Case#: a 20-year-old, female, adopted Indian patient with over 662 Mb regions of homozy-gosity who presented with intellectual disability, ataxia, schizophrenia, retinal dystrophy, moder-ate-to-severe progressive sensorineural hearing loss (SNHL), congenital hypothyroidism, cleft mi-tral valve with mild mitral valve regurgitation, and dysmorphic features.

DiseaseAssertion: a cleft mitral valve with mild regurgitation

FamilyInfo: adopted

ParentalTesting: not reported

CasePresentingHPOs: HP:0001249, HP:0001251, HP:0100753, HP:0000556, HP:0000407, HP:0000851, HP:0001633, HP:0001653

CaseHPOFreeText: cleft mitral valve and dysmorphic features

CaseNotHPOs: HP:0001638

CaseNotHPOFreeText: echocardiograms at 18 were normal

CasePreviousTesting: genetic testing, including targeted panel analysis, exome sequencing on a clinical basis, and a research-based review of her raw clinical exome data, led to identifying at least three causal gene disorders to explain distinct aspects of her complex phenotype.

Genotyping Method: Genome-wide single-nucleotide polymorphism (SNP) microarray analysis was clinically performed, with no pathogenic deletions or duplications detected.

FunctionalAnalysis: not reported

Variant: NM_001001430.2:c.68-1592

ClinVar: not reported

CAID: CA032911

gnomAD: total allele frequency: 0.00004522

AdditionalInfo: n/r

Case: Patient 18, female, 18yo, congenital onset of symptoms

CasePresentingHPOs: HP:0003327, HP:0009053, HP:0002650, HP:0011713, HP:0003458 (axial muscle weakness, distal lower limb muscle weakness, scoliosis, left bundle branch block, EMG: myopathic abnormalities)

HPOsFreeText: respiratory involvement, NIV required from 7yo, normal CK levels

FamilyInfo: no family history

DiseaseEntity: no assertion

InheritancePattern: no assertion

CasePreviousTesting: see below

CaseGenotypingMethod: 9 cases underwent targeted Sanger sequencing of MYH7, 12 cases underwent Motorplex analysis (NGS of 93 myopathy-related genes - PMID:25214167), all MYH7 variants confirmed via Sanger sequencing, segregation analysis performed on available family members, which cases received which sequencing technique is not specified

Variant: NM_000257.4(MYH7):c.5655G>A (p.Ala1885=)

ClinVar: 378215, https://www.ncbi.nlm.nih.gov/clinvar/variation/378215/

gnomAD: absent

Case: Patient 19, female, 33yo, symptom onset in childhood

CasePresentingHPOs: HP:0009027, HP:0008959, HP:0009053, HP:0008997, HP:0008994, HP:0002650, HP:0003458 (foot drop, Distal upper limb muscle weakness, Distal lower limb muscle weakness, Proximal muscle weakness in upper limbs, Proximal muscle weakness in lower limbs, scoliosis, EMG: myopathic abnormalities)

HPOsFreeText: respiratory involvement - restrictive from 25yo, normal CK levels, minicores present on muscle biopsy

CaseNotHPOs: no cardiac involvement

FamilyInfo: family history

DiseaseEntity: no assertion

InheritancePattern: no assertion

CasePreviousTesting: see below

CaseGenotypingMethod: 9 cases underwent targeted Sanger sequencing of MYH7, 12 cases underwent Motorplex analysis (NGS of 93 myopathy-related genes - PMID:25214167), all MYH7 variants confirmed via Sanger sequencing, segregation analysis performed on available family members, which cases received which sequencing technique is not specified

Variant: NM_000257.4(MYH7):c.4844_4846AGA[2] (p.Lys1617del)

ClinVar: 190401, https://www.ncbi.nlm.nih.gov/clinvar/variation/190401/

gnomAD: absent

Case: 6, femaly, 16yo, congenital onset of symptoms

CasePresentingHPOs: HP:0003327, HP:0008959, HP:0009053, HP:0002650 (axial muscle weakness, distal upper limb muscle weakness, distal lower limb muscle weakness, scoliosis)

HPOsFreeText: normal CK

CaseNotHPOs:

NotHPOsFreeText: no respiratory or cardiac involvement

FamilyInfo: family history, pedigree in Figure 1

DiseaseEntity: no assertion

InheritancePattern: no assertion

CasePreviousTesting: see below

CaseGenotypingMethod: 9 cases underwent targeted Sanger sequencing of MYH7, 12 cases underwent Motorplex analysis (NGS of 93 myopathy-related genes - PMID:25214167), all MYH7 variants confirmed via Sanger sequencing, segregation analysis performed on available family members, which cases received which sequencing technique is not specified

Variant: NM_000257.4(MYH7):c.4807G>C (p.Ala1603Pro)

ClinVar: 190407, https://www.ncbi.nlm.nih.gov/clinvar/variation/190407/

gnomAD: absent

Case: Patient 17, male, 36yo, symptom onset in childhood

CasePresentingHPOs: HP:0003327, HP:0008959, HP:0009053 (axial muscle weakness, Distal upper limb muscle weakness, Distal lower limb muscle weakness)

HPOsFreeText: normal CK levels

CaseNotHPOs: HP:0002650 (scoliosis)

NotHPOsFreeText: no respiratory or cardiac involvement

FamilyInfo: no family history

DiseaseEntity: no assertion

InheritancePattern: no assertion

CasePreviousTesting: see below

CaseGenotypingMethod: 9 cases underwent targeted Sanger sequencing of MYH7, 12 cases underwent Motorplex analysis (NGS of 93 myopathy-related genes - PMID:25214167), all MYH7 variants confirmed via Sanger sequencing, segregation analysis performed on available family members, which cases received which sequencing technique is not specified

Variant: NM_000257.4(MYH7):c.5779A>T (p.Ile1927Phe)

ClinVar: 487639, https://www.ncbi.nlm.nih.gov/clinvar/variation/487639/

gnomAD: 0.00004598, https://gnomad.broadinstitute.org/variant/14-23882979-T-A?dataset=gnomad_r2_1

Case: Patient 4, male, 22yo, symptom onset in childhood

CasePresentingHPOs: HP:0009027, HP:0003327, HP:0008959, HP:0009053, HP:0001701, HP:0030682 (foot drop, axial muscle weakness, distal upper limb muscle weakness, distal lower limb muscle weakness, pericarditis, left ventricular noncompaction)

CaseNotHPOs: HP:0003306 (rigid spine)

HPOsFreeText: restrictive respiratory involvement from age 16, CK = 711U/l, minicores present on muscle biopsy, hypertrophy of gastrocnemii

FamilyInfo: no family history

DiseaseEntity: no assertion

InheritancePattern: no assertion

CasePreviousTesting: see below; variants in SEPN1 and LMNA rules out

CaseGenotypingMethod: 9 cases underwent targeted Sanger sequencing of MYH7, 12 cases underwent Motorplex analysis (NGS of 93 myopathy-related genes - PMID:25214167), all MYH7 variants confirmed via Sanger sequencing, segregation analysis performed on available family members, which cases received which sequencing technique is not specified

Variant: NM_000257.4(MYH7):c.4844_4846AGA[2] (p.Lys1617del)

ClinVar: 190401, https://www.ncbi.nlm.nih.gov/clinvar/variation/190401/

gnomAD: absent

Case: Patient 13, female, 59yo, symptom onset in adulthood

CasePresentingHPOs: HP:0003701, HP:0003306, HP:0003458 (proximal muscle weakness, rigid spine, EMG: myopathic abnormalities)

HPOsFreeText: normal CK levels, cores present on muscle biopsy

CaseNotHPOs: no respiratory or cardiac involvement

FamilyInfo: family history

DiseaseEntity: no assertion

InheritancePattern: no assertion

CasePreviousTesting: see below

CaseGenotypingMethod: 9 cases underwent targeted Sanger sequencing of MYH7, 12 cases underwent Motorplex analysis (NGS of 93 myopathy-related genes - PMID:25214167), all MYH7 variants confirmed via Sanger sequencing, segregation analysis performed on available family members, which cases received which sequencing technique is not specified

Variant: NM_000257.4(MYH7):c.4315G>C (p.Ala1439Pro)

ClinVar: 190404, https://www.ncbi.nlm.nih.gov/clinvar/variation/190404/

gnomAD: absent

Case: Patient 8, male, 35yo, symptom onset in childhood

CasePresentingHPOs: HP:0009027, HP:0003327, HP:0002460, HP:0002650, HP:0003458 (foot drop, axial muscle weakness, distal muscle weakness, scoliosis, EMG: myopathic abnormalities)

HPOsFreeText: CK = 720U/l, neurogenic EMG, cores present on muscle biopsy

CaseNotHPOs:

NotHPOsFreeText: no respiratory or cardiac involvement

FamilyInfo: pedigree in Figure 1

DiseaseEntity: no assertion

InheritancePattern: no assertion

CasePreviousTesting: see below

CaseGenotypingMethod: 9 cases underwent targeted Sanger sequencing of MYH7, 12 cases underwent Motorplex analysis (NGS of 93 myopathy-related genes - PMID:25214167), all MYH7 variants confirmed via Sanger sequencing, segregation analysis performed on available family members, which cases received which sequencing technique is not specified

Variant 1: NM_000257.4(MYH7):c.4844_4846AGA[2] (p.Lys1617del)

ClinVar: 190401, https://www.ncbi.nlm.nih.gov/clinvar/variation/190401/

gnomAD: absent

Variant 2: NM_000257.4(MYH7):c.4855G>A(p.Glu1619Lys)

ClinVar: 181268, https://www.ncbi.nlm.nih.gov/clinvar/variation/181268/

gnomAD: absent

Case: Patient UK1-IV:1, female, 31yo, Caucasian, Irish ancestry

CasePresentingHPOs: HP:0040083, HP:0002650, HP:0001508, HP:0011471, HP:0002093, HP:0002877, HP:0001620 (toe-walking, scoliosis, poor weight gain, Feeding problem necessitating gastrostomy tube feeding, respiratory impairment, nocturnal hypoventilation, high-pitched voice)

HPOsFreeText: scoliosis required spinal fusion surgery, required nocturnal BiPAP ventilation in adolescence, reduced muscle bulk

Muscle biopsy showed variability in myofiber size, uniformity of type I myofibers on ATPase, moth-eaten appearance of myofibers

CaseNotHPOs:

FamilyInfo: non-consanguineous family

CasePreviousTesting: 32 Illumina genes

CaseGenotypingMethod: NGS (Illumina gene panel) or 32 genes previously associated with congenital myopathies, Sanger sequencing to confirm recessive inheritance

InheritancePattern: autosomal recessive

DiseaseEntity:

Variant 1: NM_000257.3:c.4699C>T (p.Gln1657Ter), maternal

CAID: CA389037829, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA389037829

gnomAD: n/a

Variant 2: NM_000257.4(MYH7):c.4664A>G (p.Glu1555Gly), paternal

ClinVar: 181261, https://www.ncbi.nlm.nih.gov/clinvar/variation/181261/

gnomAD: n/a

Case: Case report, female, 41yo

CasePresentingHPOs: HP:0001270, HP:0002094, HP:0007340, HP:0010535, HP:0002540, HP:0003323, HP:0002015, HP:0100749, HP:0001662, HP:0005952 (motor delay, dyspnea, lower limb weakness, sleep apnea, inability to walk, progressive muscle weakness, dysphagia, chest pain, bradychardia, decreased pulmonary function)

HPOsFreeText: non-smoker, onset of neuromuscular disorders in early childhood, written language delay, difficulty completing exercise, dyspnea and lower limb weakness presenting during patient's first pregnancy (33yo), required mechanical ventilation machine, symptoms of skeletal muscle disorder began after delivery of first child, unable to get up without assistance, unable to climb stairs, required use of cane, walker, then eventually a wheelchair, episodes of paralysis in lower limbs, normal tone/bulk of arm muscles but bilateral weakness in shoulders and upper limbs (MRC scale of 3/5), intact fine finger movements, down-going toes, reduced perception of vibration in lower limbs, needle EMG showed tendency of myotonic potentials, muscle biopsy of left quadricep showed features of end-stage process consistent with chronic myopathy (Fig. 2A-D), forced vital capacity = 27%, forced expiratory volume per second = 29%

CaseNotHPOs: HP:0001513, HP:0040129 (obese, abnormal nerve conduction velocity)

NotHPOsFreeText: pronator drift, sensory deficit, ocular muscle involvement

FamilyInfo: mother died at 66yo due to heart attack associated with non-compaction cardiomyopathy, daughter (11yo) has signs of muscle disorders, congenital muscular torticollis, excessive growing pains, and underdeveloped muscles in half of body

CaseGenotypingMethod: WES, variants confirmed via Sanger Sequencing

Variant: NM_000257.4(MYH7):c.1370T>G (p.Ile457Arg)

ClinVar: 560881, https://www.ncbi.nlm.nih.gov/clinvar/variation/560881/

gnomAD: absent

MultipleGeneVariants:

(1) SNCB Variant

Variant: NM_003085.5(SNCB):c.368C>A (p.Pro123His)

ClinVar: 7026, https://www.ncbi.nlm.nih.gov/clinvar/variation/7026/

gnomAD: 0.0001929, https://gnomad.broadinstitute.org/variant/5-176048219-G-T

(2) GDF6 Variant:

Variant: NM_001001557.4(GDF6):c.746C>A (p.Ala249Glu)

ClinVar: 8371, https://www.ncbi.nlm.nih.gov/clinvar/variation/8371/

gnomAD: 0.001948, https://gnomad.broadinstitute.org/variant/8-97157413-G-T

DiseaseAssertion: None

VariantPreviousTesting: Some combination of ACTC1, ACTN2, CSRP3, LAMP2, MYBPC3, MYH7, NEXN, PLN, TNNC1, TNNI3, TNNT2, TPM1, ABCC9, CTF1, DES, EMD, LDB3, LMNA, MYH6, RBM20, SGCD, TAZ, TCAP, TTN, VCL, CAV3, GLA, MYL2, MYL3, MYOZ2, PRKAG2, TTR, DSC2, DSG2, DSP, JUP, PKP2, RYR2, TMEM43, CASQ2 and RYR2 were tested via NGS.

VariantGenotypingMethod: Next-generation sequencing panels were used to sequence and read the genetic information of probands for variants within exons and in +/- 10 nucleotides within the flanking introns of the genes provided above. These variants were then interpreted and filtered for pathogenicity.

Variant: NM_000257.4(MYH7):c.4668C>A (p.Gly1556=)

ClinVar: 626810 https://www.ncbi.nlm.nih.gov/clinvar/variation/626810/

gnomAD: 0.0009022, http://gnomad.broadinstitute.org/variant/14-23885498-G-T

Case: Case 9, male, 69yo

CasePresentingHPOs: HP:0031318 (myocardial fiber disarray)

HPOsFreeText: BMI = 25.2kg/m^2, cause of death: accidental head injury, heart weight = 624g, left ventricular thickness = 1.8cm, distribution of myocyte disarray in ventricular septum, area of disarray = 7.8%, grade of fibrosis = 3

CaseNotHPOs: HP:0031296 (atrial septal hypertrophy)

CasePreviousTesting: NGS of 81 cardiovascular disorder-related genes (Supplemental Table S1)

CaseGenotypingMethod: genomic DNA extracted from whole blood, PCR, NGS of 81 cardiovascular disorder-related genes (Supplemental Table S1)

Variant: NM_000257.4(MYH7):c.2822G>A (p.Arg941His)

ClinVar: 636633, https://www.ncbi.nlm.nih.gov/clinvar/variation/636633/

gnomAD: 0.00001590, https://gnomad.broadinstitute.org/variant/14-23893216-C-T?dataset=gnomad_r2_1

Supplemental data table e-1

Case: MYH7 Case 2

InheritancePattern: autosomal recessive

DiseaseEntity: n/a

PreviouslyPublished: PMID: 16858239, PMID: 27247418

PreviousTesting: Not specified

CaseGenotypingMethod: paper notes single gene, NGS, and WES were used, but does not specify which method was used for each individual family

Variant: NM_000257.4(MYH7):c.2594A>G (p.Lys865Arg)

ClinVar: 524996, https://www.ncbi.nlm.nih.gov/clinvar/variation/524996/

gnomAD: 0.000003977, https://gnomad.broadinstitute.org/variant/14-23894063-T-C

Case 20: 3 year old male, study ID UZ067 in supplemental table

DiseaseAssertion: low VWF

FamilyInfo:

ParentalGenotype(s):

CasePresentingHPOs: HP:0032442

CaseHPOFreeRext: vWF:Ag (%) = 49; vWF:GPIbR (%) = 50.5; Act/Ag ratio = 1.03; FVIII:C (%) = 90.3; Platelets (x10^9/L) = 336

CaseNOTHPOs:

CaseNOTHPOFreeText:

CasePreviousTesting: The Thrombosis-Hemostasis gene panel test used whole exome sequencing and included 99 diagnostic-grade genes (table 1 in PMID:36696193)

GenotypingMethod:WES using the coagulation subpanel of the UZ Leuven Thrombosis-Haemostasis gene panel test. WES was performed on the sequencing platform NovaSeq 6000 (Illumina), and Alissa Interpret software v5.2-5.4 (Agilent) was used for variant interpretation. Assessment of copy number variation was validated within the bioinformatics pipeline. The American College of Medical Genetics and Genomics and the Association of Molecular Pathology guidelines were used to classify variants as pathogenic (P), likely pathogenic (LP), a variant of uncertain significance (VUS), or (likely) benign (LB, B) variants

PreviouslyPublished:

Gene: VWF

Variant: c.7287+12T>G p.?

HGVS:

ClinVarID: 2572109

CAID:

gnomAD: 0.000002479 (4 in 1613878) no homozygotes https://gnomad.broadinstitute.org/variant/12-5981774-A-C?dataset=gnomad_r4

Case 19: 2 year old male, study ID UZ070 in supplmental table

DiseaseAssertion: low VWF

FamilyInfo:

ParentalGenotype(s):

CasePresentingHPOs: HP:0032442

CaseHPOFreeRext: vWF:Ag (%) = 45; vWF:GPIbR (%) = 39.4; Act/Ag ratio = 0.88; FVIII:C (%) = 74.4; Platelets (x10^9/L) = 232

CaseNOTHPOs:

CaseNOTHPOFreeText:

CasePreviousTesting: The Thrombosis-Hemostasis gene panel test used whole exome sequencing and included 99 diagnostic-grade genes (table 1 in PMID:36696193)

GenotypingMethod:WES using the coagulation subpanel of the UZ Leuven Thrombosis-Haemostasis gene panel test. WES was performed on the sequencing platform NovaSeq 6000 (Illumina), and Alissa Interpret software v5.2-5.4 (Agilent) was used for variant interpretation. Assessment of copy number variation was validated within the bioinformatics pipeline. The American College of Medical Genetics and Genomics and the Association of Molecular Pathology guidelines were used to classify variants as pathogenic (P), likely pathogenic (LP), a variant of uncertain significance (VUS), or (likely) benign (LB, B) variants

PreviouslyPublished:

Gene: VWF

Variant: c.5746C>G p.Arg1916Gly

HGVS:

ClinVarID: 2572097

CAID:

gnomAD: 0.000004337 (7 in 1613868) no homozygotes https://gnomad.broadinstitute.org/variant/12-6011713-G-C?dataset=gnomad_r4

MultipleSequenceVariants:

Gene: SERPINC1

Variant: c.89T>A p.Val30Glu

ClinVarID: 18012

gnomAD: 0.002625 (4237 in 1614198) 14 homozygotes https://gnomad.broadinstitute.org/variant/1-173914872-A-T?dataset=gnomad_r4

Case 18: 0 year old male, study ID UZ078 in supplmental table

DiseaseAssertion: low VWF

FamilyInfo:

ParentalGenotype(s):

CasePresentingHPOs: HP:0032370

CaseHPOFreeRext: vWF:Ag (%) = 51.6; vWF:GPIbR (%) = 45.7; Act/Ag ratio = 0.89; FVIII:C (%) = 86.7; Platelets (x10^9/L) = 487

CaseNOTHPOs:

CaseNOTHPOFreeText:

CasePreviousTesting: The Thrombosis-Hemostasis gene panel test used whole exome sequencing and included 99 diagnostic-grade genes (table 1 in PMID:36696193)

GenotypingMethod: WES using the coagulation subpanel of the UZ Leuven Thrombosis-Haemostasis gene panel test. WES was performed on the sequencing platform NovaSeq 6000 (Illumina), and Alissa Interpret software v5.2-5.4 (Agilent) was used for variant interpretation. Assessment of copy number variation was validated within the bioinformatics pipeline. The American College of Medical Genetics and Genomics and the Association of Molecular Pathology guidelines were used to classify variants as pathogenic (P), likely pathogenic (LP), a variant of uncertain significance (VUS), or (likely) benign (LB, B) variants

PreviouslyPublished:

Gene: VWF

Variant: c.4342C>T p.Gln1448*

HGVS:

ClinVarID: 2572655

CAID:

gnomAD: absent

Case#: 45 yr, female, diagnosed at 13 from heart murmur

DiseaseAssertion: HCM

FamilyInfo: sibling with HCM, family history of symptoms and same mutation

CasePresentingHPOs: left ventricular hypertrophy (HP:0001712)

CaseHPOFreeText: abnormal coaptation of the mitral valve, systolic anterior motion of the mitral valve,

CaseNotHPOs: N/A

CaseNotHPOFreeText: N/A

CasePreviousTesting: N/A

CaseGenotypingMethod: stem cell derivation and cardiomyocyte differentiation; hiPSC-cardiomyocyte shRNA silencing experiments; qPCR analysis of MYH7 alleles; ECG; Micropatterning; ASO silencing

Variant: NM_000257.4(MYH7):c.1208G>A (p.Arg403Gln)

ClinVar: 14087 https://www.ncbi.nlm.nih.gov/clinvar/variation/14087/

CAID: N/A

gnomAD: absent

Case: Patient 12, male, 7yo

CasePresentingHPOs: HP:0030682 (left ventricular noncompaction)

HPOsFreeText: CK = 1400U/l

CaseNotHPOs:

NotHPOsFreeText: no muscle symptoms, no respiratory or cardiac involvement

FamilyInfo: family history, pedigree in figure 1

DiseaseEntity: no assertion

InheritancePattern: no assertion

CasePreviousTesting: see below

CaseGenotypingMethod: 9 cases underwent targeted Sanger sequencing of MYH7, 12 cases underwent Motorplex analysis (NGS of 93 myopathy-related genes - PMID:25214167), all MYH7 variants confirmed via Sanger sequencing, segregation analysis performed on available family members, which cases received which sequencing technique is not specified

Variant: NM_000257.4(MYH7):c.5401G>A (p.Glu1801Lys)

ClinVar: 43069, https://www.ncbi.nlm.nih.gov/clinvar/variation/43069/

gnomAD: absent

Case: Patient 21, female, 40yo, symptom onset in adulthood

CasePresentingHPOs: HP:0009027, HP:0002460, HP:0003458, HP:0025115 (foot drop, distal muscle weakness, EMG: myopathic abnormalities, hyalin bodies)

HPOsFreeText: CK = 500 U/l

CaseNotHPOs: HP:0002650 (scoliosis)

NotHPOsFreeText: no respiratory or cardiac involvement

FamilyInfo: no family history

DiseaseEntity: no assertion

InheritancePattern: no assertion

CasePreviousTesting: see below

CaseGenotypingMethod: 9 cases underwent targeted Sanger sequencing of MYH7, 12 cases underwent Motorplex analysis (NGS of 93 myopathy-related genes - PMID:25214167), all MYH7 variants confirmed via Sanger sequencing, segregation analysis performed on available family members, which cases received which sequencing technique is not specified

Variant: NM_000257.4(MYH7):c.1322C>T (p.Thr441Met)

ClinVar: 14122, https://www.ncbi.nlm.nih.gov/clinvar/variation/14122/

gnomAD: 0.0002227, https://gnomad.broadinstitute.org/variant/14-23898249-G-A?dataset=gnomad_r2_1

Case: Patient 16, female, 39yo, symptom onset in adulthood

CasePresentingHPOs: HP:0030237, HP:0003327, HP:0003701, HP:0002460, HP:0003458 (hand muscle weakness, axial muscle weakness, proximal muscle weakness, distal muscle weakness, EMG: myopathic abnormalities)

HPOsFreeText: normal CK values

CaseNotHPOs: HP:0002650 (scoliosis)

NotHPOsFreeText: no respiratory or cardiac involvement

FamilyInfo: no family history

DiseaseEntity: no assertion

InheritancePattern: no assertion

CasePreviousTesting: see below

CaseGenotypingMethod: 9 cases underwent targeted Sanger sequencing of MYH7, 12 cases underwent Motorplex analysis (NGS of 93 myopathy-related genes - PMID:25214167), all MYH7 variants confirmed via Sanger sequencing, segregation analysis performed on available family members, which cases received which sequencing technique is not specified

Variant: NM_000257.3:c.1780C>A

CAID: CA389049833, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA389049833

gnomAD: absent

Case: Patient 7, male, 8yo, congenital onset of symptoms

CasePresentingHPOs: HP:0003327, HP:0002650, HP:0030682, HP:0003458 (axial muscle weakness, scoliosis, left ventricular noncompaction, EMG: myopathic abnormalities)

HPOsFreeText: minicores present on muscle biopsy

FamilyInfo: no family history

DiseaseEntity: no assertion

InheritancePattern: no assertion

CasePreviousTesting: see below

CaseGenotypingMethod: 9 cases underwent targeted Sanger sequencing of MYH7, 12 cases underwent Motorplex analysis (NGS of 93 myopathy-related genes - PMID:25214167), all MYH7 variants confirmed via Sanger sequencing, segregation analysis performed on available family members, which cases received which sequencing technique is not specified

Variant: NM_000257.3:c.5655+1G>A

CAID: CA389034770, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA389034770

gnomAD: absent

Case: Patient 20, female, 39yo, symptom onset in adulthood

CasePresentingHPOs: HP:0002460, HP:0003327, HP:0003701, HP:0003458 (distal muscle weakness, axial muscle weakness, proximal muscle weakness, EMG: myopathic abnormalities)

HPOsFreeText: normal CK levels, cores present on muscle biopsy

CaseNotHPOs: HP:0002650 (scoliosis)

NotHPOsFreeText: no respiratory or cardiac involvement

FamilyInfo: no family history

DiseaseEntity: no assertion

InheritancePattern: no assertion

CasePreviousTesting: see below

CaseGenotypingMethod: 9 cases underwent targeted Sanger sequencing of MYH7, 12 cases underwent Motorplex analysis (NGS of 93 myopathy-related genes - PMID:25214167), all MYH7 variants confirmed via Sanger sequencing, segregation analysis performed on available family members, which cases received which sequencing technique is not specified

Variant: NM_000257.3:c.5808G>C

CAID: CA389033338, http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_caid?caid=CA389033338

gnomAD: absent

DiseaseAssertion: None

VariantPreviousTesting: Some combination of ACTC1, ACTN2, CSRP3, LAMP2, MYBPC3, MYH7, NEXN, PLN, TNNC1, TNNI3, TNNT2, TPM1, ABCC9, CTF1, DES, EMD, LDB3, LMNA, MYH6, RBM20, SGCD, TAZ, TCAP, TTN, VCL, CAV3, GLA, MYL2, MYL3, MYOZ2, PRKAG2, TTR, DSC2, DSG2, DSP, JUP, PKP2, RYR2, TMEM43, CASQ2 and RYR2 were tested via NGS.

VariantGenotypingMethod: Next-generation sequencing panels were used to sequence and read the genetic information of probands for variants within exons and in +/- 10 nucleotides within the flanking introns of the genes provided above. These variants were then interpreted and filtered for pathogenicity.

Variant: NM_000257.4(MYH7):c.4399C>G (p.Leu1467Val)

ClinVar: 43015 https://www.ncbi.nlm.nih.gov/clinvar/variation/43015/

gnomAD: 0.001111, http://gnomad.broadinstitute.org/variant/14-23886482-G-C

DiseaseAssertion: None

VariantPreviousTesting: Some combination of ACTC1, ACTN2, CSRP3, LAMP2, MYBPC3, MYH7, NEXN, PLN, TNNC1, TNNI3, TNNT2, TPM1, ABCC9, CTF1, DES, EMD, LDB3, LMNA, MYH6, RBM20, SGCD, TAZ, TCAP, TTN, VCL, CAV3, GLA, MYL2, MYL3, MYOZ2, PRKAG2, TTR, DSC2, DSG2, DSP, JUP, PKP2, RYR2, TMEM43, CASQ2 and RYR2 were tested via NGS.

VariantGenotypingMethod: Next-generation sequencing panels were used to sequence and read the genetic information of probands for variants within exons and in +/- 10 nucleotides within the flanking introns of the genes provided above. These variants were then interpreted and filtered for pathogenicity.

Variant: NM_000257.4(MYH7):c.3803G>A (p.Arg1268His)

ClinVar: 42975 https://www.ncbi.nlm.nih.gov/clinvar/variation/42975/

gnomAD: 0.0009786, http://gnomad.broadinstitute.org/variant/14-23888742-C-T

DiseaseAssertion: None

VariantPreviousTesting: Some combination of ACTC1, ACTN2, CSRP3, LAMP2, MYBPC3, MYH7, NEXN, PLN, TNNC1, TNNI3, TNNT2, TPM1, ABCC9, CTF1, DES, EMD, LDB3, LMNA, MYH6, RBM20, SGCD, TAZ, TCAP, TTN, VCL, CAV3, GLA, MYL2, MYL3, MYOZ2, PRKAG2, TTR, DSC2, DSG2, DSP, JUP, PKP2, RYR2, TMEM43, CASQ2 and RYR2 were tested via NGS.

VariantGenotypingMethod: Next-generation sequencing panels were used to sequence and read the genetic information of probands for variants within exons and in +/- 10 nucleotides within the flanking introns of the genes provided above. These variants were then interpreted and filtered for pathogenicity.

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

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

gnomAD: 0.001416, http://gnomad.broadinstitute.org/variant/14-23892910-A-G

DiseaseAssertion: None

VariantPreviousTesting: Some combination of ACTC1, ACTN2, CSRP3, LAMP2, MYBPC3, MYH7, NEXN, PLN, TNNC1, TNNI3, TNNT2, TPM1, ABCC9, CTF1, DES, EMD, LDB3, LMNA, MYH6, RBM20, SGCD, TAZ, TCAP, TTN, VCL, CAV3, GLA, MYL2, MYL3, MYOZ2, PRKAG2, TTR, DSC2, DSG2, DSP, JUP, PKP2, RYR2, TMEM43, CASQ2 and RYR2 were tested via NGS.

VariantGenotypingMethod: Next-generation sequencing panels were used to sequence and read the genetic information of probands for variants within exons and in +/- 10 nucleotides within the flanking introns of the genes provided above. These variants were then interpreted and filtered for pathogenicity.

Variant: NM_000257.4(MYH7):c.2890G>C (p.Val964Leu)

ClinVar: 42938 https://www.ncbi.nlm.nih.gov/clinvar/variation/42938/

gnomAD: 0.0008437, http://gnomad.broadinstitute.org/variant/14-23893148-C-G

DiseaseAssertion: None

VariantPreviousTesting: Some combination of ACTC1, ACTN2, CSRP3, LAMP2, MYBPC3, MYH7, NEXN, PLN, TNNC1, TNNI3, TNNT2, TPM1, ABCC9, CTF1, DES, EMD, LDB3, LMNA, MYH6, RBM20, SGCD, TAZ, TCAP, TTN, VCL, CAV3, GLA, MYL2, MYL3, MYOZ2, PRKAG2, TTR, DSC2, DSG2, DSP, JUP, PKP2, RYR2, TMEM43, CASQ2 and RYR2 were tested via NGS.

VariantGenotypingMethod: Next-generation sequencing panels were used to sequence and read the genetic information of probands for variants within exons and in +/- 10 nucleotides within the flanking introns of the genes provided above. These variants were then interpreted and filtered for pathogenicity.

Variant: NM_000257.4(MYH7):c.2360G>A (p.Arg787His)

ClinVar: 42900 https://www.ncbi.nlm.nih.gov/clinvar/variation/42900/

gnomAD: 0.001339, http://gnomad.broadinstitute.org/variant/14-23894554-C-T

Case: Patient AUS1-IV:1, 21yo, female, Australia

CasePresentingHPOs: HP:0030917, HP:0008947, HP:0004323, HP:0002091, HP:0002650, HP:0003306, HP:0003701, HP:0003691, HP:0005991, HP:0002058, HP:0000268, HP:0003458 (low APGAR score, early hypotonia, abnormality of habitus, restrictive lung disease, scoliosis, spinal rigidity, proximal muscle weakness, scapular winging, limited neck flexibility, myopathic face, dolichocephaly, Myopathic electromyogram)

HPOsFreeText: born at term, mild meconium aspiration, crawled at 10mo, walked at 18mo, thin body habitus, required nocturnal non-invasive ventilation at 13yo, required posterior spinal fusion at 3rd thoracic vertebra and 5th lumbar vertebra at 15yo, normal cardiac function, normal creatine kinase (at 13yo = 188 IU/l)

Muscle biopsy showed variation in myofiber size with increase in internal nuclei and split myofibers, scattered nuclear bags, scattered subsarcolemmal inclusions up to 4 µm, moth-eaten and lobulated appearance of myofibers, normal phosphorylase, inclusions reactive with slow myosin resembling hyaline bodies and were shown to be composed of fine filamentous material

CaseNotHPOs: HP:0000602, HP:0100295 (ophthalmoplegia, muscle fiber degeneration)

FamilyInfo: Pedigree in Fig. 2, consanguineous (first-cousin) parents, Middle Eastern ancestry, no family history of neurological or cardiac abnormalities, there were 2 miscarriages prior to the proband

CasePreviousTesting:

CaseGenotypingMethod: Individuals IV:1 and IV:3 had NGS of 464 neurogenetic disease genes, Sanger sequencing to confirm recessive inheritance (confirmed heterozygosity in parents)

InheritancePattern: autosomal recessive

DiseaseEntity: n/a

Variant: NM_000257.4(MYH7):c.5134C>T (p.Arg1712Trp), homozygous

ClinVar: 14118, https://www.ncbi.nlm.nih.gov/clinvar/variation/14118/

gnomAD: n/a

Case#: Case III-2, female, 64 yr, early childhood onset

DiseaseAssertion: None

FamilyInfo: Family C, her mother (II-1) and maternal grandmother (I-1) had late-onset leg weakness (Fig. 1C), her brother (III-4) had severe generalized weakness and was diagnosed with an unspecified muscular dystrophy

CasePresentingHPOs: Gait disturbance, lower limb muscle weakness, hypertension, osteoarthritis, hyperlipidemia, glaucoma, neck flexor weakness, weakness of facial musculature, weakness of long finger extensor muscles, foot dorsiflexor weakness (HP:0001288, HP:0007340, HP:0000822, HP:0002758, HP:0003077, HP:0000501, HP:0003722, HP:0030319, HP:0009077, HP:0009027)

CaseHPOFreeText: mild heel cord contractures, mild eye closure weakness, unable to stand on heels, limb weakness

CaseNotHPOs: Scoliosis, scapular winging, generalized muscle hypertrophy (HP:0002650, HP:0003691, HP:0003720)

CaseNotHPOFreeText: hand or foot deformities, normal knee bend and stand on tiptoes, normal reflexes and sensory

CasePreviousTesting: N/A

CaseGenotypingMethod: neurological examination, serum creatine kinase, nerve conduction studies, concentric needle electromyography, electrocardiogram, echocardiogram, forced vital capacity, muscle biopsy, immunohistochemical analyses, CK 156 unit/L (n < 143), FVC 2.13 L (68%), ECG and echo normal, left ventricular ejection fraction 65%, normal NCS except low-amplitude peroneal and tibial compound muscle action potential, abnormal increase of small polyphasic MUAP in tibialis anterior, no fibrillation potentials, no positive sharp waves, no myotonic discharges

Variant: NM_182476.3(COQ6):c.115G>A (p.Val39Met) & NM_000257.4(MYH7):c.4844_4846AGA[2] (p.Lys1617del)

ClinVar: 214236 https://www.ncbi.nlm.nih.gov/clinvar/variation/214236/ & 190401 https://www.ncbi.nlm.nih.gov/clinvar/variation/190401/

CAID: N/A

gnomAD: 0.00006720 African https://gnomad.broadinstitute.org/variant/14-74417150-G-A & absent

Supplemental data table e-1

Case: MYH7 Case 1

InheritancePattern: autosomal recessive

DiseaseEntity: n/a

PreviouslyPublished: PMID: 29300372

PreviousTesting: Not specified

CaseGenotypingMethod: paper notes single gene, NGS, and WES were used, but does not specify which method was used for each individual family

Variant: NM_000257.4(MYH7):c.1358G>A (p.Arg453His)

ClinVar: 42838, https://www.ncbi.nlm.nih.gov/clinvar/variation/42838/

gnomAD: n/a

Supplemental data table e-1

Case: MYH7 Case 2

InheritancePattern: autosomal recessive

DiseaseEntity: n/a

PreviouslyPublished: PMID: 27282841

PreviousTesting: Not specified

CaseGenotypingMethod: paper notes single gene, NGS, and WES were used, but does not specify which method was used for each individual family

Variant: NM_000257.4(MYH7):c.5459G>A (p.Arg1820Gln)

ClinVar: 419278, https://www.ncbi.nlm.nih.gov/clinvar/variation/419278/

gnomAD: 0.00001989, https://gnomad.broadinstitute.org/variant/14-23884304-C-T

Case: Male, 78yo

FamilyInfo: 2 sons, 1 daughter, and 1 nephew also diagnosed with same MYH7 variant and had ICDs implanted

CasePresentingHPOs: HP:0001324, HP:0003388 (muscle weakness, fatigability)

HPOsFreeText: congenital myopathy, normal cardiac assessment

CasePreviousTesting: ACTA1, BIN1, DNM2, MYH7, MTM1, NEB, RYR1, SCN4A, SEPN1, TPM2, TPM3

CaseGenotypingMethod: PCR amplification of exons of genes investigated and Sanger sequencing or NGS

Variant: NM_000257.4(MYH7):c.5177_5179AGA[3] (p.Lys1729del)

ClinVar: 42096, https://www.ncbi.nlm.nih.gov/clinvar/variation/42096/

gnomAD: absent

Case#: p.P1162L, Female, Age 52, African American

Disease Assertion: Normal Variant

Family Info: Two family members tested with normal clinical phenotype

Parental Genotype: Not listed

CasePresentingHPOs:

CaseHPOFreeText: VWF:RCo/VWF:Ag Ratio 0.50, VWF:GPIbM 98

CaseNotHPOs: HP:0040240

(Increased Ratio of VWF Propeptide to VWF antigen)

CaseNotHPOFreeText:bleeding score 2, VWF:Ag 144 IU/dL, VWF:RCo 72 IU/dL, normal multimer distribution

ProteinExpression:

CasePreviousTesting: VWF Sequencing

Gene:VWF

Variant: NM_000552.4(VWF):c.3485C>T (p.Pro1162Leu)

ClinVar: 256669 ClinVarID

CAID: CA6402756

CAID

gnomAD: MAF of 0.2207 (2023/9166 alleles) in the African American population.

gnomAD

Gene:VWF

HGNCID:12726

Case:13 yo female

DiseaseAssertion: Type 2N

FamilyInfo:Fig. 1, family 2, patient 7

ParentalGenotype(s):Unknown, obligate carriers

CasePresentingHPOs:HP:0000421, HP:0004846, HP:0012147 HP:0030132, HP:0030130

CaseHPOFreeRext:Oral cavity and joint bleeding, VWF:Ag 0.07 U/mL, VWF:Ac 0 U/mL, VWF:CB 0.05 U/mL, FVIII 0.04 U/mL, No VWF Multimers

GenotypingMethod: NGS

Gene:VWF

Variant:c.2311A>G

HGVS:NM_000552.5(VWF):c.2311A>G

ClinVarID:1065273

CAID:CA383522481

Case#: 1 female, 12 years old.

DiseaseAssertion: bilateral stage 2B Coats disease. ABCA4 gene mutations were found upon genetic analysis but Stargardt disease was not diagnosed.

FamilyInfo: Single affected individual. Past medical history and family history was reported as normal. No additional information about family is provided in text.

CasePresentingHPOs: HP:0007663 - Reduced visual acuity, HP:0001147 - Retinal exudate, HP:0007763 - Retinal telangiectasia, HP:0025355 - Retinal arteriolar macroaneurysms, HP:0011505- Cystoid macular edema, HP:0020032 - Hyperreflective retinal dots on OCT, HP:0001045 - Vitiligo

CaseHPOFreeText: bilateral significant capillary nonperfusion noted mostly in the temporal retinal periphery together with light-bulb-like capillary dilations and staining of telangiectatic vessels. Mild intravitreal hemorrhage

CaseNotHPOs: HP:0012045 - Retinal flecks, HP:0025010 - Foveal atrophy, HP:0000603 - Central scotoma, HP:0000556 - Retinal dystrophy, HP:0000512 - Abnormal electroretinogram

CaseNotHPOFreeText: Relatively normal foveal architecture.

Genotyping Method: Genetic analysis was performed using Sanger sequencing for the NDP gene, which revealed no pathogenic variants. Exome sequencing was then used with the Illumina HiSeq 2500 platform, which identified two compound heterozygous variants in the ABCA4 gene. Lastly, no mutations were found in the TINF2 gene.

PreviouslyPublished: N/A

Variant: NM_000350.3(ABCA4):c.1373C>T (p.Arg458Cys), NM_000350.3(ABCA4):c.5882G>A (p.Gly1961Glu)

ClinVar: Variation ID: 7888 ( for p.Arg458Cys variant however I believe this is mislabeled for this variant NM_000350.3(ABCA4):c.5882G>A (p.Gly1961Glu), no variantion ID found for NM_000350.3(ABCA4):c.1373C>T (p.Arg458Cys)

CAID: N/A

SupplementalData: N/A