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Comprehensive Growth Disorders / Skeletal Dysplasias and Disorders Panel

Test code: MA4301

Is a 374 panel that includes assessment of non-coding variants.

This panel covers the majority of the listed in the Nosology 2015 (PMID: 26394607) and all genes in our Malformation category that cause growth retardation, or skeletal dysplasia and is therefore a powerful diagnostic tool. It is ideal for patients suspected to have a syndromic or an isolated growth disorder or a skeletal dysplasia.

About Comprehensive Growth Disorders / Skeletal Dysplasias and Disorders

This panel covers a broad spectrum of associated with growth retardation, short stature or skeletal dysplasia. Many of these conditions have overlapping features which can make clinical diagnosis a challenge. Genetic diagnostics is therefore the most efficient way to subtype the diseases and enable individualized treatment and management decisions. Moreover, detection of causative establishes the mode of inheritance in the family which is essential for informed . For additional information regarding the conditions tested on this panel, please refer to the National Organization for Rare Disorders and / or GeneReviews.

Availability

4 weeks

Gene Set Description

Genes in the Comprehensive Growth Disorders / Skeletal Dysplasias and Disorders Panel and their clinical significance Gene Associated Inheritance ClinVar HGMD

ACAN# Spondyloepimetaphyseal dysplasia, aggrecan type, AD/AR 20 56 Spondyloepiphyseal dysplasia, Kimberley type, Osteochondritis dissecans, short stature, and early-onset osteoarthritis

ACP5 Spondyloenchondrodysplasia with immune dysregulation AR 12 26

ACTB* Baraitser-Winter syndrome AD 55 60

ACTG1* Deafness, Baraitser-Winter syndrome AD 27 47

ACVR1 Fibrodysplasia ossificans progressiva AD 14 19

ADAMTS10 Weill-Marchesani syndrome AR 8 14

ADAMTS17 Weill-Marchesani-like syndrome AR 6 7

ADAMTSL2*,# Geleophysic dysplasia 3 AR 8 28

AGPS Rhizomelic chondrodysplasia punctata type 3 AR 4 8

AIFM1 Deafness, Combined oxidative phosphorylation deficiency XL 27 31 6, Cowchock syndrome

AKT1 , AD 5 6

https://blueprintgenetics.com/ ALPL Odontohypophosphatasia, Hypophosphatasia perinatal AD/AR 78 291 lethal, infantile, juvenile and adult forms

ALX3 Frontonasal dysplasia type 1 AR 8 8

ALX4 Frontonasal dysplasia type 2, Parietal foramina AD/AR 15 24

AMER1 Osteopathia striata with cranial sclerosis XL 14 40

AMMECR1 Midface hypoplasia, hearing impairment, elliptocytosis, XL 4 5 and nephrocalcinosis

ANKH Calcium pyrophosphate deposition (familial AD 13 20 chondrocalcinosis type 2), Craniometaphyseal dysplasia autosomal dominant type

ANKRD11* KBG syndrome AD 142 132

ANO5 Gnathodiaphyseal dysplasia, LGMD2L and distal MMD3 AD/AR 64 121 muscular dystrophies

ARCN1 Rhizomelic short stature with , micrognathia, AD 3 3 and developmental delay (SRMMD)

ARHGAP31 Adams-Oliver syndrome AD 3 6

ARID1A Coffin-Siris syndrome, Mental retardation AD 27 35

ARID1B Coffin-Siris syndrome, Mental retardation AD 153 185

ARSB Mucopolysaccharidosis (Maroteaux-Lamy) AR 118 201

ARSE* Chondrodysplasia punctata X-linked recessive, XL 22 46 brachytelephalangic type (CDPX1)

ATP6V0A2 Cutis laxa, Wrinkly skin syndrome AR 16 56

ATR Cutaneous telangiectasia and , Seckel AD/AR 10 33 syndrome

B3GALT6 Spondyloepimetaphyseal dysplasia with joint laxity, AR 17 27 Ehlers-Danlos syndrome

B3GAT3* Multiple joint dislocations, short stature, craniofacial AR 6 13 dysmorphism, and congenital heart defects

B4GALT7 Ehlers-Danlos syndrome, progeroid form AR 8 9

BCS1L Bjornstad syndrome, GRACILE syndrome, Leigh AR 42 37 syndrome, Mitochondrial complex III deficiency, nuclear type 1

BGN Spondyloepimetaphyseal dysplasia, X-linked, Meester- XL 8 7 Loeys syndrome

BHLHA9 Malik-Percin type, mesoaxial synostotic, with AR 4 43 phalangeal reduction, Split hand-foot malformation with long deficiency (SHFLD3), Gollop-Wolfgang

BMP1 AR 7 21

https://blueprintgenetics.com/ BMP2 type A2 AD 5 28

BMPER Diaphanospondylodysostosis AR 6 19

BMPR1B Acromesomelic dysplasia, Demirhan, Brachydactyly AD/AR 12 23 C/Symphalangism-like pheno, Brachydactyly type A2, Pulmonary arterial hypertension (PAH)

BRAF* LEOPARD syndrome, , AD 134 65 Cardiofaciocutaneous syndrome

BRCA2 , Medulloblastoma, Glioma susceptibility, AD/AR 3369 2659 Pancreatic cancer, Wilms tumor, -ovarian cancer, familial

BRIP1 Fanconi anemia, AD/AR 238 189

CA2 , with renal tubular acidosis AR 9 31

CANT1 Desbuquois dysplasia AR 20 28

CASR Hypocalcemia, Neonatal hyperparathyroidism, Familial AD/AR 104 396 Hypocalciuric hypercalcemia with transient Neonatal hyperparathyroidism

CBL Noonan syndrome-like disorder with or without juvenile AD 24 43 myelomonocytic leukemia

CCDC47 Microcephaly, Malformations AR 1

CCDC8 Three M syndrome 3 AR 2 3

CDC42 Takenouchi-Kosaki syndrome, Noonan-syndrome like AD 11 9

CDC45 Meier-Gorlin syndrome 7 AR 10 19

CDC6 Meier-Gorlin syndrome (Ear-patella-short stature AR 2 2 syndrome)

CDH11 AR 3 8

CDKN1C Beckwith-Wiedemann syndrome, IMAGE syndrome AD 35 81

CDT1 Meier-Gorlin syndrome (Ear-patella-short stature AR 6 12 syndrome)

CENPJ , Microcephaly AR 34 9

CEP152# Seckel syndrome, Microcephaly AR 20 20

CEP63 Seckel syndrome AR 7 2

CHST14 Ehlers-Danlos syndrome, musculocontractural AR 15 21

CHST3 Spondyloepiphyseal dysplasia with congenital joint AR 18 37 dislocations (recessive )

CHSY1 Temtamy preaxial brachydactyly syndrome AR 6 16

CKAP2L Filippi syndrome AR 7 7

https://blueprintgenetics.com/ CLCN5 Proteinuria, low molecular weight, with hypercalciuric XL 48 272 nephrocalcinosis, Hypophosphatemic rickets,, Nephrolithiasis, I, Dent disease

CLCN7 Osteopetrosis AD/AR 15 98

COL10A1 Metaphyseal chondrodysplasia, Schmid AD 21 53

COL11A1 , , Stickler AD/AR 34 94 syndrome type 2

COL11A2 Weissenbacher-Zweymuller syndrome, Deafness, AD/AR 29 57 Otospondylomegaepiphyseal dysplasia, Fibrochondrogenesis, type 3 (non- ocular)

COL1A1 Ehlers-Danlos syndrome, Caffey disease, Osteogenesis AD 352 962 imperfecta type 1, Osteogenesis imperfecta type 2, Osteogenesis imperfecta type 3, Osteogenesis imperfecta type 4

COL1A2 Ehlers-Danlos syndrome, cardiac valvular form, AD/AR 186 509 Osteogenesis imperfecta type 1, Osteogenesis imperfecta type 2, Osteogenesis imperfecta type 3, Osteogenesis imperfecta type 4

COL27A1 Steel syndrome AR 7 7

COL2A1 Avascular necrosis of femoral head, Rhegmatogenous AD 180 561 retinal detachment, Epiphyseal dysplasia, with and deafness, Czech dysplasia, type 2, Platyspondylic dysplasia Torrance type, , Spondyloepiphyseal dysplasia congenital (SEDC), Spondyloepimetaphyseal dysplasia (SEMD) Strudwick type, , Spondyloperipheral dysplasia, Mild SED with premature onset arthrosis, SED with metatarsal shortening, Stickler syndrome type 1

COL3A1 Ehlers-Danlos syndrome AD 520 631

COL5A1 Ehlers-Danlos syndrome AD 101 154

COL5A2 Ehlers-Danlos syndrome AD 24 35

COL9A1 Stickler syndrome recessive type, Multiple epiphyseal AD/AR 9 6 dysplasia type 6 (EDM6)

COL9A2 Stickler syndrome, Multiple epiphyseal dysplasia type 2 AD/AR 7 12 (EDM2)

COL9A3 Multiple epihyseal dysplasia type 3 (EDM3), Stickler AD/AR 10 14 syndrome recessive type

COMP , Multiple ephiphyseal dysplasia AD 43 186

CREB3L1 Osteogenesis imperfecta, type XVI AR 2 3

CREBBP Rubinstein-Taybi syndrome AD 175 362

CRLF1 Crisponi syndrome, Cold-induced sweating syndrome, AR 21 37 type 1

https://blueprintgenetics.com/ CRTAP Osteogenesis imperfecta type 2, Osteogenesis imperfecta AR 12 30 type 3, Osteogenesis imperfecta type 4

CSPP1 Jeune asphyxiating thoracic dystrophy, AR 32 27

CTSK Pycnodysostosis AR 35 58

CUL7 3-M syndrome, Yakut short stature syndrome AR 26 83

CYP27B1 Vitamin D-dependent rickets AR 23 73

DDR2 Spondylometaepiphyseal dysplasia, short limb-hand type AR 11 9

DHCR24 Desmosterolosis AR 6 9

DHCR7 Smith-Lemli-Opitz syndrome AR 88 217

DHODH Postaxial acrofacial dysostosis (Miller syndrome) AR 8 20

DLL3 Spondylocostal dysostosis AR 12 26

DLL4 Adams-Oliver syndrome AD 13 14

DLX3 Amelogenesis imperfecta, Trichodontoosseous syndrome AD 5 11

DLX5 Split-hand/foot malformation with sensorineural hearing AR 3 9 loss

DMP1 Hypophosphatemic rickets AR 5 10

DOCK6 Adams-Oliver syndrome AR 21 21

DONSON Microcephaly, short stature, and limb abnormalities 10 19 (MISSLA), Microcephaly-Micromelia syndrome

DVL1 AD 17 19

DYM Dyggve-Melchior-Clausen dysplasia, Smith-McCort AR 22 34 dysplasia

DYNC2H1 Short - thoracic dysplasia with or without AR/Digenic 148 205 type 1, Short -rib thoracic dysplasia with or without polydactyly type 3, Asphyxiating thoracic dysplasia (ATD; Jeune), SRPS type 2 (Majewski)

EBP Chondrodysplasia punctata, Male EBP disorder with XL 43 90 neurologic defects (MEND)

EFNB1 Craniofrontonasal dysplasia XL 28 116

EFTUD2 Mandibulofacial dysostosis with microcephaly, Esophageal AD 45 99 atresia, syndromic

EIF2AK3 SED, Wolcott-Rallison type AR 9 80

ENAM Amelogenesis imperfecta AD/AR 8 18

ENPP1 Arterial calcification, Hypophosphatemic rickets AD/AR 22 72

EOGT Adams-Oliver syndrome AR 8 5

https://blueprintgenetics.com/ EP300 Rubinstein-Taybi syndrome AD 63 101

ERCC4 Fanconi anemia, , XFE progeroid AR 13 70 syndrome

ESCO2 SC syndrome, Roberts syndrome AR 30 31

EVC Weyers acrofacial dysostosis, Ellis-van Creveld syndrome AD/AR 58 83

EVC2 Ellis-van Creveld syndrome, Weyers acrodental dysostosis AD/AR 78 75

EXT1 Multiple cartilagenious exostoses 1 AD 97 523

EXT2 Multiple cartilagenious exostoses 2 AD 45 250

EXTL3 Immunoskeletal dysplasia with neurodevelopmental AR 4 8 abnormalities (ISDNA)

EZH2 AD 29 41

FAM111A Kenny-Caffey syndrome, type 2 AD 5 9

FAM20A Amelogenesis imperfecta (Enamel-renal syndrome) AR 19 41

FAM20C Hypophosphatemia, hyperphosphaturia, dental anomalies, AR 13 25 intracerebral calcifications and ()

FAM46A Osteogenesis imperfecta AR 3 3

FAM58A Toe syndactyly, telecanthus, and anogenital and renal XL 8 11 malformations (STAR syndrome)

FAM83H Amelogenesis imperfecta AD 14 32

FANCA Fanconi anemia AR 191 677

FANCB Fanconi anemia XL 11 21

FANCC Fanconi anemia AR 94 64

FANCD2* Fanconi anemia AR 21 61

FANCE Fanconi anemia AR 4 17

FANCF Fanconia anemia AR 7 16

FANCG Fanconi anemia AR 16 92

FANCI Fanconi anemia AR 13 45

FANCL Fanconi anemia AR 13 24

FANCM Fanconi anemia AR 6 50

FBN1 MASS syndrome, , , AD 1465 2679 Geleophysic dysplasia 3

FBN2 Congenital contractural (Beals syndrome) AD 50 97

FGD1 Aarskog-Scott syndrome, Mental retardation, syndromic XL 29 51

https://blueprintgenetics.com/ FGF10 Aplasia of lacrimal and salivary glands AD 15 13

FGF23 Tumoral calcinosis, hyperphosphatemic, AD/AR 10 17 Hypophosphatemic rickets

FGFR1 , , Hypogonadotropic AD/Digenic/Multigenic 72 257 , Osteoglophonic - Craniostenosis, Hartsfield syndrome

FGFR2 , Pfeiffer syndrome, Jackson-Weiss AD 100 154 syndrome, Lacrimoauriculodentodigital syndrome, Beare- Stevenson cutis gyrata syndrome, Antley-Bixler syndrome without genital anomalies or disordered steroidogenesis, Craniofacial-skeletal-dermatological dysplasia, , Bent bone dysplasia

FGFR3 Lacrimoauriculodentodigital syndrome, Muenke AD/AR 54 77 syndrome, Crouzon syndrome with acanthosis nigricans, , tall stature, and hearing loss (CATSHL) syndrome, , , type 1, Thanatophoric dysplasia type 2, SADDAN

FKBP10 Bruck syndrome 1, Osteogenesis imperfecta, type XI AR 20 44

FLNA Frontometaphyseal dysplasia, Osteodysplasty Melnick- XL 133 257 Needles, Otopalatodigital syndrome type 1, Otopalatodigital syndrome type 2, Terminal osseous dysplasia with pigmentary defects

FLNB Larsen syndrome (dominant), Atelosteogenesis type 1, AD/AR 43 121 Atelosteogenesis type 3, Spondylo-carpal-tarsal dyspasia

FN1 Glomerulopathy with fibronectin deposits 2 AD 14 25

GALNT3 Tumoral calcinosis, hyperphosphatemic AR 17 35

GDF5 Multiple synostoses syndrome, Fibular hypoplasia and AD/AR 23 53 complex brachydactyly, Acromesomelic dysplasia, Hunter- Thompson, Symphalangism, proximal, Chondrodysplasia, Brachydactyly type A2, Brachydactyly type C, Grebe dysplasia

GH1* Isolated growth deficiency, Kowarski syndrome AD/AR 25 90

GHR insensitivity syndrome () AD/AR 35 115

GHRHR Isolated growth hormone deficiency AR 13 51

GHSR Short stature AD/AR 2 12

GJA1* Oculodentodigital dysplasia mild type, Oculodentodigital AD/AR 31 107 dysplasia severe type, Syndactyly type 3

GLI2 Culler-Jones syndrome AD 29 82

GLI3 , Pallister-Hall syndrome, Grieg AD 70 235 cephalopolysndactyly syndrome, Postaxial polydactyly type A, Preaxial polydactyly type 3, Preaxial polydactyly type 4

https://blueprintgenetics.com/ GNAS McCune-Albright syndrome, Progressive osseous AD 64 274 heteroplasia, , Albright hereditary

GNPAT Rhizomelic chondrodysplasia punctata, rhizomelic AR 8 14

GPC6 Omodysplasia 1 AR 13 9

HDAC8 Cornelia de Lange syndrome XL 41 50

HESX1 Septooptic dysplasia, Pituitary hormone deficiency, AR/AD 15 26 combined

HOXA13 Hand-foot- syndrome, Hand-foot-genital syndrome, AD 8 27 Guttmacher syndrome

HOXD13 Brachydactyly-syndactyly syndrome, Synopolydactyly, AD/AR 18 41 Syndactyly, Synopolydactyly with clefting,

HRAS , Congenital myopathy with excess of AD 43 31 muscle spindles

HSPG2 Schwartz-Jampel syndrome, Dyssegmental dysplasia AD/AR 16 60 Silverman-Handmaker type, Dyssegmental dysplasia Rolland-Desbuquis type

IDS* Mucopolysaccharidosis XL 85 637

IDUA Mucopolysaccharidosis AR 105 282

IFITM5 Osteogenesis imperfecta type 5 AD 2 2

IFT122* Sensenbrenner syndrome, Cranioectodermal dysplasia AR 13 23 (Levin-Sensenbrenner) type 1, Cranioectodermal dysplasia (Levin-Sensenbrenner) type 2

IFT140 Short -rib thoracic dysplasia with or without polydactyly, AR 38 63 Asphyxiating thoracic dysplasia (ATD; Jeune)

IFT172 , Short -rib thoracic dysplasia with or AR 22 25 without polydactyly, Asphyxiating thoracic dysplasia (ATD; Jeune)

IFT43 Cranioectodermal dysplasia 3 AR 4 7

IFT52 Short-rib thoracic dysplasia 16 with or without polydactyly AR 3 4

IFT80 Short -rib thoracic dysplasia with or without polydactyly, AR 11 11 Asphyxiating thoracic dysplasia (ATD; Jeune)

IGF1 Insulin-like growth factor I deficiency AD/AR 4 8

IGF1R Insulin-like growth factor I, resistance AD/AR 12 64

IGFALS Insulin-like growth factor-binding , acid-labile AR 5 34 subunit, deficiency

IHH Acrocapitofemoral dysplasia, Brachydactyly, Syndactyly AD/AR 12 32 type Lueken

IMPAD1 Chondrodysplasia with joint dislocations, GPAPP type AR 5 5

https://blueprintgenetics.com/ INPPL1 AR 16 32

INSR Hyperinsulinemic , familial, Rabson- AD/AR 44 190 Mendenhall syndrome, Donohoe syndrome

IRS1 mellitus, noninsulin-dependent AD/AR 3 17

KAT6B Ohdo syndrome, SBBYS variant, Genitopatellar syndrome AD 47 73

KIF22 Spondyloepimetaphyseal dysplasia with joint laxity, type 2 AD 4 4

KIF7 Acrocallosal syndrome, , Al- AR/Digenic 24 44 Gazali-Bakalinova syndrome, Joubert syndrome

KMT2A Wiedemann-Steiner syndrome AD 117 114

KRAS* Noonan syndrome, Cardiofaciocutaneous syndrome AD 63 35

KYNU Hydroxykynureninuria, Vertebral, cardiac, renal, and limb AR 4 7 defects syndrome 2

LARP7 Alazami syndrome AR 19 10

LBR Pelger-Huet anomaly, Reynolds syndrome, AD/AR 22 24 Greenberg/HEM skeletal dysplasia, Hydrops-ectopic calcification-moth-eaten skeletal dysplasia

LEMD3 Buschke-Ollendorff syndrome, AD 13 32

LFNG Spondylocostal dysostosis, autosomal recessive 3 AR 1 5

LHX3 Pituitary hormone deficiency, combined AR 9 16

LHX4 Pituitary hormone deficiency, combined AD 10 23

LIFR Stuve-Wiedemann dysplasia, Schwartz-Jampel type 2 AR 12 32 syndrome

LMNA Heart-hand syndrome, Slovenian, Limb-girdle muscular AD/AR 250 564 dystrophy, Muscular dystrophy, congenital, LMNA- related, Lipodystrophy (Dunnigan), Emery-Dreiffus muscular dystrophy, Malouf syndrome, (DCM), type A, Hutchinson-Gilford type

LMX1B -patella syndrome AD 26 194

LONP1 Cerebral, Ocular, Dental, Auricular, and Skeletal AR 9 18 anomalies (CODAS) syndrome

LRP4 Cenani-Lenz syndactyly syndrome, Sclerosteosis, AD/AR 14 28 Myasthenic syndrome, congenital

LRP5* Van Buchem disease, Osteoporosis-pseudoglioma AD/AR/Digenic 57 196 syndrome, Hyperostosis, endosteal, Osteosclerosis, Exudative vitreoretinopathy, Osteopetrosis late-onset form type 1, LRP5 primary osteoporosis

LTBP2 Weill-Marchesani syndrome, Microspherophakia and/or AR 21 27 megalocornea, with and with or without secondary glaucoma, Glaucoma, primary congenital

https://blueprintgenetics.com/ LTBP3 Dental anomalies and short stature, Geleophysic dysplasia AD/AR 15 11 3

LZTR1 Schwannomatosis, Noonan syndrome AD/AR 34 71

MAFB Multicentric carpotarsal osteolysis AD 13 23

MAP2K1 Cardiofaciocutaneous syndrome AD 45 23

MAP2K2 Cardiofaciocutaneous syndrome AD 21 35

MAP3K7 Frontometaphyseal dysplasia 2 AD 12 12

MATN3 Spondyloepimetaphyseal dysplasia Matrilin type, Multiple AD/AR 8 25 epiphyseal dysplasia type 5 (EDM5)

MBTPS2 follicularis spinulosa decalvans, IFAP syndrome, XL 12 25 Palmoplantar , mutilating, with periorificial keratotic plaques

MESP2 Spondylocostal dysostosis 2, autosomal recessive AR 18 6

MGP AR 5 8

MMP13 Metaphyseal anadysplasia 1, , Spahr AD/AR 7 7 type, Spondyloepimetaphyseal dysplasia, Missouri type

MMP2 Torg-Winchester syndrome, Multicentric osteolysis, AR 8 22 nodulosis, and arthropathy

MMP9 Metaphyseal anadysplasia AR 1 7

MSX2* Parietal foramina, Parietal foramina with cleidocranial AD 9 25 dysplasia, Boston type

MYCN AD 27 41

MYO18B Klippel-Feil syndrome 4, autosomal recessive, with AR 2 4 myopathy and facial dysmorphism

NANS Spondyloepimetaphyseal dysplasiam Genevieve type AR 8 12

NEK1 Short -rib thoracic dysplasia with or without polydactyly, AR/Digenic 22 23 SRPS type 2 (Majewski)

NF1* , , Neurofibromatosis- AD 1157 2901 Noonan syndrome

NFIX Marshall-Smithsyndrome AD 49 78

NIPBL Cornelia de Lange syndrome AD 311 425

NKX3-2 Spondylo-megaepiphyseal-metaphyseal dysplasia AR 4 4

NOG Tarsal-carpal coalition syndrome, Multiple synostosis AD 20 63 syndrome, Stapes ankylosis with broad and toes (Teunissen-Cremers syndrome), Symphalangism, proximal, Brachydactyly type B2

NOTCH1 Aortic valve disease, Adams-Oliver syndrome AD 56 96

https://blueprintgenetics.com/ NOTCH2* , Hajdu-Cheney syndrome AD 37 70

NPR2 Acromesomelic dysplasia type Maroteaux, Epiphyseal AD/AR 32 75 chondrodysplasia, Miura, Short stature with nonspecific skeletal abnormalities

NRAS Noonan syndrome AD 31 14

NSD1 , Weaver syndrome, Beckwith-Wiedemann AD 329 517 syndrome

NSDHL Congenital hemidysplasia with ichthyosiform XL 15 28 erythroderma and limb defects (CHILD syndrome), CK syndrome

OBSL1 3-M syndrome AR 13 33

ORC1 Meier-Gorlin syndrome (Ear-patella-short stature AR 9 10 syndrome)

ORC4 Meier-Gorlin syndrome (Ear-patella-short stature AR 24 6 syndrome)

ORC6 Meier-Gorlin syndrome (Ear-patella-short stature AR 7 6 syndrome)

OSGEP Galloway-Mowat syndrome AR 11 17

OSTM1 Osteopetrosis, autosomal recessive 5 AR 5 9

OTX2 Microphthalmia, syndromic, Pituitary hormone deficiency, AD 23 73 combined, Retinal dystrophy, early-onset, and pituitary dysfunction

P3H1 Osteogenesis imperfecta AR 18 63

PALB2 Fanconi anemia, Pancreatic cancer, Breast cancer AD/AR 495 406

PAPSS2 Brachyolmia 4 with mild epiphyseal and metaphyseal AR 13 20 changes, SEMD PAPPS2 type

PCNT Microcephalic osteodysplastic AR 49 88

PCYT1A Spondylometaphyseal dysplasia with cone-rod dystrophy AR 12 20

PDE3A Hypertension with brachydactyly AD 7 10

PDE4D Acrodysostosis 2, with or without hormone resistance AD 15 38

PEX14 biogenesis factor disorder 14, Zellweger AR 5 4 syndrome

PEX19 Peroxisome biogenesis disorder, 19, AR 3 4

PEX7 , Rhizomelic CDP type 1 AR 44 53

PGM3 Immunodeficiency 23 AR 14 15

PHEX Hypophosphatemic rickets XL 263 437

PIK3CA* Cowden syndrome, CLOVES AD 85 56

https://blueprintgenetics.com/ PISD AR

PITX1 , congenital, with or without deficiency of long AD 3 16 and/or mirror-image polydactyly, Liebenberg syndrome

PITX2 Axenfeld-Rieger syndrome, Ring dermoid of cornea, AD 23 101 Iridogoniodysgenesis, Peters anomaly

PLOD2 Bruck syndrome, Osteogenesis imperfecta type 3 AR 8 23

PLS3 Osteoporosis and osteoporotic fractures XL 1 17

POC1A Short stature, onychodysplasia, facial dysmorphism, and AR 4 8 hypotrichosis (SOFT syndrome)

POLA1 Pigmentary disorder, reticulate, with systemic 2 1 manifestations, X-linked

POLR1C Treacher Collins syndrome AR 17 21

POLR1D Treacher Collins syndrome AD/AR 9 26

POP1 Anauxetic dysplasia 2 AR 5 6

POR Disordered steroidogenesis due to cytochrome p450 AR 14 70 oxidoreductase deficiency, Antley-Bixler syndrome

POU1F1 Pituitary hormone deficiency, combined AR 20 41

PPIB Osteogenesis imperfecta type 2, Osteogenesis imperfecta AR 8 13 type 3, Osteogenesis imperfecta type 4

PPP3CA Epilepitic encephalopathy AD 8 11

PRKAR1A , intracardiac, Acrodysostosis, Pigmented nodular AD 75 183 adrenocortical disease,

PRMT7 Short stature, brachydactyly, intellectual developmental AR 10 11 disability, and (SBIDDS)

PROP1 Pituitary hormone deficiency, combined AR 33 37

PTDSS1 Lenz-Majewski hyperostotic dwarfism AD 5 7

PTH1R Metaphyseal chondrodysplasia Jansen type, Failure of AD/AR 13 43 tooth eruption, Eiken dysplasia, Blomstrand dysplasia

PTHLH Brachydactyly, type E2 AD 5 18

PTPN11 Noonan syndrome, AD 135 140

PUF60 Short stature, Microcephaly AD 24 30

PYCR1 Cutis laxa AR type 2B AR 19 38

RAB33B Dyggve-Melchior-Clausen syndrome, Smith-McCort AR 6 7 dysplasia 2

RAD21* Cornelia de Lange syndrome 4 AD 14 11

https://blueprintgenetics.com/ RAD51C Fanconi anemia, Breast-ovarian cancer, familial AD/AR 107 125

RAF1 LEOPARD syndrome, Noonan syndrome, Dilated AD 45 53 cardiomyopathy (DCM)

RALA AD 1

RASA2# Noonan syndrome AD 1 3

RBBP8 Seckel syndrome, Jawad syndrome AR 6 6

RBM8A*,# Thrombocytopenia - absent radius AD/AR 5 12

RBPJ* Adams-Oliver syndrome AD 7 6

RECQL4 Baller-Gerold syndrome, RAPADILINO syndrome, AR 82 114 Rothmund-Thomson syndrome

RIT1 Noonan syndrome AD 23 26

RMRP Cartilage-hair hypoplasia, Metaphyseal dysplasia without AR 87 123 hypotrichosis, Anauxetic dysplasia

RNU4ATAC Roifman syndrome, Microcephalic osteodysplastic AR 15 24 primordial dwarfism type 1, Microcephalic osteodysplastic primordial dwarfism type 3

ROR2 Robinow syndrome recessive type, Brachydactyly type B AD/AR 21 40

RRAS Noonan-syndrome like phenotype AD/AR 2

RSPRY1 Spondyloepimetaphyseal dysplasia, Faden-Alkuraya type AR 2 2

RTTN Microcephaly, short stature, and polymicrogyria with or AR 16 16 without seizures

RUNX2 Cleidocranial dysplasia, Metaphyseal dysplasia with AD 21 216

SALL1* Townes-Brocks syndrome 1 AD 31 87

SALL4 Acro-renal-ocular syndrome, Duane-radial ray/Okohiro AD 21 56 syndrome

SBDS* Aplastic anemia, Shwachman-Diamond syndrome, Severe AR 19 90 spondylometaphyseal dysplasia

SEC24D Cole- 2 AR 4 12

SERPINF1 Osteogenesis imperfecta, type VI AR 9 41

SERPINH1 Osteogenesis imperfecta type 3 AR 3 6

SETBP1 Mental retardation, autosomal dominant 29, Schinzel- AD 23 46 Giedion midface retraction syndrome

SF3B4 Acrofacial dysostosis 1, Nager AD 27 38

SGMS2 Osteoporosis and osteoporotic fractures, Skeletal AD dysplasia and disorders

https://blueprintgenetics.com/ SH3BP2 AD 9 16

SH3PXD2B Frank-ter Haar syndrome AR 8 20

SHOC2 Noonan-like syndrome with loose anagen hair AD 2 4

SHOX* Leri-Weill dyschondrosteosis, Langer mesomelic dysplasia, XL/PAR 25 431 Short stature

SKI Shprintzen-Goldberg syndrome AD 20 23

SLC26A2 , Atelosteogenesis type 2, De la AR 73 54 Chapelle dysplasia, Recessive Multiple Epiphyseal dysplasia,

SLC29A3 Histiocytosis-lymphadenopathy plus syndrome, AR 17 25 Dysosteosclerosis

SLC34A3 Hypophosphatemic rickets with hypercalciuria AR 22 38

SLC35D1 Schneckenbecken dysplasia AR 7 7

SLC39A13 Spondylodysplastic Ehlers-Danlos syndrome AR 2 9

SLCO2A1 Hypertrophic osteoarthropathy AD/AR 13 72

SLX4 Fanconi anemia AR 18 72

SMAD3 Aneurysms-osteoarthritis syndrome, Loeys-Dietz AD 48 82 syndrome

SMAD4 Juvenile polyposis/hereditary hemorrhagic telangiectasia AD 179 143 syndrome, Polyposis, juvenile intestinal, Myhre dysplasia, Hereditary hemorrhagic telangiectasia

SMARCA2 Nicolaides-Baraitser syndrome AD 41 73

SMARCAL1 Schimke immunoosseous dysplasia AR 20 88

SMARCE1 Coffin-Siris syndrome AD 14 12

SMC1A Cornelia de Lange syndrome XL 73 87

SMC3 Cornelia de Lange syndrome AD 25 21

SNX10 Osteopetrosis, autosomal recessive 8 AR 3 13

SOS1 Noonan syndrome AD 44 71

SOST Craniodiaphyseal dysplasia, autosomal dominant, AD/AR 6 14 Sclerosteosis 1, van Buchem disease

SOX11 Mental retardation, autosomal dominant 27 AD 11 14

SOX2* Microphthalmia, syndromic AD 34 104

SOX3 Panhypopituitarism XL 4 26

SOX9 Campomelic dysplasia, 46,XY sex reversal, Brachydactyly AD 47 144 with anonychia (Cooks syndrome)

https://blueprintgenetics.com/ SP7 Osteogenesis imperfecta, type XII AR 2 3

SPARC Keratoconus, Osteogenesis imperfecta, type XVII AR 2 4

SRCAP Floating-Harbor syndrome AD 16 43

STAG2 Congenital heart defects, dysmorphic facial features, and XL 6 14 intellectual developmental disorder

STAMBP Microcephaly-capillary malformation syndrome AR 15 19

STAT5B* Growth hormone insensitivity with immunodeficiency AR 9 13

TALDO1 Transaldolase deficiency AR 6 10

TBX15 Cousin syndrome AR 2 4

TBX19 Adrenocorticotropic hormone deficiency AR 12 27

TBX2 AD 1 12

TBX3 Ulnar-Mammary syndrome AD 6 20

TBX4 Small patella syndrome AD 8 58

TBX5 Holt-Oram syndrome AD 61 127

TBX6 Spondylocostal dysostosis 5 AD/AR 9 34

TCF12 Craniosynostosis AD 23 56

TCIRG1 Osteopetrosis, severe neonatal or infantile forms (OPTB1) AD/AR 48 130

TCOF1 Treacher Collins syndrome AD 50 330

TCTEX1D2 Short-rib thoracic dysplasia 17 with or without polydactyly, AR 4 6 Jeune Asphyxiating Thoracic Dystrophy

TCTN3 Orofaciodigital syndrome (Mohr-Majewski syndrome), AR 9 12 Joubert syndrome

TGFB1 Diaphyseal dysplasia Camurati-Engelmann AD 15 23

TGFB2 Loeys-Dietz syndrome AD 36 38

TGFB3 Loeys-Dietz syndrome (Reinhoff syndrome), AD 19 26 Arrhythmogenic right ventricular dysplasia

TGFBR1 Loeys-Dietz syndrome AD 40 69

TGFBR2 Loeys-Dietz syndrome AD 58 139

TMEM38B Osteogenesis imperfecta, type XIV AR 2 7

TNFRSF11A Familial expansile osteolysis, Paget disease of bone, AD/AR 8 24 Osteopetrosis, severe neonatal or infantile forms (OPTB1)

TNFRSF11B Paget disease of bone, juvenile AR 8 18

TNFSF11 Osteopetrosis, autosomal recessive 2 AR 3 5

https://blueprintgenetics.com/ TONSL Spondyloepimetaphyseal dysplasia AR 4

TOP3A 8

TP63 Rapp-Hodgkin syndrome, Orofacial cleft, ADULT AD 59 122 syndrome, , ectodermal dysplasia, and cleft lip/palate syndrome, Ankyloblepharon-ectodermal defects-cleft lip/palate, Split-hand/foot malformation, Limb-mammary syndrome

TRAPPC2* Spondyloepiphyseal dysplasia tarda XL 12 55

TRIM37 AR 19 23

TRIP11* Achondrogenesis, type IA AR 11 17

TRMT10A Microcephaly, short stature, and impaired glucose AR 2 7 metabolism 1

TRPS1 Trichorhinophalangeal syndrome type 1, AD 66 140 Trichorhinophalangeal syndrome type 3

TRPV4 Metatropic dysplasia, Spondyloepiphyseal dysplasia AD 61 78 Maroteaux type, Parastremmatic dwarfism, Hereditary motor and sensory neuropathy, Spondylometaphyseal dysplasia Kozlowski type, , Charcot-Marie-Tooth disease, Brachyolmia (autosomal dominant type), Familial Digital arthropathy with brachydactyly

TTC21B Short-rib thoracic dysplasia, , AR 23 63 Asphyxiating thoracic dysplasia (ATD; Jeune)

TWIST1 Saethre-Chotzen syndrome, Robinow-Sorauf syndrome, AD 28 205 Craniosynostosis

TYROBP Nasu-Hakola disease, Polycystic lipomembranous AR 8 14 osteodysplasia with sclerosing leukoencephalopathy

VDR Vitamin D-dependent rickets AD/AR 17 66

VIPAS39 , renal dysfunction, and cholestasis 2 AR 8 13

WDR19 Retinitis pigmentosa, Nephronophthisis, Short -rib thoracic AR 33 43 dysplasia with or without polydactyly, Senior-Loken syndrome, Cranioectodermal dysplasia (Levin- Sensenbrenner) type 1, Cranioectodermal dysplasia (Levin- Sensenbrenner) type 2, Asphyxiating thoracic dysplasia (ATD; Jeune)

WDR34 Short -rib thoracic dysplasia with or without polydactyly, AR 18 21 Asphyxiating thoracic dysplasia (ATD; Jeune)

WDR35 Cranioectodermal dysplasia (Levin-Sensenbrenner) type 1, AR 28 31 Cranioectodermal dysplasia (Levin-Sensenbrenner) type 2, Short rib-polydactyly syndrome type 5

WDR60 Short-rib thoracic dysplasia 8 with or without polydactyly AR 12 13

WISP3 Arthropathy, progressive pseudorheumatoid, of childhood, AR 16 69 Spondyloepiphyseal dysplasia tarda with progressive arthropathy

https://blueprintgenetics.com/ WNT1 Osteoprosis, autosomal dominant, Osteogenesis AD/AR 9 40 imperfecta, type XV

WNT5A Robinow syndrome AD 7 11

WNT7A Ulna and fibula, absence of, with severe limb deficiency AR 6 11 (Al-Awadi/Raas-Rothschild/Schinzel phocomelia syndrome), Fuhrmann syndrome

XRCC2 Hereditary breast cancer AD/AR 10 21

XRCC4 Short stature, microcephaly, and endocrine dysfunction AR 9 10

XYLT1 Desbuquois dysplasia 2 AR 11 19

XYLT2 Spondyloocular syndrome AR 2 10

*Some regions of the gene are duplicated in the . Read more.

# The gene has suboptimal coverage (means <90% of the gene’s target nucleotides are covered at >20x with mapping quality score (MQ>20) reads), and/or the gene has exons listed under Test limitations section that are not included in the panel as they are not sufficiently covered with high quality sequence reads.

The sensitivity to detect variants may be limited in genes marked with an asterisk (*) or number sign (#). Due to possible limitations these genes may not be available as single gene tests.

Gene refers to the HGNC approved gene symbol; Inheritance refers to inheritance patterns such as autosomal dominant (AD), autosomal recessive (AR), mitochondrial (mi), X-linked (XL), X-linked dominant (XLD) and X-linked recessive (XLR); ClinVar refers to the number of variants in the gene classified as pathogenic or likely pathogenic in this database (ClinVar); HGMD refers to the number of variants with possible disease association in the gene listed in Gene Database (HGMD). The list of associated, gene specific phenotypes are generated from CGD or Mitomap databases.

Non-coding disease causing variants covered by the panel

Gene Genomic location HGVS RefSeq RS-number HG19

AIFM1 ChrX:129274636 c.697-44T>G NM_004208.3

AIFM1 ChrX:129299753 c.-123G>C NM_004208.3 rs724160014

ALPL Chr1:21835920 c.-195C>T NM_000478.4

ALPL Chr1:21896764 c.793-30_793-11delGGCATGTGCTGACACAGCCC NM_000478.4

ANKH Chr5:14871567 c.-11C>T NM_054027.4

BCS1L Chr2:219524871 c.-147A>G NM_004328.4

BCS1L Chr2:219525123 c.-50+155T>A NM_004328.4 rs386833855

BMP1 Chr8:22058957 c.*241T>C NM_001199.3 rs786205217

BMPR1B Chr4:95797053 c.-113+2T>G NM_001203.2

BRCA2 Chr13:32889805 c.-40+1G>A NM_000059.3

BRCA2 Chr13:32890469 c.-39-89delC NM_000059.3

BRCA2 Chr13:32890556 c.-39-1_-39delGA NM_000059.3 rs758732038

BRCA2 Chr13:32890558 c.-39-1G>A NM_000059.3 rs1060499566

BRCA2 Chr13:32900222 c.426-12_426-8delGTTTT NM_000059.3 rs276174844

BRCA2 Chr13:32945079 c.8488-14A>G NM_000059.3

https://blueprintgenetics.com/ BRCA2 Chr13:32953872 c.8954-15T>G NM_000059.3

BRCA2 Chr13:32971007 c.9502-28A>G NM_000059.3 rs397508059

BRCA2 Chr13:32971023 c.9502-12T>G NM_000059.3 rs81002803

BRIP1 Chr17:59858864 c.1629-498A>T NM_032043.2

CANT1 Chr17:77005745 c.-342+1G>A NM_138793.3

CASR Chr3:121994640 c.1378-19A>C NM_001178065.1

CDKN1C Chr11:2905209 c.*5+20G>T NM_000076.2 rs760540648

CEP152 Chr15:49059406 c.2148-17G>A NM_001194998.1 rs751691427

CLCN7 Chr16:1506057 c.916+57A>T NM_001287.5

CLCN7 Chr16:1507356 c.739-18G>A NM_001287.5 rs371893553

COL11A1 Chr1:103386637 c.3744+437T>G NM_080629.2

COL11A1 Chr1:103488576 c.1027-24A>G NM_080629.2

COL11A1 Chr1:103491958 c.781-450T>G NM_080629.2 rs587782990

COL1A1 Chr17:48266910 c.2668-11T>G NM_000088.3 rs786205505

COL1A1 Chr17:48267594 c.2451+94G>T NM_000088.3

COL1A1 Chr17:48267611 c.2451+77C>T NM_000088.3 rs72651665

COL1A1 Chr17:48268147 c.2343+31T>A NM_000088.3

COL1A1 Chr17:48272201 c.1354-12G>A NM_000088.3 rs72648337

COL1A1 Chr17:48273368 c.1003-43_1003-32delTGCCATCTCTTC NM_000088.3 rs72645359

COL1A1 Chr17:48273574 c.958-18_958-15delTTCC NM_000088.3 rs72645351

COL1A1 Chr17:48273742 c.904-14G>A NM_000088.3

COL1A1 Chr17:48273743 c.904-15T>A NM_000088.3

COL1A2 Chr7:94025130 c.70+717A>G NM_000089.3 rs72656354

COL1A2 Chr7:94030856 c.226-22_226-11delTTTTTTTTTTTT NM_000089.3

COL2A1 Chr12:48379984 c.1527+135G>A NM_001844.4

COL3A1 Chr2:189872183 c.3256-43T>G NM_000090.3 rs587779667

COL5A1 Chr9:137645685 c.1720-11T>A NM_000093.4 rs863223444

COL5A1 Chr9:137680989 c.2647-12A>G NM_000093.4

COL5A1 Chr9:137686903 c.2701-25T>G NM_000093.4 rs765079080

COL5A1 Chr9:137726806 c.5137-11T>A NM_000093.4 rs183495554

COL5A2 Chr2:189927655 c.1924-11T>C NM_000393.3

CREBBP Chr16:3788684 c.4281-11C>G NM_004380.2 rs587783493

CRTAP Chr3:33160815 c.472-1021C>G NM_006371.4 rs72659360

CTSK Chr1:150778521 c.244-29A>G NM_000396.3

CUL7 Chr6:43010511 c.3897+29G>A NM_001168370.1

DONSON Chr21:34955994 c.786-22A>G NM_017613.3 rs1135401960

DYNC2H1 Chr11:103019205 c.2819-14A>G NM_001080463.1 rs781091611

DYNC2H1 Chr11:103055609 c.6478-16G>A NM_001080463.1 rs376892534

EFNB1 ChrX:68049209 c.-411C>G NM_004429.4

https://blueprintgenetics.com/ EFNB1 ChrX:68049525 c.-95T>C/G NM_004429.4

EFNB1 ChrX:68049525 c.-95T>C NM_004429.4

EFNB1 ChrX:68049525 c.-95T>G NM_004429.4

EP300 Chr22:41537040 c.1879-12A>G NM_001429.3

ESCO2 Chr8:27650167 c.1354-18G>A NM_001017420.2 rs80359865

EVC Chr4:5749725 c.940-150T>G NM_153717.2

FANCA Chr16:89805127 c.4261-19_4261-12delACCTGCTC NM_000135.3

FANCA Chr16:89816056 c.3239+82T>G NM_000135.2

FANCA Chr16:89818822 c.2982-192A>G NM_000135.2

FANCA Chr16:89831215 c.2778+83C>G NM_000135.2 rs750997715

FANCA Chr16:89836111 c.2504+134A>G NM_000135.2

FANCA Chr16:89836805 c.2223-138A>G NM_000135.2

FANCA Chr16:89849346 c.1567-20A>G NM_000135.2 rs775154397

FANCA Chr16:89864654 c.893+920C>A NM_000135.2

FANCC Chr9:98011653 c.-78-2A>G NM_000136.2 rs587779898

FANCC Chr9:98079807 c.-79+1G>A NM_000136.2

FANCD2 Chr3:10083186 c.696-121C>G NM_033084.3

FANCD2 Chr3:10102127 c.1766+40T>G NM_033084.3

FANCD2 Chr3:10106024 c.1948-16T>G NM_033084.3

FANCI Chr15:89825208 c.1583+142C>T NM_001113378.1

FANCL Chr2:58433394 c.375-2033C>G NM_001114636.1

FBN1 Chr15:48707358 c.8051+375G>T NM_000138.4

FBN1 Chr15:48720682 c.6872-14A>G NM_000138.4

FBN1 Chr15:48721629 c.6872-961A>G NM_000138.4

FBN1 Chr15:48739106 c.5672-87A>G NM_000138.4

FBN1 Chr15:48739107 c.5672-88A>G NM_000138.4

FBN1 Chr15:48764885 c.4211-32_4211-13delGAAGAGTAACGTGTGTTTCT NM_000138.4

FBN1 Chr15:48786466 c.2678-15C>A NM_000138.4

FBN1 Chr15:48802380 c.1589-14A>G NM_000138.4

FBN1 Chr15:48818478 c.863-26C>T NM_000138.4

FBN2 Chr5:127670560 c.3974-24A>C NM_001999.3

FBN2 Chr5:127670562 c.3974-26T>G NM_001999.3

FBN2 Chr5:127671284 c.3725-15A>G NM_001999.3

FGD1 ChrX:54476768 c.2016-35delA NM_004463.2

FGFR2 Chr10:123099960 c.*139411C>T .

FLNA ChrX:153581587 c.6023-27_6023-16delTGACTGACAGCC NM_001110556.1

GH1 Chr17:61995330 c.291+29_291+46delGATGGGGGAGACCTGTAG NM_000515.3

GH1 Chr17:61995349 c.291+28G>A NM_000515.3 rs863223306

GH1 Chr17:61996359 c.-223C>T NM_000515.3 rs41295015

https://blueprintgenetics.com/ GHR Chr5:42689204 c.287+83G>T NM_001242399.2

GHR Chr5:42700896 c.639+792A>G NM_001242399.2

GHR Chr5:42701904 c.639+1800A>G NM_001242399.2

GHRHR Chr7:31003560 c.-124A>C NM_000823.3

GNAS Chr20:57478716 c.2242-11A>G NM_080425.2

HSPG2 Chr1:22211006 c.1654+15G>A NM_005529.5

HSPG2 Chr1:22215993 c.574+481C>T NM_005529.5

IDS ChrX:148564764 c.1181-15C>A NM_000202.5

IDS ChrX:148568762 c.*57A>G NM_006123.4

IDS ChrX:148578704 c.709-657G>A NM_000202.5

IFITM5 Chr11:299504 c.-14C>T NM_001025295.2 rs587776916 Explain PMID almost 23240094 all cases of OI type V

IFT122 Chr3:129207087 c.2005-13T>A NM_052985.3

IFT140 Chr16:1576595 c.2577+25G>A NM_014714.3 rs1423102192

LHX4 Chr1:180243784 c.*70G>A NM_033343.3

LMNA Chr1:156100609 c.513+45T>G NM_170707.3

LMNA Chr1:156105681 c.937-11C>G NM_170707.3 rs267607645

LMNA Chr1:156107037 c.1608+14G>A NM_170707.3

LMNA Chr1:156107433 c.1609-12T>G NM_170707.3 rs267607582

LMX1B Chr9:129377616 c.140-37_140-21delGGCGCTGACGGCCGGGC NM_001174146.1

LZTR1 Chr22:21336623 c.-38T>A NM_006767.3

LZTR1 Chr22:21350968 c.2220-17C>A NM_006767.3 rs1249726034

NF1 Chr17:29422055 c.-273A>C NM_001042492.2

NF1 Chr17:29422056 c.-272G>A NM_001042492.2

NF1 Chr17:29431417 c.60+9031_60+9035delAAGTT NM_001042492.2

NF1 Chr17:29475515 c.61-7486G>T NM_001042492.2

NF1 Chr17:29488136 c.288+2025T>G NM_001042492.2

NF1 Chr17:29508426 c.587-14T>A NM_001042492.2

NF1 Chr17:29508428 c.587-12T>A NM_001042492.2

NF1 Chr17:29510334 c.888+651T>A NM_001042492.2

NF1 Chr17:29510427 c.888+744A>G NM_001042492.2

NF1 Chr17:29510472 c.888+789A>G NM_001042492.2

NF1 Chr17:29527428 c.889-12T>A NM_001042492.2

NF1 Chr17:29530107 c.1260+1604A>G NM_001042492.2

NF1 Chr17:29533239 c.1261-19G>A NM_001042492.2

NF1 Chr17:29534143 c.1392+754T>G NM_001042492.2

NF1 Chr17:29540877 c.1393-592A>G NM_001042492.2

NF1 Chr17:29542762 c.1527+1159C>T NM_001042492.2

https://blueprintgenetics.com/ NF1 Chr17:29548419 c.1642-449A>G NM_001042492.2 rs863224655

NF1 Chr17:29549489 c.*481A>G NM_001128147.2

NF1 Chr17:29553439 c.2002-14C>G NM_001042492.2

NF1 Chr17:29554225 c.2252-11T>G NM_001042492.2

NF1 Chr17:29556025 c.2410-18C>G NM_001042492.2

NF1 Chr17:29556027 c.2410-16A>G NM_001042492.2

NF1 Chr17:29556028 c.2410-15A>G NM_001042492.2

NF1 Chr17:29556031 c.2410-12T>G NM_001042492.2

NF1 Chr17:29556839 c.2851-14_2851-13insA NM_001042492.2

NF1 Chr17:29557267 c.2991-11T>G NM_001042492.2

NF1 Chr17:29558777 c.3198-314G>A NM_001042492.2

NF1 Chr17:29563299 c.3974+260T>G NM_001042492.2

NF1 Chr17:29577082 c.4110+945A>G NM_001042492.2

NF1 Chr17:29580296 c.4173+278A>G NM_001042492.2

NF1 Chr17:29588708 c.4578-20_4578-18delAAG NM_001042492.2

NF1 Chr17:29588715 c.4578-14T>G NM_001042492.2

NF1 Chr17:29654479 c.5269-38A>G NM_001042492.2

NF1 Chr17:29656858 c.5610-456G>T NM_001042492.2

NF1 Chr17:29657848 c.5812+332A>G NM_001042492.2 rs863224491

NF1 Chr17:29661577 c.5813-279A>G NM_001042492.2

NF1 Chr17:29664375 c.6428-11T>G NM_001042492.2

NF1 Chr17:29664618 c.6642+18A>G NM_001042492.2

NF1 Chr17:29676126 c.7190-12T>A NM_001042492.2

NF1 Chr17:29676127 c.7190-11_7190-10insGTTT NM_001042492.2

NF1 Chr17:29685177 c.7971-321C>G NM_001042492.2

NF1 Chr17:29685481 c.7971-17C>G NM_001042492.2

NF1 Chr17:29685665 c.8113+25A>T NM_001042492.2

NIPBL Chr5:36877039 c.-321_-320delCCinsA NM_133433.3 rs724159980

NIPBL Chr5:36877266 c.-94C>T NM_133433.3

NIPBL Chr5:36953718 c.-79-2A>G NM_133433.3

NIPBL Chr5:37022138 c.5329-15A>G NM_133433.3 rs587783968

NIPBL Chr5:37026318 c.5710-13_5710-12delCTinsAA NM_133433.3

NSDHL ChrX:152037789 c.*129C>T NM_015922.2 rs145978994

OSGEP Chr14:20920111 c.411+12_411+22delGCTCTACCCACinsTAAATAGAG NM_017807.3

PALB2 Chr16:23649285 c.109-12T>A NM_024675.3 rs774949203

PEX7 Chr6:137143759 c.-45C>T NM_000288.3 rs267608252

PHEX ChrX:22076478 c.349+11149A>T NM_000444.4

PHEX ChrX:22113485 c.849+1268G>T NM_000444.4

PHEX ChrX:22237137 c.1701-16T>A NM_000444.4

https://blueprintgenetics.com/ PHEX ChrX:22237393 c.1768+177_1768+180dupGTAA NM_000444.4

PHEX ChrX:22266301 c.*231A>G NM_000444.4

PITX2 Chr4:111538758 c.*520_*522delTAT NM_000325.5 rs561702585,rs775662096

PITX2 Chr4:111539855 c.412-11A>G NM_000325.5

PITX2 Chr4:111559138 c.-1214_-1213delAT NM_153426.2

PLS3 ChrX:114856534 c.74-24T>A NM_005032.5

POLA1 ChrX:24744696 c.1375-354A>G NM_016937.3 rs869312979

POR Chr7:75544501 c.-5+4A>G NM_000941.2

PRKAR1A Chr17:66508599 c.-97G>A NM_002734.4

PRKAR1A Chr17:66508689 c.-7G>A NM_002734.4

PRKAR1A Chr17:66508690 c.-7+1G>A NM_002734.4

PRKAR1A Chr17:66521878 c.550-17T>A NM_002734.4

PRKAR1A Chr17:66523964 c.709-7_709-2delTTTTTA NM_002734.4 rs281864801

PROP1 Chr5:177420059 c.343-11C>G NM_006261.4

PTH1R Chr3:46939842 c.544-25_544-23delCTG NM_000316.2

PTH1R Chr3:46942604 c.1049+29C>T NM_000316.2

PTPN11 Chr12:112915602 c.934-59T>A NM_002834.3

RBBP8 Chr18:20581745 c.2287+53T>G NM_002894.2

RBM8A Chr1:145507646 c.-21G>A NM_005105.4

RBM8A Chr1:145507765 c.67+32G>C NM_005105.4 rs201779890

RMRP Chr9:35658026 NR_003051.3 rs781730798

RMRP Chr9:35658026 NR_003051.3

RMRP Chr9:35658026 NR_003051.3

RMRP Chr9:35658026 NR_003051.3

RMRP Chr9:35658027 NR_003051.3

RMRP Chr9:35658027 NR_003051.3

RMRP Chr9:35658027 NR_003051.3

RMRP Chr9:35658027 NR_003051.3 rs727502775

RMRP Chr9:35658027 NR_003051.3

RMRP Chr9:35658028 NR_003051.3

RMRP Chr9:35658028 NR_003051.3

RMRP Chr9:35658029 NR_003051.3

RMRP Chr9:35658029 NR_003051.3

RMRP Chr9:35658032 NR_003051.3

RTTN Chr18:67727297 c.4748-19T>A NM_173630.3

RTTN Chr18:67815044 c.2309+1093G>A NM_173630.3

SERPINF1 Chr17:1665408 c.-9+2dupT NM_002615.5 rs398122519

SERPINF1 Chr17:1674512 c.439+34C>T NM_002615.5

SERPINF1 Chr17:1675121 c.440-40_440-38delTCG NM_002615.5 rs775552455

https://blueprintgenetics.com/ SERPINF1 Chr17:1679209 c.787-617G>A NM_002615.5

SHOX ChrX:585123 c.-645_-644insGTT NM_000451.3 rs199946685

SHOX ChrX:585124 c.-645_-644insGTT NM_000451.3

SHOX ChrX:591198 c.-432-3C>A NM_000451.3

SHOX ChrX:591568 c.-65C>A NM_000451.3

SLC26A2 Chr5:149340544 c.-26+2T>C NM_000112.3 rs386833492

SLC29A3 Chr10:73122778 c.*413G>A NM_018344.5

SOX9 Chr17:70117348 c.-185G>A NM_000346.3

STAMBP Chr2:74077998 c.1005+358A>G NM_006463.4

TBX2 Chr17:59476302 c.-1236G>C NM_005994.3

TBX2 Chr17:59477201 c.-337C>T NM_005994.3

TBX2 Chr17:59477347 c.-191G>A NM_005994.3

TBX2 Chr17:59477352 c.-185delG NM_005994.3

TBX2 Chr17:59477371 c.-167G>A NM_005994.3

TBX3 Chr12:115122148 NM_016569.3

TBX5 Chr12:114704515 c.*88822C>A NM_000192.3 rs141875471

TBX6 Chr16:30097525 c.*21C>T NM_004608.3 rs758420111

TCF12 Chr15:57554272 c.1468-20T>A NM_207036.1

TCIRG1 Chr11:67806587 c.-5+1G>C/T NM_006019.3

TCIRG1 Chr11:67806587 c.-5+1G>C NM_006019.3

TCIRG1 Chr11:67806587 c.-5+1G>T NM_006019.3

TCIRG1 Chr11:67816893 c.1887+132T>C NM_006019.3

TCIRG1 Chr11:67816903 c.1887+142T>A NM_006019.3

TCIRG1 Chr11:67816907 c.1887+146G>A NM_006019.3

TCIRG1 Chr11:67816910 c.1887+149C>T NM_006019.3

TGFB3 Chr14:76425035 c.*495C>T NM_003239.2 rs387906514

TGFB3 Chr14:76447266 c.-30G>A NM_003239.2 rs770828281

TGFBR2 Chr3:30648317 c.-59C>T NM_001024847.2

TRIM37 Chr17:57106096 c.1949-12A>G NM_015294.3

TRPS1 Chr8:116427335 c.2824-23T>G NM_014112.2

TWIST1 Chr7:19157199 c.-255G>A NM_000474.3

TWIST1 Chr7:19157207 c.-263C>A NM_000474.3

WDR35 Chr2:20151929 c.1434-684G>T NM_001006657.1

WDR35 Chr2:20182313 c.143-18T>A NM_001006657.1

WISP3 Chr6:112381431 c.103-763G>T NM_198239.1

WISP3 Chr6:112386227 c.643+27C>G NM_198239.1 rs200472841

XRCC4 Chr5:82400728 c.-10-1G>T NM_022406.2 rs869320678

https://blueprintgenetics.com/ Test Strengths

The strengths of this test include:

CAP accredited laboratory CLIA-certified personnel performing clinical testing in a CLIA-certified laboratory Powerful sequencing technologies, advanced target enrichment methods and precision bioinformatics pipelines ensure superior analytical performance Careful construction of clinically effective and scientifically justified gene panels Some of the panels include the whole mitochondrial genome (please see the Panel Content section) Our Nucleus online portal providing transparent and easy access to quality and performance data at the patient level Our publicly available analytic validation demonstrating complete details of test performance ~2,000 non-coding disease causing variants in our clinical grade NGS assay for panels (please see ‘Non-coding disease causing variants covered by this panel’ in the Panel Content section) Our rigorous variant classification scheme Our systematic clinical interpretation workflow using proprietary software enabling accurate and traceable processing of NGS data Our comprehensive clinical statements

Test Limitations

The following exons are not included in the panel as they are not sufficiently covered with high quality sequence reads: ADAMTSL2 (NM_014694:11-19), B3GAT3 (NM_001288722:5), POLR1C (NM_001318876:9), SHOX (NM_006883:6). Genes with suboptimal coverage in our assay are marked with number sign (#) and genes with partial, or whole gene, segmental duplications in the are marked with an asterisk (*) if they overlap with the UCSC pseudogene regions. Gene is considered to have suboptimal coverage when >90% of the gene's target nucleotides are not covered at >20x with mapping quality score (MQ>20) reads. The technology may have limited sensitivity to detect variants in genes marked with these symbols (please see the Panel content table above).

This test does not d etect the following:

Complex inversions Gene conversions Balanced translocations Some of the panels include the whole mitochondrial genome (please see the Panel Content section) Repeat expansion disorders unless specifically mentioned Non-coding variants deeper than ±20 base pairs from exon-intron boundary unless otherwise indicated (please see above Panel Content / non-coding variants covered by the panel).

This test may not reliably detect the following:

Low level mosaicism in nuclear genes (variant with a minor allele fraction of 14.6% is detected with 90% probability) Stretches of mononucleotide repeats Low level heteroplasmy in mtDNA (>90% are detected at 5% level) Indels larger than 50bp Single exon deletions or duplications Variants within pseudogene regions/duplicated segments Some disease causing variants present in mtDNA are not detectable from blood, thus post-mitotic tissue such as skeletal muscle may be required for establishing molecular diagnosis.

The sensitivity of this test may be reduced if DNA is extracted by a laboratory other than Blueprint .

For additional information, please refer to the Test performance section and see our Analytic Validation.

https://blueprintgenetics.com/ Test Performance

The genes on the panel have been carefully selected based on scientific literature, mutation databases and our experience.

Our panels are sectioned from our high-quality, clinical grade NGS assay. Please see our sequencing and detection performance table for details regarding our ability to detect different types of alterations (Table).

Assays have been validated for various sample types including EDTA-blood, isolated DNA (excluding from formalin fixed paraffin embedded tissue), saliva and dry blood spots (filter cards). These sample types were selected in order to maximize the likelihood for high-quality DNA yield. The diagnostic yield varies depending on the assay used, referring healthcare professional, hospital and country. Plus analysis increases the likelihood of finding a genetic diagnosis for your patient, as large deletions and duplications cannot be detected using sequence analysis alone. Blueprint Genetics’ Plus Analysis is a combination of both sequencing and deletion/duplication (copy number variant (CNV)) analysis.

The performance metrics listed below are from an initial validation performed at our main laboratory in Finland. The performance metrics of our laboratory in Seattle, WA, are equivalent.

Performance of Blueprint Genetics high-quality, clinical grade NGS sequencing assay for panels.

Sensitivity % (TP/(TP+FN) Specificity %

Single nucleotide variants 99.89% (99,153/99,266) >99.9999%

Insertions, deletions and indels by sequence analysis

1-10 bps 99.2% (7,745/7,806) >99.9999%

11-50 bps 99.13% (2,524/2,546) >99.9999%

Copy number variants (exon level dels/dups)

1 exon level deletion (heterozygous) 100% (20/20) NA

1 exon level deletion (homozygous) 100% (5/5) NA

1 exon level deletion (het or homo) 100% (25/25) NA

2-7 exon level deletion (het or homo) 100% (44/44) NA

1-9 exon level duplication (het or homo) 75% (6/8) NA

Simulated CNV detection

5 exons level deletion/duplication 98.7% 100.00%

Microdeletion/-duplication sdrs (large CNVs, n=37))

Size range (0.1-47 Mb) 100% (25/25)

The performance presented above reached by Blueprint Genetics high-quality, clinical grade NGS sequencing assay with the following coverage metrics

Mean sequencing depth 143X

Nucleotides with >20x sequencing coverage (%) 99.86%

https://blueprintgenetics.com/ Performance of Blueprint Genetics Mitochondrial Sequencing Assay.

Sensitivity % Specificity %

ANALYTIC VALIDATION (NA samples; n=4)

Single nucleotide variants

Heteroplasmic (45-100%) 100.0% (50/50) 100.0%

Heteroplasmic (35-45%) 100.0% (87/87) 100.0%

Heteroplasmic (25-35%) 100.0% (73/73) 100.0%

Heteroplasmic (15-25%) 100.0% (77/77) 100.0%

Heteroplasmic (10-15%) 100.0% (74/74) 100.0%

Heteroplasmic (5-10%) 100.0% (3/3) 100.0%

Heteroplasmic (<5%) 50.0% (2/4) 100.0%

CLINICAL VALIDATION (n=76 samples)

All types

Single nucleotide variants n=2026 SNVs

Heteroplasmic (45-100%) 100.0% (1940/1940) 100.0%

Heteroplasmic (35-45%) 100.0% (4/4) 100.0%

Heteroplasmic (25-35%) 100.0% (3/3) 100.0%

Heteroplasmic (15-25%) 100.0% (3/3) 100.0%

Heteroplasmic (10-15%) 100.0% (9/9) 100.0%

Heteroplasmic (5-10%) 92.3% (12/13) 99.98%

Heteroplasmic (<5%) 88.9% (48/54) 99.93%

Insertions and deletions by sequence analysis n=40 indels

Heteroplasmic (45-100%) 1-10bp 100.0% (32/32) 100.0%

Heteroplasmic (5-45%) 1-10bp 100.0% (3/3) 100.0%

Heteroplasmic (<5%) 1-10bp 100.0% (5/5) 99,997%

SIMULATION DATA /(mitomap mutations)

Insertions, and deletions 1-24 bps by sequence analysis; n=17

Homoplasmic (100%) 1-24bp 100.0% (17/17) 99.98%

Heteroplasmic (50%) 100.0% (17/17) 99.99%

Heteroplasmic (25%) 100.0% (17/17) 100.0%

Heteroplasmic (20%) 100.0% (17/17) 100.0%

https://blueprintgenetics.com/ Heteroplasmic (15%) 100.0% (17/17) 100.0%

Heteroplasmic (10%) 94.1% (16/17) 100.0%

Heteroplasmic (5%) 94.1% (16/17) 100.0%

Copy number variants (separate artifical mutations; n=1500)

Homoplasmic (100%) 500 bp, 1kb, 5 kb 100.0% 100.0%

Heteroplasmic (50%) 500 bp, 1kb, 5 kb 100.0% 100.0%

Heteroplasmic (30%) 500 bp, 1kb, 5 kb 100.0% 100.0%

Heteroplasmic (20%) 500 bp, 1kb, 5 kb 99.7% 100.0%

Heteroplasmic (10%) 500 bp, 1kb, 5 kb 99.0% 100.0%

The performance presented above reached by following coverage metrics at assay level (n=66)

Mean of medians Median of medians

Mean sequencing depth MQ0 (clinical) 18224X 17366X

Nucleotides with >1000x MQ0 sequencing coverage (%) (clinical) 100%

rho zero line (=no mtDNA), mean sequencing depth 12X

Bioinformatics

The target region for each gene includes coding exons and ±20 base pairs from the exon-intron boundary. In addition, the panel includes non-coding variants if listed above (Non-coding variants covered by the panel). Some regions of the gene(s) may be removed from the panel if specifically mentioned in the ‘Test limitations” section above. The sequencing data generated in our laboratory is analyzed with our proprietary data analysis and annotation pipeline, integrating state-of-the art algorithms and industry-standard software solutions. Incorporation of rigorous quality control steps throughout the workflow of the pipeline ensures the consistency, validity and accuracy of results. Our pipeline is streamlined to maximize sensitivity without sacrificing specificity. We have incorporated a number of reference population databases and mutation databases such as, but not limited, to 1000 Project, gnomAD, ClinVar and HGMD into our clinical interpretation software to make the process effective and efficient. For missense variants, in silico variant prediction tools such as SIFT, PolyPhen, MutationTaster are used to assist with variant classification. Through our online ordering and statement reporting system, Nucleus, the customer has an access to details of the analysis, including patient specific sequencing metrics, a gene level coverage plot and a list of regions with inadequate coverage if present. This reflects our mission to build fully transparent diagnostics where customers have easy access to crucial details of the analysis process.

Clinical Interpretation

We provide customers with the most comprehensive clinical report available on the market. Clinical interpretation requires a fundamental understanding of clinical genetics and genetic principles. At Blueprint Genetics, our PhD molecular geneticists, medical geneticists and clinical consultants prepare the clinical statement together by evaluating the identified variants in the context of the phenotypic information provided in the requisition form. Our goal is to provide clinically meaningful statements that are understandable for all medical professionals regardless of whether they have formal training in genetics.

Variant classification is the corner stone of clinical interpretation and resulting patient management decisions. Our classifications follow the ACMG guideline 2015.

The final step in the analysis of sequence variants is confirmation of variants classified as pathogenic or likely pathogenic

https://blueprintgenetics.com/ using bi-directional Sanger sequencing. Variant(s) fulfilling the following criteria are not Sanger confirmed: the variant quality score is above the internal threshold for a true positive call, and visual check-up of the variant at IGV is in-line with the variant call. Reported variants of uncertain significance are confirmed with bi-directional Sanger sequencing only if the quality score is below our internally defined quality score for true positive call. Reported copy number variations with a size <10 exons are confirmed by orthogonal methods such as qPCR if the specific CNV has been seen less than three times at Blueprint Genetics.

Our clinical statement includes tables for sequencing and copy number variants that include basic variant information (genomic coordinates, HGVS nomenclature, , allele frequencies, in silico predictions, OMIM phenotypes and classification of the variant). In addition, the statement includes detailed descriptions of the variant, gene and phenotype(s) including the role of the specific gene in human disease, the mutation profile, information about the gene’s variation in population cohorts and detailed information about related phenotypes. We also provide links to the references used, congress abstracts and mutation variant databases used to help our customers further evaluate the reported findings if desired. The conclusion summarizes all of the existing information and provides our rationale for the classification of the variant.

Identification of pathogenic or likely pathogenic variants in dominant disorders or their combinations in different alleles in recessive disorders are considered molecular confirmation of the clinical diagnosis. In these cases, family member testing can be used for risk stratification within the family. In the case of variants of uncertain significance (VUS), we do not recommend family member risk stratification based on the VUS result. Furthermore, in the case of VUS, we do not recommend the use of genetic information in patient management or genetic counseling.

Our interpretation team analyzes millions of variants from thousands of individuals with rare diseases. Thus, our database, and our understanding of variants and related phenotypes, is growing by leaps and bounds. Our laboratory is therefore well positioned to re-classify previously reported variants as new information becomes available. If a variant previously reported by Blueprint Genetics is re-classified, our laboratory will issue a follow-up statement to the original ordering health care provider at no additional cost.

Sample Requirements

Blood (min. 1ml) in an EDTA tube Extracted DNA, min. 2 μg in TE buffer or equivalent Saliva (Please see Sample Requirements for accepted saliva kits)

Label the sample tube with your patient's name, date of birth and the date of sample collection.

We do not accept DNA samples isolated from formalin-fixed paraffin-embedded (FFPE) tissue. In addition, if the patient is affected with a hematological malignancy, DNA extracted from a non-hematological source (e.g. skin fibroblasts) is strongly recommended.

Please note that, in rare cases, mitochondrial genome (mtDNA) variants may not be detectable in blood or saliva in which case DNA extracted from post-mitotic tissue such as skeletal muscle may be a better option.

Read more about our sample requirements here.

For Patients

Other

Bonafe, L. et al. Nosology and classification of genetic skeletal disorders: 2015 revision. Am J Med Genet A. 2015 Dec;167A(12):2869-92. Child Growth Foundation GeneReviews - 3M Syndrome GeneReviews - Achondroplasia GeneReviews - Autosomal Dominant Robinow Syndrome GeneReviews - COL1A1/2-Related Osteogenesis Imperfecta GeneReviews - Cartilage-Hair Hypoplasia – Anauxetic Dysplasia Spectrum Disorders GeneReviews - Rhizomelic Chondrodysplasia Punctata Type 1

https://blueprintgenetics.com/ GeneReviews - Seckel Syndrome Little People of America Restricted Growth Association Rhizokids International Walking With Giants Foundation

https://blueprintgenetics.com/