College of Medical Genetics and Genomics–Association for Molecular Pathology (ACMG–AMP).[28 (link)] Briefly, a variant was classified as likely/pathogenic if it arose de novo (or
from a somatic mosaic parent) and was not found in the publically available control datasets (ExAC v0.31, ESP6500, 5000 Genomes,
gnomAD r2.0.2).[21 –23 (link)] In cases where DNA
from both parents was unavailable for segregation analysis, likely/pathogenicity was inferred on the basis of (1) the variant type
(truncations and splice variants were seen as likely pathogenic), (2) recurrence (previously recorded as disease-causing in the
literature or disease databases (3) analysis with in silico pathogenicity prediction tools (CADD, PolyPhen-2, and
GERP), where all outputs had to be in agreement (CADD > 25, PolyPhen-2 > 0.9, and GERP > 5). Microsatellite
analysis (Authentifiler™ PCR Amplification kit, ThermoFisher Scientific) was performed on of all parents of probands with a
de novo variants to confirm parentage.