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  1. Last 7 days
    1. STGD1 was determined according to initial symptoms of VA loss; fundus images showing orange-yellow flecks in the retina, a beaten-bronze appearance; and normal or cone-altered ffERG results

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

      DiseaseAssertion: STGD1

      FamilyInfo: Segregation noted, but no specific details provided

      CasePresentingHPOs:

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

      CaseNotHPOs:

      CaseNotHPOFreeText: VF loss, abnormal ERG

      GenotypingMethod:

      PreviouslyPublished: n/a

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

      ClinVar: 99073

      CAID: CA226919

      SupplementalData: Table S1

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

      Case#: Patient #13

      DiseaseAssertion: STGD1

      FamilyInfo: n/a

      CasePresentingHPOs:

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

      CaseNotHPOs:

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

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

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

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

      ClinVar: n/a

      CAID: CA341290648

      SupplementalData: supplement 1 has the genotype for probands

    1. S2 File: This file contains the following sub-files: Figures A-C, Tables A-E and the references of the detected mutations in Tables A-E. Figure A shows the overall coverage of genes in the panel. Figures B and C show the genes that doesn’t reach 100% and 99%, respectively. Table A shows the variant numbers detected by NGS of 68 samples have previously tested by Sanger sequencing before. Table B shows the results of all 68 samples previously screened by Sanger sequencing. Table C shows the Z-score results for CNV detecting of family P041 and P048. Table D: Statistics of targeted NGS in 99 RP patients, shows the depth, coverage and variant numbers detected in 99 RP patients. Table E shows the mutations identified in 61 out of 99 RP patients.(RAR)pone.0185237.s002.rar (1.9M)GUID: D12AF020-8D31-4449-ACC9-879865E75832

      Unable to open this type of file, but according to LOVD this paper contains this variant and it is not in the main text.

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

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

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

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

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

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

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

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

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

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

      annotating here since unable to annotate on PDF.

      Case#: Stargardt patient 22, Italian

      DiseaseAssertion: STGD

      FamilyInfo:

      CasePresentingHPOs:

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

      CaseNotHPOs:

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

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

      PreviouslyPublished: n/a

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

      ClinVar: 99113

      CAID: CA226972

      SupplementalData: Table S2

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

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

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

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

      DiseaseAssertion: Stargardt

      FamilyInfo: Genotypes not provided for parents. No siblings

      CasePresentingHPOs:

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

      CaseNotHPOs:

      CaseNotHPOFreeText:

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

      PreviouslyPublished: n/a

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

      ClinVar: 438100

      CAID: CA26843511

      SupplementalData: pedigree in fig s2

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

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

      DiseaseAssertion: Nonsyndromic Inherited Retinal Dystrophies. Stargardt

      FamilyInfo: Family RPN-133

      CasePresentingHPOs:

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

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: NGS; MLPA and array CGH

      PreviouslyPublished: n/a

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

      ClinVar: 99283

      CAID: CA227192

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

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

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

      DiseaseAssertion: Stargardt disease

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: category IIA (autosomal recessive stargardt disease)

      CaseNotHPOs:

      CaseNotHPOFreeText:

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

      PreviouslyPublished: n/a

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

      CAID: CA239745

      SupplementalData: supplemental table 1

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

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

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

      DiseaseAssertion: ABCA4-Associated Retinopathy

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

      PreviouslyPublished: n/a

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

      CAID: CA227402

      SupplementalData: eTable 1

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

      Case#: Bauwens Case ID #20864, German

      DiseaseAssertion: Simplex Retinitis Pigmentosa

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

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

      PreviouslyPublished:

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

      CAID: CA239745

      SupplementalData: supplemental table s3

  2. Aug 2026
    1. We performed diagnostic NGS testing for 537 patients (287 males and 250 females) referred with clinical indications of IRD. All of the 537 individuals were initially referred on a singleton basis.Phenotype classification IRDs have a diverse spectrum of overlapping clinical presentation, which can vary by age of onset, extent of visual impairment, nature of disease progression and involvement of additional clinical features. We grouped all referred patients into 10 distinct clinical classifications (see online supplementary table S3). The most common referral was non-syndromic RCD/RP (n=250). The most common referral of syndromic disease was Usher syndrome (n=38), a disorder characterised by neurosensory hearing loss and visual impairment. There were eight cases of suspected syndromic ciliopathies referred, including seven cases of BBS.

      Case#: Case #82863

      DiseaseAssertion: CRD

      FamilyInfo: n/a

      CasePresentingHPOs: n/a

      CaseHPOFreeText: n/a

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      CasePreviousTesting: n/a

      GenotypingMethod: NGS panel of 105 genes

      PreviouslyPublished: possible since this is an international cohort

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

      ClinVar: 236516

      CAID: CA10581650

      SupplementalData: supplemental table S3 has genotype info and phenotype

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

      Case#: Patient #126, Chinese

      DiseaseAssertion: Stargardt

      FamilyInfo: n/a

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

      CaseHPOFreeText: n/a

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

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

      PreviouslyPublished: n/a

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

      CAID: CA232815

      SupplementalData: info found in table S2

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

      Case#: Patient #133, Chinese

      DiseaseAssertion: Stargardt

      FamilyInfo: n/a

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

      CaseHPOFreeText: n/a

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      PreviouslyPublished: n/a

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

      ClinVar: 2202780

      CAID: CA341277622

      SupplementalData: info found in table S2

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

      Case#: Patient #9, Canadian

      DiseaseAssertion: Stargardt

      FamilyInfo: n/a

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

      CaseHPOFreeText: n/a

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      PreviouslyPublished: n/a

      Variant: c.6383 A>G p.(H2128R); c.785 G>A p.(G1961E)

      ClinVar: 99455

      CAID: CA227399

      SupplementalData: info found in table S2

    1. Screening of reported pathogenic variants in ABCA4 for Stargardt (STGD) The disease prevalence of STGD is estimated as 1 in 10000 individuals4. It has been estimated that about 70% of STGD patients carry variants in ABCA45. Therefore, this represents the scenario of a recessive disease with a relatively homogeneous genetic cause. We screened 945 reported pathogenic variants in ABCA4 genes collected in HGMD. Among them, 11 variants are likely benign, as their population AF in is higher than 0.7% (1/20000‾‾‾‾‾‾‾‾√)<math xmlns:mml="http://www.w3.org/1998/Math/MathML" display="inline" id="M11"><mrow><mrow><mo>(</mo><mrow><msqrt><mrow><mn>1</mn><mo>/</mo><mn>20000</mn></mrow></msqrt></mrow><mo>)</mo></mrow></mrow></math>, the cutoff based on STGD disease prevalence, therefore were excluded from further analysis. The remaining 934 variants were subjected to our test model. As a result, 26 variants with the AF in the range of 0.46% to 0.03% were identified as likely benign (Binomial test1, Bonferroni correction p-value ≤ 0.05/934 and test2 Bonferroni correction p-value > 0.05/934) (Figure 3A).

      This variant is reported in Table S6, but only location, predictions, frequencies, etc are reported for it, not cases.

    2. Screening of reported pathogenic variants in ABCA4 for Stargardt (STGD) The disease prevalence of STGD is estimated as 1 in 10000 individuals4. It has been estimated that about 70% of STGD patients carry variants in ABCA45. Therefore, this represents the scenario of a recessive disease with a relatively homogeneous genetic cause. We screened 945 reported pathogenic variants in ABCA4 genes collected in HGMD. Among them, 11 variants are likely benign, as their population AF in is higher than 0.7% (1/20000‾‾‾‾‾‾‾‾√)<math xmlns:mml="http://www.w3.org/1998/Math/MathML" display="inline" id="M11"><mrow><mrow><mo>(</mo><mrow><msqrt><mrow><mn>1</mn><mo>/</mo><mn>20000</mn></mrow></msqrt></mrow><mo>)</mo></mrow></mrow></math>, the cutoff based on STGD disease prevalence, therefore were excluded from further analysis. The remaining 934 variants were subjected to our test model. As a result, 26 variants with the AF in the range of 0.46% to 0.03% were identified as likely benign (Binomial test1, Bonferroni correction p-value ≤ 0.05/934 and test2 Bonferroni correction p-value > 0.05/934) (Figure 3A).

      This variant is reported in Table S6, but only location, predictions, frequencies, etc are reported for it, not cases.

    3. Screening of reported pathogenic variants in ABCA4 for Stargardt (STGD) The disease prevalence of STGD is estimated as 1 in 10000 individuals4. It has been estimated that about 70% of STGD patients carry variants in ABCA45. Therefore, this represents the scenario of a recessive disease with a relatively homogeneous genetic cause. We screened 945 reported pathogenic variants in ABCA4 genes collected in HGMD. Among them, 11 variants are likely benign, as their population AF in is higher than 0.7% (1/20000‾‾‾‾‾‾‾‾√)<math xmlns:mml="http://www.w3.org/1998/Math/MathML" display="inline" id="M11"><mrow><mrow><mo>(</mo><mrow><msqrt><mrow><mn>1</mn><mo>/</mo><mn>20000</mn></mrow></msqrt></mrow><mo>)</mo></mrow></mrow></math>, the cutoff based on STGD disease prevalence, therefore were excluded from further analysis. The remaining 934 variants were subjected to our test model. As a result, 26 variants with the AF in the range of 0.46% to 0.03% were identified as likely benign (Binomial test1, Bonferroni correction p-value ≤ 0.05/934 and test2 Bonferroni correction p-value > 0.05/934) (Figure 3A).

      This variant is reported in Table S6, but only location, predictions, frequencies, etc are reported for it, not cases.

    4. Screening of reported pathogenic variants in ABCA4 for Stargardt (STGD) The disease prevalence of STGD is estimated as 1 in 10000 individuals4. It has been estimated that about 70% of STGD patients carry variants in ABCA45. Therefore, this represents the scenario of a recessive disease with a relatively homogeneous genetic cause. We screened 945 reported pathogenic variants in ABCA4 genes collected in HGMD. Among them, 11 variants are likely benign, as their population AF in is higher than 0.7% (1/20000‾‾‾‾‾‾‾‾√)<math xmlns:mml="http://www.w3.org/1998/Math/MathML" display="inline" id="M11"><mrow><mrow><mo>(</mo><mrow><msqrt><mrow><mn>1</mn><mo>/</mo><mn>20000</mn></mrow></msqrt></mrow><mo>)</mo></mrow></mrow></math>, the cutoff based on STGD disease prevalence, therefore were excluded from further analysis. The remaining 934 variants were subjected to our test model. As a result, 26 variants with the AF in the range of 0.46% to 0.03% were identified as likely benign (Binomial test1, Bonferroni correction p-value ≤ 0.05/934 and test2 Bonferroni correction p-value > 0.05/934) (Figure 3A).

      This variant is reported in Table S6, but only location, predictions, frequencies, etc are reported for it, not cases.

    1. TABLE S2 Description and classification of variants observed to change classifications over time or between laboratories depicted in Figure 4. Separate tabs are present for different types of variant classifications changes: (a) changes from uncertain to pathogenic or benign, (b) changes from pathogenic to uncertain or benign, (c) changes from benign to pathogenic, (d) changes without clear trend.

      This variant is listed in table S2 to show the change in classification over time, but no additional details are provided.

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

      Case#: DNAID 071549/Pat23, male

      DiseaseAssertion: STGD1

      FamilyInfo: n/a

      CasePresentingHPOs:

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

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: smMIPs sequencing of the complete ABCA4 locus

      PreviouslyPublished: n/a

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

      CAID: CA10611614

      SupplementalData: tables s9 and s11

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

      Case#: DNAID 072888/Pat258, female

      DiseaseAssertion: STGD1

      FamilyInfo: n/a

      CasePresentingHPOs:

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

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: smMIPs sequencing of the complete ABCA4 locus

      PreviouslyPublished: n/a

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

      CAID: CA10611614

      SupplementalData: tables s9 and s11

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

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

      DiseaseAssertion:

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

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

      PreviouslyPublished: n/a

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

      ClinVar: 866538

      CAID: CA341279017

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

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

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

      DiseaseAssertion: stargardt

      FamilyInfo: n/a

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

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: p.P2097S; p.A1773V phase unknown

      ClinVar: 2202780

      CAID: CA341277622

      SupplementalData: supplementary table S3 has phenotype information

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

      Per ClinVar entry, this variant was associated with this paper. however, after reading through the genotypes, this variant was not found. Likely this paper was mentioned to support the statement that "Loss-of-function variants in ABCA4 are known to be pathogenic"

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

      Case#: 93RE proband, Spanish

      DiseaseAssertion: cone rod dystrophy

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

      CasePresentingHPOs: n/a

      CaseHPOFreeText:

      CaseNotHPOs: n/a

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

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

      ClinVar: 2202779

      CAID: CA341277358

      SupplementalData: pedigree with genotype in supplemental file

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

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

      DiseaseAssertion: stargardt

      FamilyInfo: n/a

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

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

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

      ClinVar: 2202780;

      CAID: CA341277622;

      SupplementalData: supplementary table S4 has phenotype information

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

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

      DiseaseAssertion: stargardt

      FamilyInfo: n/a

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

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

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

      ClinVar: 2202780;

      CAID: CA341277622;

      SupplementalData: supplementary table S4 has phenotype information

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

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

      DiseaseAssertion: stargardt

      FamilyInfo: n/a

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

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

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

      ClinVar: 2202780;

      CAID: CA341277622;

      SupplementalData: supplementary table S4 has phenotype information

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

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

      DiseaseAssertion: Stargardt disease

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: category IIA (autosomal recessive stargardt disease)

      CaseNotHPOs:

      CaseNotHPOFreeText:

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

      PreviouslyPublished: n/a

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

      CAID: CA10611614

      SupplementalData: supplemental table 1

    1. To overcome these limitations, we designed a genotyping microarray (gene chip) for ABCR that includes all approximately 400 disease-associated and other variants currently described, enabling simultaneous detection of all known ABCR variants.

      Article is a PDF, so annotating here. In the supplemental file (table S1), this variant was listed as being included on the microarray, but that is all the information provided.

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

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

      DiseaseAssertion: macular dystrophy or cone-rod dystrophy

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

      CasePresentingHPOs:

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

      CaseNotHPOs:

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

      CasePreviousTesting: n/a

      GenotypingMethod: Sanger sequencing of ABCA4

      PreviouslyPublished: n/a

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

      ClinVar: 236516

      CAID: CA10581650

      SupplementalData: Supplementary table 1

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

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

      DiseaseAssertion: STGD1

      FamilyInfo: n/a

      CasePresentingHPOs:

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

      CaseNotHPOs:

      CaseNotHPOFreeText:

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

      PreviouslyPublished: n/a

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

      ClinVar: 99283

      CAID: CA227192

      SupplementalData: supplementary table 2 has genotype/phenotype info

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

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

      DiseaseAssertion: cone-rod dystrophy

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

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

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

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: 19365591

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

      ClinVar: 1460063

      CAID: 341283936

      SupplementalData: Table S2 has phenotype details

    1. ABCA4

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

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

    2. ABCA4

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

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

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

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

      DiseaseAssertion: Stargardt

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

      CasePresentingHPOs:

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

      CaseNotHPOs:

      CaseNotHPOFreeText:

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

      PreviouslyPublished: n/a

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

      ClinVar: 438100

      CAID: CA26843511

      SupplementalData: pedigree in fig s2

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

      Case#: Braun Family 5 Proband (from left to right, top to bottom of available pedigrees), male

      DiseaseAssertion: Stargardt

      FamilyInfo: Proband has 1 affected sister with the same genotype and 1 unaffected, heterozygous brother. Genotypes not provided for parents.

      CasePresentingHPOs:

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

      CaseNotHPOs:

      CaseNotHPOFreeText:

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

      PreviouslyPublished: n/a

      Variant: c.5196+1137G>A; c.4363T>C (p.C1455R)

      ClinVar: 438100

      CAID: CA26843511

      SupplementalData: pedigree in fig s2

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

      Case#: Braun Family 7 Proband (from left to right, top to bottom of available pedigrees), female

      DiseaseAssertion: Stargardt

      FamilyInfo: Unaffected carrier parents. c.5196+1137G>A maternally inherited; c.4561-10T>C paternally inherited

      CasePresentingHPOs:

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

      CaseNotHPOs:

      CaseNotHPOFreeText:

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

      PreviouslyPublished: n/a

      Variant: c.5196+1137G>A; c.4561-10T>C

      ClinVar: 438100

      CAID: CA26843511

      SupplementalData: pedigree in fig s2

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

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

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

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

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

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

      DiseaseAssertion: STGD

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

      CasePresentingHPOs:

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod:

      PreviouslyPublished: n/a

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

      ClinVar: 99135

      CAID: CA227000

      SupplementalData: supplemental table 1

    1. ilename Description aos14218-sup-0001-TableS1.xlsxMS Excel, 27.1 KB Table S1. List of genetic variants found in IRD patients, Norway, 2018. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

      This variant is reported to be found in 1 individual in heterozygous or compound heterozygous form, but there is no patient identifier, so impossible to know whether they have a second variant

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

      Case#: Liu Proband A034, Chinese, female

      DiseaseAssertion: Stargardt

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

      CasePresentingHPOs:

      CaseHPOFreeText: no individual details provided

      CaseNotHPOs:

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

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

      PreviouslyPublished: n/a

      Variant: c.203C>T p.(Pro68Leu); c.3883_3884del p.(Glu1295Lysfs*126)

      ClinVar: 99113

      CAID: CA226972

      SupplementalData: S1 only provides group demographics for the different clinical classifications (fundus grade, FAF type, etc)

    1. Supplementary data. bjophthalmol-2018-312064supp004.pdf

      This variant is found on pg 16 in proband 14075. Compound heterozygous for c.6817-2A>C. MEH institute (UK). Said to have Stargardt based on the following criteria: "(1) patients (at least 6 years old) with at least two ABCA4 variants or one ABCA4 variant associated with a typical STGD1 phenotype and (2) presence of a well-defined atrophic lesion with/without flecks at the most recent visit of at least 300 µm in diameter (the total area of all lesions <12 mm2)." No additional details provided

    1. Additional file 2: All supplemental tables cited in the text. Enclosed data include data set meta-information, CAP scores for all drug-related genes, DRP scores for all drugs, CAP and DRP differences between populations, and a comparison between allele frequencies in the studied data set and CPIC guidelines. (XLSX 776 kb)13073_2017_502_MOESM2_ESM.xlsx (776K)GUID: B02AAF40-A613-411F-A471-357C45A33F82

      This variant is mentioned in the supplemental table, S1 CAP. No additional details provided

    1. To determine the overall CF for all AR-IRD–causing mutations in different subpopulations, we initially calculated CF for each of the 10,044 likely pathogenic variants in each subpopulation (SI Appendix, Tables S2 and S3).

      This variant is found in Supplemental Table S3, but this table lists frequencies and does not give case information

    2. To determine the overall CF for all AR-IRD–causing mutations in different subpopulations, we initially calculated CF for each of the 10,044 likely pathogenic variants in each subpopulation (SI Appendix, Tables S2 and S3).

      This variant is found in Supplemental Table S3, but this table lists frequencies and does not give case information

    1. the model would predict foveal disease in the first decade of life for three alleles (P68L;G1961E, L541P;A1038V, and T1019M)

      Case#: Cideciyan Case #86, male, 20.5yo at report

      DiseaseAssertion: "clinical diagnosis within the spectrum of Stargardt disease or cone–rod dystrophy caused by ABCA4 mutations."

      FamilyInfo: Parental segregation of the reported alleles confirmed. P87 is the proband's sibling, affected, same genotype

      CasePresentingHPOs:

      CaseHPOFreeText: LDF eccentricity along principal meridians [deg]: superior=16.9, inferior=11.7, temporal=18.9, inner nasal=9.6, outer nasal=18.9

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: NGS

      PreviouslyPublished: PMID: 24550365

      Variant: c.203 C>T p.Pro68Leuc.5882 G>A p.(Gly1961Glu); c.5882 G>A p.(Gly1961Glu). Phase confirmed.

      ClinVar: 99113

      CAID: CA226972

      SupplementalData: table s1

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

      Case#: MD-0790, Spanish

      DiseaseAssertion: STGD1

      FamilyInfo: n/a

      CasePresentingHPOs:

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

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: Index cases were studied by different next-generation sequencing (NGS) strategies, including targeted gene panels, clinical exome, and/or whole-exome sequencing

      PreviouslyPublished: n/a

      Variant: c.1715G>C p.(Arg572Pro); c.4918C>T p.(Arg1640Trp)

      ClinVar: 99073

      CAID: CA226919

      SupplementalData: Table S1

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

      This variant was found in homozygosity 3 times in table S1 (Families MD-0991, MD-1164, and MD-1302). All with a STGD1 phenotype.

      MD-0991 had onset of VA loss at 25yo, cone-rod pattern on ERG, and BCVA was 1.2/1.2. Segregation was mentioned, but no details provided.

      MD-1164 had onset of VA loss at 42yo, no VF loss, and BCVA was 0.2/0.3. Segregation was not mentioned.

      MD-1302 had no clinical details available.

      GenotypingMethod: Index cases were studied by different next-generation sequencing (NGS) strategies, including targeted gene panels, clinical exome, and/or whole-exome sequencing

    1. We found statistically significant association for six variations (c.1268A>G, c.4203C>A, c.5603A>T, c.5682G>C, c.5843C>T, c.6249C>T) (FDR < 0.05, Supplementary Table S4)

      This paper is listed under the ClinVar citations for this variant, but only as a paper that references other variants in the initiator codon that have been observed in individuals with ABCA4-related conditions. The actual initiator variant included in this paper is c.1A>G

    1. The study cohort consisted of 643 individuals of (mostly Eastern) European descent. Of these, 2 ABCA4 mutations were identified in 437 cases (68%), 1 mutation in 117 cases (18%) and 0 mutations in 89 cases (14%) (see online supplementary table 1), leaving ~23% of disease-associated alleles in 32% of patients yet to be identified. Almost all patients with no ABCA4 mutations and ~50% of patients with 1 mutation have been screened by whole exome sequencing to determine if variants in other genes were causal in these cases. All cases, where disease-associated variants in other genes were detected, were excluded from this cohort.

      Case#: Case #3483, likely European, 10yo at onset

      DiseaseAssertion: ABCA4 disease

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText: foveal sparing

      GenotypingMethod: NGS, Sanger

      PreviouslyPublished: n/a

      Variant: c.2453G>A (p.Gly818Glu); c.4462T>C (p.Cys1488Arg)

      ClinVar: 99135

      CAID: CA227000

      SupplementalData: supplemental table 1

    1. Subjects All subjects provided written informed consent for this research study, which was approved by the University of Iowa Human Subjects Committee. The study included 176 patients with SD, 457 patients with RP, 60 patients with CRD and 272 normal control subjects. Seventeen members of this cohort (13 with SD, 1 with CRD and 3 with RP) had disease-causing mutations identified on one or both alleles in previous studies that employed single-strand conformational polymorphism analysis as the primary screening method (3). All patients and control subjects were ascertained in the outpatient ophthalmology clinic at the University of Iowa. All patients received a complete eye examination including measurement of Snellen visual acuity, slit lamp biomicroscopy of the anterior segment and fundus, and binocular indirect ophthalmoscopy. Most patients had fundus photography and Goldmann perimetry performed as well.Molecular characterization of the ABCA4 gene A multi-platform screening approach was used to genotype the ABCA4 gene in all 693 research subjects and 272 controls. Thirty-two of the most common disease-causing ABCA4 variations were selected for the initial screen. The entire research cohort was assayed for these 32 variations using a combination of SNPlex, SSCP analysis, TaqMan and automated DNA sequencing (3). The SNPlex and TaqMan assays were performed as previously described (22,23). Fourteen of the variations were compatible with Applied Biosystems SNPlex allele-specific assay platform. Nine variations were screened by SSCP analysis, three were screened using an Applied Biosystems' TaqMan assay and six were screened by automated DNA sequencing. All CRD and RP patients who had one plausible disease-causing allele identified in the first tier of screening were assayed by automated sequencing of the entire coding region of the ABCA4 gene in an effort to identify their second disease-causing allele. In addition, Stargardt patients who had one of the three most common alleles (Gly863Ala, Gly1961Glu or IVS38-10) were also sequenced through the entire coding region of the ABCA4 gene.Visual acuity The best-corrected visual acuity was recorded in each patient's medical record as a Snellen fraction (normal = 20/20). Before statistical analysis, these values were converted to the logarithm of the minimal angle of resolution (logMAR) by calculating the base 10 logarithm of the Snellen fraction [e.g. normal = log(20/20) = 0]. For patients with multiple hospital visits, the acuity measurements taken closest to the patient's 27th birthday were used for the statistical analysis. Values from the left eye and right eye were averaged.Visual field volume scores Goldmann visual fields were scanned with a Sharp scanner and analyzed with ImageJ software (available at http://rsbweb.nih.gov/ij/) as follows: transparent layers were added to each field, and the isopters of the visual fields were manually traced onto these layers. Each isopter was assigned a z-axis value according to relative luminous energy of the stimulus (I2e = 100, I3e = 31.7, I4e = 10, III4e = 0.49, V4e = 0.024, no detection = 0). The volume scores were calculated by multiplying the area of each isopter by its associated z-axis value and then summing the values for all isopters. For patients with multiple hospital visits, the visual field measurements taken closest to the patient's 27th birthday were used for the statistical analysis. Values from the left eye and right eye were averaged.Statistical analyses The frequencies of disease-causing alleles observed among the three groups of retinal disease patients were compared with the frequency in controls using Fisher's exact test. The phenotype of each patient was assumed to result from the additive effect of two alleles and one or more additional factors that were cumulatively represented by a single residual value for each subject. The values for the quantitative contribution of each allele were estimated using a multiple linear regression analysis (24). Specifically, to dissect the effect of each allele, we decomposed the mean phenotype of a person whose genotype consists of allele i and allele j into ai + aj, where ai is the effect of the i-th allele. To do this, we created a vector Yva of length 51 containing the average logMAR visual acuities for each subject, and a 51x16 matrix, X. Each cell of this matrix, Xij, indicated the number of occurrences of the j-th allele for each subject i. This system of 51 equations was solved with multiple linear regression to give estimates of a, using the statistics program R (available at http://www.R-project.org). To verify the allelic data, each row of X summed to 2, and each column summed to the corresponding number of occurrences of each allele for this cohort. These calculations were performed in the same manner for Yvol, the vector of containing each subject's visual field quantitative phenotype. The estimates of a, the coefficients for each allele, for both Yva and Yvol are given in Table 1.

      Case#: Patient on line 28, US

      DiseaseAssertion: retinitis pigmentosa (RP)

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: Thirty-two of the most common disease-causing ABCA4 variations were selected for the initial screen. The entire research cohort was assayed for these 32 variations using a combination of SNPlex, SSCP analysis, TaqMan and automated DNA sequencing. All CRD and RP patients who had one plausible disease-causing allele identified in the first tier of screening were assayed by automated sequencing of the entire coding region of the ABCA4 gene in an effort to identify their second disease-causing allele. In addition, Stargardt patients who had one of the three most common alleles (Gly863Ala, Gly1961Glu or IVS38-10) were also sequenced through the entire coding region of the ABCA4 gene.

      PreviouslyPublished: n/a

      Variant: c.6601_6602del (p.Arg2201AlafsTer?) "Glu2200del2 aggGA"; c.5461-10T>C "IVS38-10 T>C"

      CAID: CA227421

      SupplementalData: genotype in supplemental table 1

    1. Rp125 arRP ABCA4 NM_000350 Heterozygous c.6416G > C p.(Arg2139Pro) Novel Heterozygous c.1519G > T p.(Asp507Tyr) (Fujinami et al. 2013b)

      Case#: Zhao Case Rp125, N. Ireland

      DiseaseAssertion: arRP

      FamilyInfo: familial case. affected sister with the same genotype

      CasePresentingHPOs:

      CaseHPOFreeText: "Retinitis pigmentosa was diagnosed on the basis of the typical fundal features (bone spicule retinal pigmentation, arteriolar attenuation, and optic disc pallor), visual field constriction, and an attenuated or abolished electroretinogram." 7yo at onset. BCVA= CF, HM. ERG findings: extinguished OU

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: Targeted next-generation sequencing using a retinal capture panel to test 55 RP genes and 131 other retinal disease genes. All putative mutations identified by NGS were validated using Sanger sequencing and tested for co-segregation if additional affected family members are available

      PreviouslyPublished: n/a

      Variant: NM_000350 c..6416G>C p.(Arg2139Pro); c.1519G>T p.(Asp507Tyr)

      CAID: CA956878

      SupplementalData: table s6, figure s1

    1. All reported ABCA4 variants (Supplementary Table S1) were classified as follows:

      Patient 38 has this variant and also c.5882G>A p.(Gly1961Glu) (Supplement 4-supplementary table 1). Phase is unknown and more specific phenotype information is not provided.

      clinical diagnosis of STGD1 was supported by the presence of ≥1 (likely) pathogenic ABCA4 variants with a follow-up data of ≥6 months on FAF imaging.

  3. Jul 2026
    1. A cohort of 500 unrelated IRD patients was sequenced with the targeted NGS panel Genetic Eye Disease test (GEDi)3 and analyzed with a comprehensive approach, which included a standard NGS analysis pipeline detecting single-nucleotide variants (SNVs) and small insertions and deletions (indels),16 interrogation of sequence reads to detect the known pathogenic MAK-Alu insertion,21 and application of NGS read-depth algorithms (ExomeDepth15 and gCNV16) to detect larger deletions and duplications, or CNVs (Fig. 1). In this study we define CNVs as deletions or duplications that range from an average size of an exon (≈50–200 bp) and that are not detectable by standard NGS pipelines, to megabases of DNA.22

      Case#: OGI802_001554

      DiseaseAssertion: IRD

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: detection of CNVs on the panel-based NGS Genetic Eye Disease (GEDi) diagnostic test that involves sequencing the exons of all known IRD disease genes

      PreviouslyPublished: n/a

      Variant: c.1715G>C; c.5196+1137G>A

      ClinVar: 99073

      CAID: CA226919

      SupplementalData: Table S2

    1. Seventy eyes (38 patients), of which 46 (66%) were female and 24 (34%) male, with RPE atrophy secondary to ABCA4 -related retinopathy (age [years], 45.51 ± 16.70; range 14–78) were included in the study ( Table 1 and see Table, Supplemental Digital Content 2 , http://links.lww.com/IAE/B170 , which shows the individual baseline and progression data of all included eyes).

      Case#: Patient #34, female, 61yo at baseline visit, "intermediate" age of onset

      DiseaseAssertion: ABCA4-related retinopathy with secondary RPE atrophy

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: Inclusion criteria were defined as 1) presence of at least one mutated allele in ABCA4 (NM_000350.2) in Sanger sequencing with multiplex ligation-dependent probe amplification analysis or next-generation sequencing 2) a compatible phenotype with flecks at the level of the RPE consistent with ABCA4 -related Stargardt disease 3) presence of RPE atrophy, and 4) serial examinations with an interval of at least 6 months. RPE atrophy to the end-stage (i.e., demarcated lesions with ≥90% darkness of the optic disc under short-wavelength excitation light, DDAF) that previously showed highest interreader agreement.7 The size of DDAF has to be at least 0.05 mm 2 (each single atrophic area in cases of multifocality), and the entire lesion must be completely visualized on the AF image at each visit to be advanced for analysis. Self-reported symptom onset into early-onset (≤10 years), intermediate-onset (11–44 years), and late-onset (≥45 years). ff-ERG based Category: Group 1 contained eyes with normal scotopic and photopic responses; Group 2, eyes with normal scotopic responses, but reduced (over 2 SDs) photopic B-wave and 30-Hz flicker amplitudes; and Group 3, eyes with impairment of both rod- and cone-driven responses. BCVA: OD=n/a, OS=1 [LogMAR] .

      CaseNotHPOs:

      CaseNotHPOFreeText: Insufficient pupil dilation, additional retinal pathology, previous retinal treatment, or other ocular comorbidities substantially affecting image quality led to exclusion from the study

      GenotypingMethod: Sanger sequencing with multiplex ligation-dependent probe amplification analysis or next-generation sequencing

      PreviouslyPublished: possible since Birtel is an author on this paper and the probands both have the same second variant as in PMID: 29555955

      Variant: allele 1: c.3468C>G p.(Tyr1156*) allele 2: c.5059A>T p.(Ile1687Phe)

      ClinVar: n/a

      CAID: CA341290648

      SupplementalData: The supplemental table linked here contains genotype and phenotype information.

    2. Seventy eyes (38 patients), of which 46 (66%) were female and 24 (34%) male, with RPE atrophy secondary to ABCA4 -related retinopathy (age [years], 45.51 ± 16.70; range 14–78) were included in the study ( Table 1 and see Table, Supplemental Digital Content 2 , http://links.lww.com/IAE/B170 , which shows the individual baseline and progression data of all included eyes).

      Case#: Patient #32, male, 60yo at baseline visit, "late" age of onset

      DiseaseAssertion: ABCA4-related retinopathy with secondary RPE atrophy

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: Inclusion criteria were defined as 1) presence of at least one mutated allele in ABCA4 (NM_000350.2) in Sanger sequencing with multiplex ligation-dependent probe amplification analysis or next-generation sequencing 2) a compatible phenotype with flecks at the level of the RPE consistent with ABCA4 -related Stargardt disease 3) presence of RPE atrophy, and 4) serial examinations with an interval of at least 6 months. RPE atrophy to the end-stage (i.e., demarcated lesions with ≥90% darkness of the optic disc under short-wavelength excitation light, DDAF) that previously showed highest interreader agreement.7 The size of DDAF has to be at least 0.05 mm 2 (each single atrophic area in cases of multifocality), and the entire lesion must be completely visualized on the AF image at each visit to be advanced for analysis. Self-reported symptom onset into early-onset (≤10 years), intermediate-onset (11–44 years), and late-onset (≥45 years). ff-ERG based Category: Group 1 contained eyes with normal scotopic and photopic responses; Group 2, eyes with normal scotopic responses, but reduced (over 2 SDs) photopic B-wave and 30-Hz flicker amplitudes; and Group 3, eyes with impairment of both rod- and cone-driven responses. BCVA: OD=0, OS=0 [LogMAR] .

      CaseNotHPOs:

      CaseNotHPOFreeText: Insufficient pupil dilation, additional retinal pathology, previous retinal treatment, or other ocular comorbidities substantially affecting image quality led to exclusion from the study

      GenotypingMethod: Sanger sequencing with multiplex ligation-dependent probe amplification analysis or next-generation sequencing

      PreviouslyPublished: n/a

      Variant: allele 1: c.52C>T/p.(Arg18Trp) // c.1715G>A/p.(Arg572Gln) // c.2828G>A/p.(Arg943Gln) allele 2: c.1588G>A/p.(Gly863Ala) // c.5603A>T/p.(Asn1868Ile)

      ClinVar: 7900

      CAID: CA226918

      SupplementalData: The supplemental table linked here contains genotype and phenotype information.

    3. Seventy eyes (38 patients), of which 46 (66%) were female and 24 (34%) male, with RPE atrophy secondary to ABCA4 -related retinopathy (age [years], 45.51 ± 16.70; range 14–78) were included in the study ( Table 1 and see Table, Supplemental Digital Content 2 , http://links.lww.com/IAE/B170 , which shows the individual baseline and progression data of all included eyes).

      Case#: Patient #33, female, 64yo at baseline visit, "late" age of onset

      DiseaseAssertion: ABCA4-related retinopathy with secondary RPE atrophy

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: Inclusion criteria were defined as 1) presence of at least one mutated allele in ABCA4 (NM_000350.2) in Sanger sequencing with multiplex ligation-dependent probe amplification analysis or next-generation sequencing,9 2) a compatible phenotype with flecks at the level of the RPE consistent with ABCA4 -related Stargardt disease,9 3) presence of RPE atrophy, and 4) serial examinations with an interval of at least 6 months. RPE atrophy to the end-stage (i.e., demarcated lesions with ≥90% darkness of the optic disc under short-wavelength excitation light, DDAF) that previously showed highest interreader agreement.7 The size of DDAF has to be at least 0.05 mm 2 (each single atrophic area in cases of multifocality), and the entire lesion must be completely visualized on the AF image at each visit to be advanced for analysis. Self-reported symptom onset into early-onset (≤10 years), intermediate-onset (11–44 years), and late-onset (≥45 years). ff-ERG based Category: Group 1 contained eyes with normal scotopic and photopic responses; Group 2, eyes with normal scotopic responses, but reduced (over 2 SDs) photopic B-wave and 30-Hz flicker amplitudes; and Group 3, eyes with impairment of both rod- and cone-driven responses. BCVA: OD=0.4, OS=1.1 [LogMAR] .

      CaseNotHPOs:

      CaseNotHPOFreeText: Insufficient pupil dilation, additional retinal pathology, previous retinal treatment, or other ocular comorbidities substantially affecting image quality led to exclusion from the study

      GenotypingMethod: Sanger sequencing with multiplex ligation-dependent probe amplification analysis or next-generation sequencing

      PreviouslyPublished: possible since Birtel is an author on this paper and the probands both have the same second variant as in PMID: 29555955

      Variant: allele 1: c.3468C>G p.(Tyr1156*) allele 2: c.5059A>T p.(Ile1687Phe); c.4297G>A p.(Val1433Ile)

      ClinVar: n/a

      CAID: CA341290648

      SupplementalData: The supplemental table linked here contains genotype and phenotype information.

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

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

      DiseaseAssertion: stargardt

      FamilyInfo: n/a

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

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: PMID: 26780318

      Variant: p.P2097S; p.A1773V phase unknown

      ClinVar: 2202780

      CAID: CA341277622

      SupplementalData: supplementary table S4 has phenotype information

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

      Case#: Patient#010633, Chinese, female, 20yo at onset

      DiseaseAssertion: stargardt

      FamilyInfo: n/a

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

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: p.P2097S; c.3468C>G p.(Tyr1156*) phase unknown

      ClinVar: 2202780;

      CAID: CA341277622;

      SupplementalData: supplementary table S4 has phenotype information

    1. Panel-based NGS testing was performed for all recruited patients for the identification of disease-causing variants. All patients recruited in this present cohort had two allele disease-causing ABCA4 variants confirmed according to the American College of Medical Genetics and Genomics guidelines (Supplementary Table S2).

      Case#: Family F23 Patient P26, 42yo

      DiseaseAssertion: MD-C

      FamilyInfo: family f23

      CasePresentingHPOs:

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: capture-based next-generation sequencing (NGS) testing

      PreviouslyPublished: n/a

      Variant: c.4555del(;)6119G>A genotype b (a patient harboring a severe/null variant and a missense or in-frame insertion/deletion variant)

      CAID: CA232815

      SupplementalData: table s2

    1. Supplement 4Click here for additional data file.(480K, pdf)Supplement 5Click here for additional data file.(460K, pdf)

      This variant was found in 92 of the 670 alleles in this cohort (Supplement 4). Supplement 5 has the individuals listed with their genotypes, but only mentions variants that were classified as VUS/LP/P, so it is unknown which individuals specifically had this variant or which other variants they also had.

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

      Case#: DNAID 072962/Pat272, male

      DiseaseAssertion: STGD1

      FamilyInfo: n/a

      CasePresentingHPOs:

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

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: smMIPs sequencing of the complete ABCA4 locus

      PreviouslyPublished: n/a

      Variant: c.6416G>A (p.Arg2139Gln); c.6445C>T (p.Arg2149Ter)

      CAID: CA956878

      SupplementalData: tables s9 and s11

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

      Case#: DNAID 072284/Pat191, female

      DiseaseAssertion: STGD1

      FamilyInfo: n/a

      CasePresentingHPOs:

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

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: smMIPs sequencing of the complete ABCA4 locus

      PreviouslyPublished: n/a

      Variant: c.1519G>T (p.Asp507Tyr); c.4139C>T (p.Pro1380Leu) phase not confirmed

      CAID: CA958508

      SupplementalData: tables s9 and s11

    1. Supplementary data. bjophthalmol-2018-312064supp004.pdf

      This variant is found on pg 2 in proband 11019. Compound heterozygous for c.4532C>A, (p.Pro1511His). JHU institute (US). Said to have Stargardt based on the following criteria: "(1) patients (at least 6 years old) with at least two ABCA4 variants or one ABCA4 variant associated with a typical STGD1 phenotype and (2) presence of a well-defined atrophic lesion with/without flecks at the most recent visit of at least 300 µm in diameter (the total area of all lesions <12 mm2)." No additional details provided

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

      Case#: Patient #42, female, 31yo at onset, German

      DiseaseAssertion: macular dystrophy or cone-rod dystrophy

      FamilyInfo: phase not confirmed, but assumed in case of parental consanguinity or if only siblings were affected

      CasePresentingHPOs: HP:0012508

      CaseHPOFreeText:

      CaseNotHPOs:

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

      PreviouslyPublished: n/a

      Variant: c.3468C>G (p.Tyr1156Ter); c.5059A>T (p.Ile1687Phe) Sanger sequencing of ABCA4

      ClinVar: n/a

      CAID: CA341290648

      SupplementalData: Supplementary table 1

    1. Screening of reported pathogenic variants in ABCA4 for Stargardt (STGD) The disease prevalence of STGD is estimated as 1 in 10000 individuals4. It has been estimated that about 70% of STGD patients carry variants in ABCA45. Therefore, this represents the scenario of a recessive disease with a relatively homogeneous genetic cause. We screened 945 reported pathogenic variants in ABCA4 genes collected in HGMD. Among them, 11 variants are likely benign, as their population AF in is higher than 0.7% (1/20000‾‾‾‾‾‾‾‾√)<math xmlns:mml="http://www.w3.org/1998/Math/MathML" display="inline" id="M11"><mrow><mrow><mo>(</mo><mrow><msqrt><mrow><mn>1</mn><mo>/</mo><mn>20000</mn></mrow></msqrt></mrow><mo>)</mo></mrow></mrow></math>, the cutoff based on STGD disease prevalence, therefore were excluded from further analysis. The remaining 934 variants were subjected to our test model. As a result, 26 variants with the AF in the range of 0.46% to 0.03% were identified as likely benign (Binomial test1, Bonferroni correction p-value ≤ 0.05/934 and test2 Bonferroni correction p-value > 0.05/934) (Figure 3A).

      This variant is reported in Table S6, but only location, predictions, frequencies, etc are reported for it, not cases.

    2. Screening of reported pathogenic variants in ABCA4 for Stargardt (STGD) The disease prevalence of STGD is estimated as 1 in 10000 individuals4. It has been estimated that about 70% of STGD patients carry variants in ABCA45. Therefore, this represents the scenario of a recessive disease with a relatively homogeneous genetic cause. We screened 945 reported pathogenic variants in ABCA4 genes collected in HGMD. Among them, 11 variants are likely benign, as their population AF in is higher than 0.7% (1/20000‾‾‾‾‾‾‾‾√)<math xmlns:mml="http://www.w3.org/1998/Math/MathML" display="inline" id="M11"><mrow><mrow><mo>(</mo><mrow><msqrt><mrow><mn>1</mn><mo>/</mo><mn>20000</mn></mrow></msqrt></mrow><mo>)</mo></mrow></mrow></math>, the cutoff based on STGD disease prevalence, therefore were excluded from further analysis. The remaining 934 variants were subjected to our test model. As a result, 26 variants with the AF in the range of 0.46% to 0.03% were identified as likely benign (Binomial test1, Bonferroni correction p-value ≤ 0.05/934 and test2 Bonferroni correction p-value > 0.05/934) (Figure 3A).

      This variant is reported in Table S6, but only location, predictions, frequencies, etc are reported for it, not cases.

    1. See Supplementary Table S2 for a complete genotypic glossary of the cohort.

      Case#: Patients were identified from the inherited retinal disease (IRD) database at UC San Diego (UCSD).

      DiseaseAssertion: RP with macular edema

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: Dx of RP based on "a history of progressive peripheral vision loss or nyctalopia, and ocular examination findings of RP including bone spicule pigmentation, disc pallor and attenuated vessels and genetic confirmation."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: Next-generation sequencing (NGS), exome sequencing, and/or targeted Sanger sequencing were the primary genetic testing approaches.

      PreviouslyPublished: PMID:10206579 is referenced but it seems a reference to the variant and not the proband

      Variant: c.6383A>G (p.His2128Arg); c.3G>T (p.Met1?). phase unknown

      ClinVar: 99455

      CAID: CA227399

      SupplementalData: Variant is found in table S2

    2. See Supplementary Table S2 for a complete genotypic glossary of the cohort.

      Case#: Patients were identified from the inherited retinal disease (IRD) database at UC San Diego (UCSD).

      DiseaseAssertion: RP with macular edema

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: Dx of RP based on "a history of progressive peripheral vision loss or nyctalopia, and ocular examination findings of RP including bone spicule pigmentation, disc pallor and attenuated vessels and genetic confirmation."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: Next-generation sequencing (NGS), exome sequencing, and/or targeted Sanger sequencing were the primary genetic testing approaches.

      PreviouslyPublished: PMID:10206579 is referenced but it seems a reference to the variant and not the proband

      Variant: c.6383A>G (p.His2128Arg); c.3G>T (p.Met1?). phase unknown

      ClinVar: 99455

      CAID: CA227399

      SupplementalData: Variant is found in table S2

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

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

      DiseaseAssertion: STGD

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

      CasePresentingHPOs:

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod:

      PreviouslyPublished: n/a

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

      ClinVar: 99135

      CAID: CA227000

      SupplementalData: supplemental table 1