List of families displaying pseudo-dominant inheritance. Fig2: Number of alleles for most common variants.

    4. F17-003

      Case#: Patient 225, Female, age of onset 7 y.o, Poland

      DiseaseAssertion: STGD-1

      FamilyInfo: no given family information.

      CasePresentingHPOs: HP:0007722, HP:0000608, HP:0025158

      CaseHPOFreeText: RPE atrophy, macular degeneration, central hyper-autofluorescence in fundus autofluorescence

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a, non-proband identified HPO's mentioned, but not assignable to individual proband.

      Genotyping Method: DNA isolated from peripheral blood from patients and relatives via MagNA Pure 24, samples screened with MIPs targeting 108 genes involved in pathogensis of IRD's. PCR completed on library, analysed with NGS fragment analysis kit.

      PreviouslyPublished: yes

      Variant: c.[1622T>C;3113C>T]

      ClinVar: 99067, 7894

      CAID: n/a

      gnomeAD 0.0001266 allele frequency

      SupplementalData: Fig1: List of families displaying pseudo-dominant inheritance. Fig2: Number of alleles for most common variants.

    1. Patient 1

      Case#: Patient 1, Female, age 40

      DiseaseAssertion: STGD1

      FamilyInfo: n/a

      CasePresentingHPOs: HP:0007722, HP:0000608, HP:0000007

      CaseHPOFreeText: Patient diagnosed with STGD type 1, presenting with retinal pigment atrophy as well as other symptoms typical of STGD1 with reduced visual acuity. Patient daignosed at age 16.

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      Genotyping Method: Patient ABCA-4 gene sequenced via Sanger sequencing of all 50 exons, Splice variants were identified by synthesized cDNA from RNA isolation with RT-PCR analysis with exonic primers.

      PreviouslyPublished: Variant 1 identified in association with retinal dystrophy in these PMC articles: 23982839, 25082829, 25082885, 28327576

      Variant: NM_000350.3(ABCA4):c.859-9T>C, NM_000350.3(ABCA4):c.303-3C>G

      ClinVar: 3249248, 859348

      gnomAD total allele frequency: 0.005% of var . 1

      CAID: n/a

      SupplementalData: Fig 1: Minigene RNA analysis of splice variants. A: genomic region of exon 40 on ABCA-4. B: genomic regions of exons 39-41 to investigate specific variant:oncanonical splice site variant c.5714+5G>A Fig 2: overview of wild-type midigene splice constructs of ABCA-4 and locations of 47 different non canonical splice site variants Fig 3: Overview of splice defects from nine different non canonnical splice variants in ABCA-4 gene. Fig 4: percentages of normal ABCA-4 transcripts as a result of noncanonical splice variants using electrophoresis system analysis. Table 1: Non canonical splice variants and observed protein affects.

    1. 35-year-old woman

      **Case#: ** Female, 35yo

      FamilyInfo: Unremarkable

      CasePresentingHPOs: HP:0000529 Progressive visual loss, HP:0030532 Visual acuity, HP:0007401 Macular atrophy

      CaseHPOFreeText: 35-year-old woman presented with symptom of gradually progressive diminution of vision in both eyes since childhood. Patient gave no history of defective night vision.

      CaseNotHPO n/a

      GenoTypeMethod: n/a (optical coherence tomography (OCT))

    1. Patient 2, a 46-year-old Caucasian woman, presented in July 1998 with a history of progressive decline in visual acuity since the age of 16

      PMID: 10612508

      Gene: ABCA4

      Case#: Patient 2, 46-year-old female

      DiseaseAssertion: STGD1

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

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

      CaseHPOFreeText: Progressive visual decline since age 16. Best-corrected visual acuity 20/400 in both eyes. Fundus examination showed bilateral symmetrical central chorioretinal atrophy (~3 disc diameters) with prominent pigment deposits and numerous yellow flecks in the posterior pole. Fluorescein angiography demonstrated central hypofluorescence with surrounding hyperfluorescence and peripheral dark choroid.

      CaseNotHPOs: Not reported

      CaseNotHPOFreeText: Not reported

      GenotypingMethod: PCR amplification and direct sequencing of ABCA4 after SSCP screening

      PreviouslyPublished: Yes

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

      ClinVar: Not reported

      CAID: Not reported

      SupplementalData: Segregation and sequencing data shown in Figures 1 and 4

    2. Patient 3, a 37-year-old Caucasian woman, presented in July 1998 with a gradual decline in visual acuity that began at the age of 12.

      Case#: Patient 3, 37-year-old female

      PMID: 10612508

      DiseaseAssertion: STGD1

      FamilyInfo: Affected sibling in autosomal recessive family.

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

      CaseHPOFreeText: Gradual visual decline beginning at age 12. Visual acuity 20/400 in both eyes. Fundus examination revealed bilateral macular atrophy with pigment deposits and numerous yellow flecks in the posterior pole and midperiphery. Fluorescein angiography showed large hypofluorescent regions with surrounding hyperfluorescence and peripheral dark choroid.

      CaseNotHPOs: Not reported

      CaseNotHPOFreeText: Not reported

      GenotypingMethod: PCR and direct sequencing of ABCA4

      PreviouslyPublished: Yes

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

      ClinVar: Not reported

      CAID: Not reported

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