Case#: Patient (case report), male, 1 month old, ethnicity unknown

DiseaseAssertion: Pompe disease

FamilyInfo: No history of consanguinity in parents. The patient has a 15 months old sibling that is healthy.

Family medical history was notable for tuberous sclerosis in the patient’s father’s first cousin.

CasePresentingHPOs: HP:0200128, HP:0001639, HP:0002240

(Biventricular hypertrophy, Hypertrophic cardiomyopathy, Hepatomegaly,

CaseHPOFreeText: Echogenic mass within the left ventricle.

Short-axis images revealed the possibility of an additional mass within the left ventricle adjacent to the papillary muscles

Right axis deviation

CaseNotHPOs: N/A

CaseNotHPOFreeText: N/A

Normal results were noted for levels of plasma amino acids, lactate and pyruvate, total and free carnitine, and acylcarnitine compounds. Urine organic acid quantitation was normal.

PR interval was normal

CasePreviousTesting: The serum creatine kinase was elevated (478 U/L; normal 60–305 U/L).

GAA activity in whole blood from a blood spot was 1.8 pmol/punch/hour (control 10–49 pmol/punch/hour)

The GAA gene was sequenced.

Variant 1: NM_000152.5(GAA):c.525del (p.Glu176fs)

ClinVar: 4033

CAID: CA220406

gnomAD: N/A

Variant 2: NM_000152.5(GAA):c.1927G>A (p.Gly643Arg)

ClinVar: 4023

CAID: CA116596

gnomAD: Highest population MAF=0.00003667 (Euroean (non-Finnish))

ParentalGenotype:N/A

PreviouslyPublished:N/A

Case#: Patient 1, Gender N/A, age N/A, ethnicity unknown

DiseaseAssertion: Pompe disease

FamilyInfo: N/A

CasePresentingHPOs: HP:0001638, HP:0003756

(Cardiomyopathy, Skeletal myopathy)

CaseHPOFreeText: N/A

CaseNotHPOs: N/A

CaseNotHPOFreeText: N/A

CasePreviousTesting: Sequence analysis of the GAA gene was performed in a CLIA and CAP certified laboratory.

Cross Reactive Immune reaction was indeterminate in peripheral blood mononuclear cells (PBMCs)

Cross Reactive Immune reaction was negative in Dried blood spots.

Variant 1: c.437delT (p.Met146ArgfsX7)

ClinVar: N/A

CAID: N/A

gnomAD: N/A

Variant 2: NM_000152.5(GAA):c.2237G>A (p.Trp746Ter)

ClinVar: 280063

CAID: CA8815664

gnomAD: Two variants with same consequence (protein) were identified.

Highest population MAF = 0.00004011 (African)

Highest population MAF = 0.000008834 (European non-Finnish)

ParentalGenotype: N/A

Previously published: N/A

Case#: Patient 3, Gender unknown, age unknown, ethnicity unknown

DiseaseAssertion: Pompe disease

FamilyInfo: N/A

CasePresentingHPOs: HP:0001638, HP:0003756

(Cardiomyopathy, Skeletal myopathy)

CaseHPOFreeText: N/A

CaseNotHPOs: N/A

CaseNotHPOFreeText: N/A

CasePreviousTesting: Sequence analysis of the GAA gene was performed in a CLIA and CAP certified laboratory. Cross Reactive Immune reaction was indeterminate in peripheral blood mononuclear cells (PBMCs)

Cross Reactive Immune reaction was negative in Dried blood spots.

Variant: NM_000152.5(GAA):c.2560C>T (p.Arg854Ter)Cite this record

ClinVar: 4034

CAID: CA340130

gnomAD: Highest population MAF= 0.001891 (African)

ParentalGenotype: N/A

PreviouslyPublished:N/A

Case#: Patient 4, Gender unknown, age unknown, ethnicity unknown

DiseaseAssertion: Pompe disease

FamilyInfo: N/A

CasePresentingHPOs: HP:0001638, HP:0003756

(Cardiomyopathy, Skeletal myopathy)

CaseHPOFreeText: N/A

CaseNotHPOs: N/A

CaseNotHPOFreeText: N/A

CasePreviousTesting: Sequence analysis of the GAA gene was performed in a CLIA and CAP certified laboratory. Cross Reactive Immune reaction was indeterminate in peripheral blood mononuclear cells (PBMCs)

Cross Reactive Immune reaction was not available in Dried blood spots.

Variant: NM_000152.5(GAA):c.2560C>T (p.Arg854Ter)

ClinVar: 4034

CAID:CA340130

gnomAD: Highest population MAF= 0.001891 (African)

ParentalGenotype: N/A

Case#: Patient 6, gender unknown, age unknown, ethnicity unknown

DiseaseAssertion: Pompe disease

FamilyInfo: N/A

CasePresentingHPOs: HP:0001638, HP:0003756

(Cardiomyopathy, Skeletal myopathy)

CaseHPOFreeText:N/A

CaseNotHPOs: N.A

CaseNotHPOFreeText: N/A

CasePreviousTesting: Sequence analysis of the GAA gene was performed in a CLIA and CAP certified laboratory.

Cross Reactive Immune reaction was negative in peripheral blood mononuclear cells (PBMCs)

Cross Reactive Immune reaction was not available in Dried blood spots.

Variant: NM_000152.5(GAA):c.2297A>C (p.Tyr766Ser)

ClinVar: 420102

CAID: CA8815680

gnomAD: Highest population MAF= 0.00005441 (East asian)

ParentalGenotype: N/A

PreviouslyPublished:N/A

Case#: LOPD patient #1, Male, 69, ethnicity unknown.

DiseaseAssertion: Pompe disease

FamilyInfo: N/A

CasePresentingHPOs: HP:0002094, HP:0006554, HP:0012378, HP:0001324 (Dyspnea, Acute respiratory failure, Fatigue, Lower Girdle Muscle Weakness and Upper Girdle Muscle Weakness)

CaseHPOFreeText: Dyspnea was present during exercise, not at rest. Lower Girdle Muscle Weakness and Upper Girdle Muscle Weakness share the same HPO.

CaseNotHPOs:

CaseNotHPOFreeText: Patient has normal creatine phosphokinase levels, No Dyspnea at rest, No Ortopnea, No Airways infections, no myalgia

CasePreviousTesting: GAA gene sequencing to asses genotype.

GAA activity was reduced (0.36 microMol/L/h) in reference to standard (10.1 ± 6.6 microMol/L/h) This was measured by dried blood spot .

GAA muscle activity was 3.6 pmol/min/mg, no reference range was provided

Variant: Variant 1: NM_000152.5:c.-32-13T>G

ClinVar: 4027

CAID: CA116606

gnomAD: MAF= 0.005541 (Ashkenazi Jewish)

Variant 2: NM_000152.5(GAA):c.1564C>G (p.Pro522Ala)

ClinVar:371277

CAID:CA16041893

gnomAD: N/A

ParentalGenotype: N/A

PreviouslyPublished: N/A

Case#: Patient 4, Female, 10 days old at diagnosis, African American

DiseaseAssertion: Pompe disease

FamilyInfo:N/A

CasePresentingHPOs: HP:0009062, HP:0001638

(Infantile axial hypotonia, Cardiomyopathy)

CaseHPOFreeText: Before ERT patient withdraws extremities to stimulation, contractures of large joint of upper and lower extremities, weak grasp. Also patient was invasively ventilated. Baseline – G-tube feeds and continues

Currently patient is off ventilator 10-12 hours a day. Sits with support; and has minimal capacity for weight bearing on lower extremities. G tube feed.

CaseNotHPOs: N/A

CaseNotHPOFreeText: N/A

CasePreviousTesting: No GAA measurement

Variant 1: M_000152.5(GAA):c.525del (p.Glu176fs)

ClinVar: 4033

CAID: CA220406

gnomAD: N/A

Variant 2: NM_000152.5(GAA):c.2560C>T (p.Arg854Ter)

ClinVar: 4034

CAID: CA340130

gnomAD: Highest population MAF= 0.001891 (African)

ParentalGenotype:N/A

PreviouslyPublished:N/A

Case#: Patient 6, Female, 5.5 months old at diagnosis, Asian

DiseaseAssertion: Pompe disease

FamilyInfo: N/A

CasePresentingHPOs: HP:0001252, HP:0001638

(Muscular hypotonia, Cardiomyopathy)

CaseHPOFreeText:

Previous to ERT, patient was invasively ventilated, and had . Also Aspiration and penetration with feeding and started on NG tube feeds at baseline

Current patient has marked axial and peripheral hypotonia, G-tube feeds and requires BiPAP at night. Patient has near-complete lower extremity immobility

CaseNotHPOs: N/A

CaseNotHPOFreeText: Antigravity movement in arms

CasePreviousTesting: N/A

Variant: NM_000152.5(GAA):c.525_526del (p.Asn177fs) Please double check

ClinVar: 189057

CAID: CA274328

gnomAD: N/A

ParentalGenotype: N/A

PreviouslyPublished: N/A

Case#: Patient 2, Male, 2.5 months old at diagnosis, African Canadian

DiseaseAssertion: Pompe disease

FamilyInfo: N/A

CasePresentingHPOs: HP:0001638, HP:0032988

(Cardiomyopathy, Persistent head lag)

CaseHPOFreeText: antigravity movements arms>legs

Previous to ERT NG tube feeding was necessary due to aspiration, after ERT patient uses a GJ tube.

Patient requires oxygen and BiPAP at night.

CaseNotHPOs: N/A

CaseNotHPOFreeText: Patient can bear its weight independently.

CasePreviousTesting: No GAA measurement

Variant: NM_000152.3:c.546+2T>C

ClinVar: N/A Double check

CAID: CA401361919

gnomAD: N/A

ParentalGenotype:N/A

PreviouslyPublished:N/A

Case#: Patient 7, Female, diagnosed at 3 months old (died at 15 months old), African American

DiseaseAssertion: Pompe disease

FamilyInfo: N/A

CasePresentingHPOs: HP:0001638 (Cardiomyopathy)

CaseHPOFreeText: Previous to ERT patient did not required oxygen support. Patient needed Invasive ventilation at week 38 ERT until death 2 months later.

Previous to ERT and during it patient was unable to independently hold head or sit unsupported.

Previous to ERT NG tube feeds at age 3 months due to aspiration. During ERT patient used a GJ tube

CaseNotHPOs: N/A

CaseNotHPOFreeText: N/A

CasePreviousTesting: N/A

Variant: NM_000152.5(GAA):c.2560C>T (p.Arg854Ter)

ClinVar: 4034

CAID: CA340130

gnomAD: Highest population MAF= 0.001891 (African)

ParentalGenotype:N/A

PreviouslyPublished: N/A

Case#: Patient 5, Female, 3.0 months old at diagnosis, African American

DiseaseAssertion: Pompe disease

FamilyInfo: N/A

CasePresentingHPOs: HP:0032988, HP:0001638

(Persistent head lag, Cardiomyopathy)

CaseHPOFreeText:

Previous to ERT patient was invasively ventilated, patient was unable to sit or roll over. NJ feeds started at age 3 months

Currently patient requires Oxygen and BiPAP at night. Stands with support and uses G tube for feeding.

CaseNotHPOs: N/A

CaseNotHPOFreeText: N/A

CasePreviousTesting: No GAA measurement

Variant: NM_000152.5(GAA):c.2560C>T (p.Arg854Ter)

ClinVar: 4034

CAID: CA340130

gnomAD: Highest population MAF= 0.001891 (African)

ParentalGenotype: N/A

PreviouslyPublished: N/A

Case#: Patient 3, Female, 2 months old at diagnosis, Caucasian

DiseaseAssertion: Pompe disease

FamilyInfo: N/A

CasePresentingHPOs: HP:0001252, HP:0001638

(Muscular hypotonia, Cardiomyopathy)

CaseHPOFreeText: floppy baby, no head or neck control

NG tube feeds started at age 1.4 months, currently the patient orally feeds.

Before ERT patient needed oxygen, currently the patient does not need respiratory support.

CaseNotHPOs:

CaseNotHPOFreeText:

Patient ambulates independently

No infusion associated reactions to ERT

CasePreviousTesting: No GAA measurement

Variant: NM_000152.5(GAA):c.236_246del (p.Pro79fs)

ClinVar: 371302

CAID: CA16041880

gnomAD: N/A

ParentalGenotype: N/A

PreviouslyPublished: N/A

Case#: Patient 3, male, 21 year old, ethnicity unknown

DiseaseAssertion: Pompe disease

FamilyInfo: No family history of muscle disease

CasePresentingHPOs: HP:0003236, HP:0100284

(Elevated serum creatine kinase, EMG: myotonic discharges

CaseHPOFreeText: Mild weakness (4/5) of iliopsoas muscles

Myotonic discharges in the lumbar paraspinal muscles

Elevated aspartate aminotransferase of 172 I/U ( Normal range 19–55 I/U)

Elevated alanine aminotransferase of 203 I/U (Normal range 19–72 I/U)

Serum CK was elevated at 1,373 U/L (normal range 70–185 U/L)

CaseNotHPOs:

CaseNotHPOFreeText: Normal alkaline phosphatase and γ-glutamyl transpeptidase levels.

Liver ultrasound and biopsy at an outside facility were normal

CasePreviousTesting: GAA level was 1.4 pmol/punch/h (normal range 10–49 pmol/punch/h)

Variant 1: NM_000152.5(GAA):c.-32-13T>G

ClinVar: 4027

CAID: CA116606

gnomAD: Hughest population MAF= 0.005541 (Ashkenazi Jewish)

Variant 2: NM_000152.5(GAA):c.877G>A (p.Gly293Arg)

ClinVar: 4036

CAID: CA116622

gnomAD: Highest population MAF= 0.00005704 (Latinos)

ParentalGenotype:N/A

PreviouslyPublished:N/A

Case#: Patient 2, Male, 71 year old, ethnicity unknown

DiseaseAssertion: Pompe disease

diagnosed at age 52 with SMA type III following an EMG reporting neurogenic changes and a muscle biopsy from a hamstring muscle that demonstrated denervation atrophy

FamilyInfo: N/A

CasePresentingHPOs: HP:0003701, HP:0003445

(Proximal muscle weakness, EMG:neuropathic changes

CaseHPOFreeText: Normal strength in the upper extremities with moderate weakness of hip flexion at 3/5, hip abduction 3–4/5, hip adduction 3–4/5, and hamstrings 4/5.

EMG showed myotonic discharges in the anterior tibialis, medial gastrocnemius, iliopsoas, tensor fasciae latae, and biceps brachii muscles.

CaseNotHPOs: N/A

CaseNotHPOFreeText: N/A

Staining for PAS and acid phosphatase was normal.

Serum CK was 208 U/L (normal range 70–185)

CasePreviousTesting: GAA activity was 1.3pmol/punch/h (normal 10–49 pmol/punch/h) and he was found to have 2 heterozygous mutations

Variant 1: NM_000152.5(GAA):c.-32-13T>G

ClinVar: 4027

CAID: CA116606

gnomAD: Highest population MAF= 0.005541 (Ashkenazi Jewish)

Variant 2: NM_000152.5(GAA):c.1841C>A (p.Thr614Lys)

ClinVar: 167113

CAID: CA234050

gnomAD: Highest population MAF= 0.00004784 (European nin-Finnish)

ParentalGenotype:N/A

PreviouslyPublished:N/A

Case#: Patient 1, woman, 58 years old, ethnicity unknown

DiseaseAssertion:Pompe disease

Was also misdiagnosed with adult-onset spinal muscular atrophy (SMA)

FamilyInfo: No family history of muscle disease

CasePresentingHPOs: HP:0003701, HP:0100284

(Proximal muscle weakness, EMG myotonic discharges)

CaseHPOFreeText: Denervation atrophy from a muscle biopsy

Weakness of hip flexion 2–3/5, hip abduction 2/5, and hip adduction 2/5

Myotonic discharges were in the lumbar paraspinals, vastus medialis, and tensor fasciae latae muscles.

CaseNotHPOs: N/A

CaseNotHPOFreeText: N/A

CasePreviousTesting: GAA enzyme activity assay was 1 pmol/punch/h (normal range 10–49 pmol/punch/h)

Her creatine kinase (CK) level at presentation had been elevated as high as 429 U/L (normal range 45–145)

Found with two mutations in the GAA gene

Variant: NM_000152.5(GAA):c.-32-13T>G

ClinVar: 4027

CAID: CA116606

gnomAD: Highest population MAF= 0.005541 (Ashkenazi Jewish)

Variant: NM_000152.5(GAA):c.525del (p.Glu176fs) Double check this variant

ClinVar: 4033

CAID: CA220406

gnomAD: N/A

ParentalGenotype:N/A

Previously Published: N/A

Case#: Case 2, male, 50 days old when diagnosed, ethnicity unknown

DiseaseAssertion: Pompe disease

FamilyInfo: N/A

CasePresentingHPOs: HP:0001638, HP:0001252, HP:0000282 (cardiomyopathy, muscular hypotonia, facial edema)

CaseHPOFreeText:(Associated to Pompe disease) increased serum CK.

CaseHPOFreeText: (Infussion associated reactions) Generalized rash, cough and bronchospasm

CaseNotHPOs: N/A

CaseNotHPOFreeText: Infusion associated reactions are not associated with an IgE mediated mechanism.

CasePreviousTesting: See Table 1 for reports on GAA metabolic activity.

GAA activity in dried blood spots is 0 μmol/l/h with a reference range of 1.86–21.9 μmol/l/h

GAA activity on lymphocytes is 0.5 nmol 4 Mu/mg prot/h with a reference range of 21.4 ± 6.2 nmol 4 Mu/mg prot/h

Variant: c1124G>T (p.R375L)

ClinVar: N/A

CAID: N/A

gnomAD: N/A

ParentalGenotype: N/A

PreviouslyPublished: N/A

Case#: Patient, female, 61 years old, ethnicity unknown

DiseaseAssertion: Pompe disease

FamilyInfo: N/A

CasePresentingHPOs: HP:0040213, HP:0010535, HP:0003326, HP:0002273, HP:0002877 (Hypopnea, Sleep Apnea, Myalgia, Tetraparesis, Nocturnal hypoventilation)

CaseHPOFreeText: Sleep Apnea-Hypopnea Syndrome (SAHS), predominantly proximal tetraparesis

CaseNotHPOs: N/A

CaseNotHPOFreeText: Serum measurements were normal, includind Creatine Phosphokinase levels (CPK)

CasePreviousTesting: GAA enzyme level 0.72 µkat/kg was significantly reduced in lymphocytes with a reference range of 4.8–13.3 µkat/kg protein. This test was done with maltase-glucoamylase inhibitor acarbose

All exons and flanking introns were bidirectionally sequenced after PCR amplification. "sequence-analysis of GAA transcripts"

Variant: c.1194+5G>A

ClinVar:

CAID:CA658795243

gnomAD:

ParentalGenotype:

PreviouslyPublished: N/A

Case#: Case 1, Boy, Death at 6-7 months old, Hispanic

DiseaseAssertion: Pompe disease

FamilyInfo: N/A

CasePresentingHPOs: HP:0002240, HP:0001640, 0000961, HP:0002090, HP:0001270, HP:0031664, HP:0200128, HP:0001252

(Hepatomegaly, Cardiomegaly, Cyanosis, Pneumonia, Motor delay, Systolic heart murmur, Biventricular hypertrophy, Muscular Hypotonia)

CaseHPOFreeText: Heart failure, Systolic murmur grade II-III, Enlarged, EKG showed an inverted T wave from V4-V6 as well as AVF, suggesting left systolic overload.

CaseNotHPOs:

CaseNotHPOFreeText:

CasePreviousTesting: Ejection fraction of 52%

Serum creatine kinase was 386 IU/L (mildly elevated)

GAA activity on dried blood spot was decreased (1.08 nmol/L; normal range: 1.5-10 nmol/L)

Whole exon and exon-intron boundaries direct sequencing revealed a homozygous single base deletion c.1987delC

Variant: c.1987delC

ClinVar: N/A

CAID: N/A

gnomAD: N/A

ParentalGenotype: N/A

PreviouslyPublished: N/A